EP0621760A1 - Endocardial mapping apparatus - Google Patents
Endocardial mapping apparatusInfo
- Publication number
- EP0621760A1 EP0621760A1 EP93902396A EP93902396A EP0621760A1 EP 0621760 A1 EP0621760 A1 EP 0621760A1 EP 93902396 A EP93902396 A EP 93902396A EP 93902396 A EP93902396 A EP 93902396A EP 0621760 A1 EP0621760 A1 EP 0621760A1
- Authority
- EP
- European Patent Office
- Prior art keywords
- probe
- electrograms
- relative
- mapping
- arm
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Withdrawn
Links
- 238000013507 mapping Methods 0.000 title claims abstract description 22
- 239000000523 sample Substances 0.000 claims abstract description 32
- 230000002861 ventricular Effects 0.000 claims abstract description 12
- 238000002679 ablation Methods 0.000 claims abstract description 7
- 230000004913 activation Effects 0.000 claims abstract description 7
- 210000003484 anatomy Anatomy 0.000 claims description 6
- 230000000712 assembly Effects 0.000 claims description 2
- 238000000429 assembly Methods 0.000 claims description 2
- 238000000034 method Methods 0.000 abstract description 11
- 238000001356 surgical procedure Methods 0.000 abstract description 6
- 238000006073 displacement reaction Methods 0.000 abstract 1
- 210000005240 left ventricle Anatomy 0.000 description 8
- 206010047302 ventricular tachycardia Diseases 0.000 description 5
- 210000001765 aortic valve Anatomy 0.000 description 3
- 208000001871 Tachycardia Diseases 0.000 description 2
- 210000001174 endocardium Anatomy 0.000 description 2
- 230000006794 tachycardia Effects 0.000 description 2
- 210000000709 aorta Anatomy 0.000 description 1
- 239000008280 blood Substances 0.000 description 1
- 210000004369 blood Anatomy 0.000 description 1
- 230000002612 cardiopulmonary effect Effects 0.000 description 1
- 230000008602 contraction Effects 0.000 description 1
- 210000004351 coronary vessel Anatomy 0.000 description 1
- 230000001627 detrimental effect Effects 0.000 description 1
- 229910003460 diamond Inorganic materials 0.000 description 1
- 239000010432 diamond Substances 0.000 description 1
- 230000000694 effects Effects 0.000 description 1
- 238000010291 electrical method Methods 0.000 description 1
- 230000002452 interceptive effect Effects 0.000 description 1
- 210000004115 mitral valve Anatomy 0.000 description 1
- 238000012986 modification Methods 0.000 description 1
- 230000004048 modification Effects 0.000 description 1
- 208000010125 myocardial infarction Diseases 0.000 description 1
- 210000004165 myocardium Anatomy 0.000 description 1
- 238000000718 qrs complex Methods 0.000 description 1
- 210000005241 right ventricle Anatomy 0.000 description 1
- 231100000241 scar Toxicity 0.000 description 1
- 210000001519 tissue Anatomy 0.000 description 1
- 210000000707 wrist Anatomy 0.000 description 1
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/02—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by cooling, e.g. cryogenic techniques
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
- A61B5/25—Bioelectric electrodes therefor
- A61B5/279—Bioelectric electrodes therefor specially adapted for particular uses
- A61B5/28—Bioelectric electrodes therefor specially adapted for particular uses for electrocardiography [ECG]
- A61B5/283—Invasive
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/50—Supports for surgical instruments, e.g. articulated arms
Definitions
- This invention relates to mapping apparatus, and in particular to a device for charting left ventricular endocardial activation in surgery for ventricular tachycardia .
- Ventricular tachycardia is characterised by abnor ⁇ mal and rapid contraction of the heart muscle. This most commonly occurs following a heart attack, where the site of origin is an area of scar tissue on the left ventricle of the heart.
- the condition may be treated surgically by locating the origin of the tachycardia followed by local ablation.
- the mapping procedure may be carried out using an electrode to record electrograms at a number of points on the left ventricle, and comparing the timing of activation at each successive point with a reference ventricular electrogram or surface electrocardiogram. The relative timings of the electrograms are used to identify the area of interest, early activation relative to the QRS complex of the electrocardiogram indicating the origin of ventricular tachycardia. Location of the origin is thus time consuming, being largely down to trial and error, and so requires undesirably long operating times.
- Mapping of the kind described necessitates the surgical opening of the left ventricle in order to introduce the electrode, and thus can have severe and undesirable effects on the function of the already-damaged left ventricle.
- an "array mapping" procedure may be used, in which a spaced array of electrodes positioned on the surface of a suitable vehicle is used to record the electrograms.
- Mapping techniques of this kind offer no means of determining the position of any particular electrode with respect to the ventricular anatomy, and accordingly the best estimate of the origin of ventri ⁇ cular tachycardia is the fixed but unknown position of that electrode on the array for which the electrogram indicates earliest activation. High energy ablation may accordingly be carried out using that electrode.
- the number of electrodes, and thus the accuracy of the technique, is limited by the space available.
- endo ⁇ cardial mapping apparatus comprising releasably mounted electrode probe means for producing electrograms of endocardial activation, movable support means on which the probe means may be mounted for use, measuring means by which the relative position of the probe means may be determined, means for recording the electrograms and display means for visually mapping the instant position of the probe means and the positions of recorded
- the support means may comprise a jointed arm assembly attachable to the operating table.
- the arm has three joint assemblies, each of which has two axes of rotation.
- the relative position of the probe may be determined by measuring the rotation of the joints about each axis.
- the apparatus includes means for determining the relative timings of the recorded electrograms.
- the timings of the respective left ventricular electrograms relative to a reference right ventricular electrogram or surface electrocardiogram may be indicated by the display means.
- the apparatus provides cryosur- gical probe means selectively mountable on the support means to permit cryosurgical ablation at any required position.
- the invention therefore seeks to mitigate or obviate the aforementioned difficulties by providing a system which permits mapping to take place through the aortic valve (or the mitral valve) of the heart, and thus with minimum detrimental effect on the heart itself, and in which a single electrode probe is used to record a number of successive electrograms, the positions of which can be determined relative to reference sites on particular anatomical structures.
- the position of each electrogram is also recorded and continuously displayed together with the current probe position during surgery, such that the electrode may be returned to the site of any particular electrogram as required.
- the area of interest may thus be located more accurately and more quickly.
- the system also permits the electrode to be substituted by a cryosurgical probe so that ablation may be carried out cryogenically, again by returning to the position of any previously recorded electrogra .
- Fig. 1 is a simplified perspective view of part of an apparatus according to the invention.
- Fig. 2 is a map obtained using apparatus according to the invention.
- a mounting arm which forms part of an endocardial mapping apparatus.
- An upper part 12 of the arm is indirectly mounted on an operating table (not shown) so as to position the arm for use in an appropriate position above the table.
- a lower part of the arm comprises two rigid sections 14, 16.
- the section 14 is joined at its upper end to the upper part 12 of the mounting arm at a first joint assembly 18.
- the section 14 is joined to an end of the section 16 by way of a second joint assembly 20.
- the other end of the section 16 terminates at a third joint assembly 22 which connects in turn to a releasably mounted sterile electrode probe 24.
- Each joint assembly has two axes of rotation, the six axes of the arm being designated A to F in Fig. 1.
- the arm therefore has similar mobility to the human arm and wrist.
- the lower sections of the arm are wrapped in a sterile plastic sleeve 26.
- a probe mount 28 is also sterile, and permits the probe 24 to be exchanged during the mapping procedure such that an appropriate instrument may be used for each part of a map.
- the probe 24 is inserted into the left ventricle to produce the required electrograms.
- the rotation of the arm sections about each of the six axes A to F is measured by coaxially mounted servopotentio- meters.
- the rotation data of each joint, together with the dimensions of the arm may be used to define the position of the electrode on the tip of the probe 24.
- Voltage signals from the potentiometers are processed and analysed by computer, as are electrograms recorded by the probe, together with reference electrograms of the right ventricle.
- Fig. 2 illustrates a map so obtained.
- the display depicts the geometry of the left ventricular endocardial surface in a simplified manner to ensure unambiguous representation in two dimensions of mapped points. In this particular case, this is achieved by constructing a parabolic surface around the left ventricle and projecting all positions on the endocardium onto this surface. The resulting map is further projected onto a plane surface, to give the displayed two-dimensional representation.
- the patient is prepared for operation by being placed on cardiopulmonary bypass according to establis ⁇ hed techniques.
- the aorta is cross-clamped, the aortic root opened and the coronary arteries are cannulated and perfused with blood.
- the left ventricular endocardium is thus exposed for mapping across the aortic valve.
- the probe 24 is first used to mark and record the reference points on the anatomy. These are the positions of the anterior, left and right aortic valve commissures, designated AC, LC and RC respectively in Fig. 2, an upright reference position and the left ventricular endocardial apex. These are used to form a reference coordinate system which is in turn used to produce the two dimensional display surface on which all subsequent electrograms may be charted.
- Interactive software is used to assist the surgeon, who then proceeds to record electrograms at selected positions within the left ventricle.
- the position of the electrogram is measured and recorded by following the rotation of each of the joints 18, 20, 22.
- the position of each electrogram is shown by a diamond shape 50 on the map of Fig. 2.
- the instant position of the probe is also continuously displayed, in Fig. 2 this is represented by a cross within a square.
- the relative timings between the reference and the probe electrograms are compared. In this way, the region sought may be roughly identified, after which it may be explored and mapped in greater detail.
- the relative timings of the electrograms may be indicated on the map, for example by colour-coding the various mapped points.
- the electrode 24 is removed from the mount 28, and replaced by the chosen ablating system, which in this case is a cryoprobe. Any other known or proposed ablating system could be substi ⁇ tuted.
- the cryoprobe may then be inserted into the left ventricle and accurately located for surgery at the origin of the ventricular tachycardia previously identified by the mapping procedure.
- mapping system allowing a transannular approach, and in which the probe position and the positions of sampled electrograms may be recor ⁇ ded and displayed on a map relative to known reference points on the left ventricular endocardial surface.
- the position of the probe is displayed continuously to the surgeon during the operation enabling him to return to the position of a previously recorded electrogram.
- the system is also arranged such that on completion of the mapping procedure the mapping probe may be removed and replaced by a cryoprobe which may be accurately directed to the previously-determined origin of the ventricular tachycardia.
- cryoprobe which may be accurately directed to the previously-determined origin of the ventricular tachycardia.
Landscapes
- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Surgery (AREA)
- Molecular Biology (AREA)
- General Health & Medical Sciences (AREA)
- Veterinary Medicine (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Medical Informatics (AREA)
- Public Health (AREA)
- Animal Behavior & Ethology (AREA)
- Pathology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Cardiology (AREA)
- Physics & Mathematics (AREA)
- Biophysics (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Otolaryngology (AREA)
- Measurement And Recording Of Electrical Phenomena And Electrical Characteristics Of The Living Body (AREA)
Abstract
Dispositif servant à établir la cartographie de l'activation endocardiaque ventriculaire gauche pendant une opération chirurgicale et comportant un bras de support articulé (12, 14, 16) pour une sonde à électrodes (24). La position relative de la sonde est déterminée au moyen de la mesure du déplacement autour des articulations du bras (18, 20, 22) et est affichée automatiquement sur un appareil de contrôle tout au long de l'opération chirurgicale avec les positions et les durées relatives des éléctrocardiogrammes enregistrés, ainsi qu'avec les points de références anatomiques. Lorsqu'on effectue une procédure de cartographie, on peut substituer la sonde à électrodes par un dispositif cryochirurgical qu'on peut faire revenir à la position souhaitée sur la carte dans le but de procéder à une cryo-ablation.Device for mapping the left ventricular endocardiac activation during surgery and comprising an articulated support arm (12, 14, 16) for an electrode probe (24). The relative position of the probe is determined by measuring the displacement around the joints of the arm (18, 20, 22) and is displayed automatically on a recording device throughout the surgical operation with the positions and the durations. relative of the recorded electrocardiograms, as well as with the anatomical reference points. When carrying out a mapping procedure, the electrode probe can be replaced by a cryosurgical device which can be returned to the desired position on the map in order to carry out a cryo-ablation.
Description
Claims
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
GB929200838A GB9200838D0 (en) | 1992-01-15 | 1992-01-15 | Endocardial mapping apparatus |
GB9200838 | 1992-01-15 | ||
PCT/GB1993/000096 WO1993013708A1 (en) | 1992-01-15 | 1993-01-15 | Endocardial mapping apparatus |
Publications (1)
Publication Number | Publication Date |
---|---|
EP0621760A1 true EP0621760A1 (en) | 1994-11-02 |
Family
ID=10708648
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
EP93902396A Withdrawn EP0621760A1 (en) | 1992-01-15 | 1993-01-15 | Endocardial mapping apparatus |
Country Status (4)
Country | Link |
---|---|
EP (1) | EP0621760A1 (en) |
JP (1) | JPH07506012A (en) |
GB (1) | GB9200838D0 (en) |
WO (1) | WO1993013708A1 (en) |
Families Citing this family (8)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
NL9301851A (en) * | 1993-10-26 | 1995-05-16 | Cordis Europ | Cryo-ablation catheter. |
CA2242360C (en) * | 1996-01-08 | 2009-03-10 | Biosense, Inc. | Cardiac electro-mechanics |
US8897516B2 (en) * | 2011-03-16 | 2014-11-25 | Biosense Webster (Israel) Ltd. | Two-dimensional cardiac mapping |
US10827977B2 (en) | 2012-05-21 | 2020-11-10 | Kardium Inc. | Systems and methods for activating transducers |
US9198592B2 (en) | 2012-05-21 | 2015-12-01 | Kardium Inc. | Systems and methods for activating transducers |
US9011423B2 (en) | 2012-05-21 | 2015-04-21 | Kardium, Inc. | Systems and methods for selecting, activating, or selecting and activating transducers |
US10368936B2 (en) | 2014-11-17 | 2019-08-06 | Kardium Inc. | Systems and methods for selecting, activating, or selecting and activating transducers |
US10722184B2 (en) | 2014-11-17 | 2020-07-28 | Kardium Inc. | Systems and methods for selecting, activating, or selecting and activating transducers |
Family Cites Families (3)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4777955A (en) * | 1987-11-02 | 1988-10-18 | Cordis Corporation | Left ventricle mapping probe |
US5156151A (en) * | 1991-02-15 | 1992-10-20 | Cardiac Pathways Corporation | Endocardial mapping and ablation system and catheter probe |
FI93607C (en) * | 1991-05-24 | 1995-05-10 | John Koivukangas | Cutting Remedy |
-
1992
- 1992-01-15 GB GB929200838A patent/GB9200838D0/en active Pending
-
1993
- 1993-01-15 JP JP5512295A patent/JPH07506012A/en active Pending
- 1993-01-15 EP EP93902396A patent/EP0621760A1/en not_active Withdrawn
- 1993-01-15 WO PCT/GB1993/000096 patent/WO1993013708A1/en not_active Application Discontinuation
Non-Patent Citations (1)
Title |
---|
See references of WO9313708A1 * |
Also Published As
Publication number | Publication date |
---|---|
GB9200838D0 (en) | 1992-03-11 |
JPH07506012A (en) | 1995-07-06 |
WO1993013708A1 (en) | 1993-07-22 |
Similar Documents
Publication | Publication Date | Title |
---|---|---|
EP2085026B1 (en) | System for Determining the Location of a Catheter during an Intra-Body Medical Procedure | |
US6926714B1 (en) | Method for pulmonary vein isolation and catheter ablation of other structures in the left atrium in atrial fibrillation | |
US5657755A (en) | Apparatus and method for cardiac ablation | |
US6522905B2 (en) | Apparatus and method for cardiac ablation | |
US6711429B1 (en) | System and method for determining the location of a catheter during an intra-body medical procedure | |
US8050732B2 (en) | Apparatus and method for cardiac ablation | |
US7311705B2 (en) | Catheter apparatus for treatment of heart arrhythmia | |
US6939309B1 (en) | Electrophysiology mapping system | |
CA3017171A1 (en) | Automatic display of earliest lat point | |
US8364252B2 (en) | Identifying a structure for cannulation | |
AU697414B2 (en) | Apparatus for cardiac mapping and ablation | |
US20060116576A1 (en) | System and use thereof to provide indication of proximity between catheter and location of interest in 3-D space | |
US20040006268A1 (en) | System and method of recording and displaying in context of an image a location of at least one point-of-interest in a body during an intra-body medical procedure | |
US20030074011A1 (en) | System and method of recording and displaying in context of an image a location of at least one point-of-interest in a body during an intra-body medical procedure | |
US20090264743A1 (en) | Interference Blocking and Frequency Selection | |
US20070244479A1 (en) | Electrophysiology Therapy Catheter | |
US20090262980A1 (en) | Method and Apparatus for Determining Tracking a Virtual Point Defined Relative to a Tracked Member | |
AU2007200115A1 (en) | Mapping of complex fractionated atrial electrogram | |
WO2009129475A1 (en) | Method and apparatus for mapping a structure | |
EP0766527A1 (en) | Apparatus for cardiac ablation | |
CA2578962A1 (en) | Ablation-therapy of cardiac arrhythmias | |
WO2006020920A2 (en) | Catheter apparatus for treatment of heart arrhythmia | |
Chang et al. | Computerized activation sequence mapping of the human atrial septum | |
EP0621760A1 (en) | Endocardial mapping apparatus | |
EP1788936A2 (en) | Catheter apparatus for treatment of heart arrhythmia |
Legal Events
Date | Code | Title | Description |
---|---|---|---|
PUAI | Public reference made under article 153(3) epc to a published international application that has entered the european phase |
Free format text: ORIGINAL CODE: 0009012 |
|
17P | Request for examination filed |
Effective date: 19940720 |
|
AK | Designated contracting states |
Kind code of ref document: A1 Designated state(s): AT BE CH DE DK ES FR GB GR IE IT LI LU MC NL PT SE |
|
GRAG | Despatch of communication of intention to grant |
Free format text: ORIGINAL CODE: EPIDOS AGRA |
|
17Q | First examination report despatched |
Effective date: 19960216 |
|
GRAH | Despatch of communication of intention to grant a patent |
Free format text: ORIGINAL CODE: EPIDOS IGRA |
|
STAA | Information on the status of an ep patent application or granted ep patent |
Free format text: STATUS: THE APPLICATION IS DEEMED TO BE WITHDRAWN |
|
18D | Application deemed to be withdrawn |
Effective date: 19960801 |