EP0621760A1 - Dispositif de cartographie endocardiaque - Google Patents

Dispositif de cartographie endocardiaque

Info

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Withdrawn
Application number
EP93902396A
Other languages
German (de)
English (en)
Inventor
Brian Kevin Roderick Clarke
Richard Charles Saumarez
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Cryogenic Technology Ltd
Original Assignee
Cryogenic Technology Ltd
Priority date (The priority date 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 date listed.)
Filing date
Publication date
Application filed by Cryogenic Technology Ltd filed Critical Cryogenic Technology Ltd
Publication of EP0621760A1 publication Critical patent/EP0621760A1/fr
Withdrawn legal-status Critical Current

Links

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)
  • Animal Behavior & Ethology (AREA)
  • Public Health (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Veterinary Medicine (AREA)
  • General Health & Medical Sciences (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Pathology (AREA)
  • Cardiology (AREA)
  • Physics & Mathematics (AREA)
  • Biophysics (AREA)
  • Otolaryngology (AREA)
  • Oral & Maxillofacial Surgery (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.
EP93902396A 1992-01-15 1993-01-15 Dispositif de cartographie endocardiaque Withdrawn EP0621760A1 (fr)

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
GB9200838 1992-01-15
GB929200838A GB9200838D0 (en) 1992-01-15 1992-01-15 Endocardial mapping apparatus
PCT/GB1993/000096 WO1993013708A1 (fr) 1992-01-15 1993-01-15 Dispositif de cartographie endocardiaque

Publications (1)

Publication Number Publication Date
EP0621760A1 true EP0621760A1 (fr) 1994-11-02

Family

ID=10708648

Family Applications (1)

Application Number Title Priority Date Filing Date
EP93902396A Withdrawn EP0621760A1 (fr) 1992-01-15 1993-01-15 Dispositif de cartographie endocardiaque

Country Status (4)

Country Link
EP (1) EP0621760A1 (fr)
JP (1) JPH07506012A (fr)
GB (1) GB9200838D0 (fr)
WO (1) WO1993013708A1 (fr)

Families Citing this family (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
NL9301851A (nl) * 1993-10-26 1995-05-16 Cordis Europ Cryo-ablatie catheter.
EP0944350B1 (fr) * 1996-01-08 2003-12-03 Biosense Inc. Dispositif cardiaque electro-mecanique
US8897516B2 (en) * 2011-03-16 2014-11-25 Biosense Webster (Israel) Ltd. Two-dimensional cardiac mapping
US9017321B2 (en) 2012-05-21 2015-04-28 Kardium, Inc. Systems and methods for activating transducers
US9198592B2 (en) 2012-05-21 2015-12-01 Kardium Inc. Systems and methods for activating transducers
US10827977B2 (en) 2012-05-21 2020-11-10 Kardium Inc. Systems and methods for activating transducers
US10722184B2 (en) 2014-11-17 2020-07-28 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

Family Cites Families (3)

* Cited by examiner, † Cited by third party
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 (fi) * 1991-05-24 1995-05-10 John Koivukangas Leikkaustoimenpidelaite

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
See references of WO9313708A1 *

Also Published As

Publication number Publication date
GB9200838D0 (en) 1992-03-11
WO1993013708A1 (fr) 1993-07-22
JPH07506012A (ja) 1995-07-06

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