EP1233698A1 - Systemes de cartographie cardiaque - Google Patents

Systemes de cartographie cardiaque

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Publication number
EP1233698A1
EP1233698A1 EP00976883A EP00976883A EP1233698A1 EP 1233698 A1 EP1233698 A1 EP 1233698A1 EP 00976883 A EP00976883 A EP 00976883A EP 00976883 A EP00976883 A EP 00976883A EP 1233698 A1 EP1233698 A1 EP 1233698A1
Authority
EP
European Patent Office
Prior art keywords
catheter
image
chamber
data
electrodes
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Withdrawn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
EP00976883A
Other languages
German (de)
English (en)
Inventor
Murphy L. Pickard
James J. Esteban
John E. Rouquette
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.)
Zynergy Cardiovascular Inc
Original Assignee
Zynergy Cardiovascular Inc
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 Zynergy Cardiovascular Inc filed Critical Zynergy Cardiovascular Inc
Publication of EP1233698A1 publication Critical patent/EP1233698A1/fr
Withdrawn legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/48—Diagnostic techniques
    • A61B6/486—Diagnostic techniques involving generating temporal series of image data
    • A61B6/487—Diagnostic techniques involving generating temporal series of image data involving fluoroscopy
    • 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
    • A61B5/287—Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/12—Arrangements for detecting or locating foreign bodies
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
    • A61B2034/101—Computer-aided simulation of surgical operations
    • A61B2034/102—Modelling of surgical devices, implants or prosthesis
    • 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
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B90/37—Surgical systems with images on a monitor during operation
    • A61B2090/376—Surgical systems with images on a monitor during operation using X-rays, e.g. fluoroscopy
    • 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
    • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
    • A61B2090/3966—Radiopaque markers visible in an X-ray image
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/54—Control of apparatus or devices for radiation diagnosis
    • A61B6/541—Control of apparatus or devices for radiation diagnosis involving acquisition triggered by a physiological signal

Definitions

  • the present invention 1 elates generally to catheters which conform to the shape ol a cardiac chambei or vessel (or other space) and which are useful in mapping these cardiac chambers and vessels, and more particularly to the use of conformal catheters to generate cardiac chamber maps showing the mechanical movement and electrical properties of the cardiac chamber.
  • Non-surgical cardiology mapping applications can be broadly divided into two markets with distinct, but somewhat overlapping needs interventional cardiology and
  • Interventional cardiologists are interested in rapid evaluation of tissue health, and rapid application of appropriate treatment, if possible, the same day. They are less concerned with electrograms than they are with what low voltage readings mean to tissue viability Low voltage electrograms may indicate tissue that is dying from suboptimal blood flow (ischemic) or already dead (necrotic), or possibly "hibernating". Hibernating tissue may often be revascularized and restored to health with proper drug therapy. Interventional cardiologists are also concerned with the mechanical motion of areas of cardiac tissue that is the natural result of muscle fiber contraction during a cardiac cycle. Normal muscle tissue will cause movement of the area of its locus, and movement is decreased when the muscle is dysfunctional or starved for blood. Low voltage electrograms coupled with low local wall motion status usually indicates a restricted blood flow to the indicated area, that the interventional cardiologists may be able to correct with arterial stints, properly placed laser therapy to induce collateral circulation development, or drug therapy to enhance blood flow to the area.
  • Electrophysiologists are concerned primarily with cardiac electrical anomalies known as arrhythmias. Although there are a number of common dysfunctions those patients present with, there are also many unique arrhythmias that can be treated if diagnosed properly.
  • the physician can locate specific sites of origins of electrical stimulation (foci) or aberrant conductive pathways in the tissue that can be interrupted.
  • the electrophysiologists therefore prefer to see a time-ordered and correlated sequence of dozens of electrograms in order to formulate a path of diagnosis and therapy. It is of primary importance in this case to be able to locate fairly precisely the position of each electrode and its corresponding electrogram.
  • the relative timing of arrival of a pacing pulse, corresponding to the cardiac QRS (the portion of the electrogram indicting ventricular contraction) at each electrode is necessary to determine problem areas
  • the depola ⁇ zation/repola ⁇ zation waveshape is analyzed to pick "activation points" on the waveform
  • the EP often desires to stipulate amplitude and slope parameters for picking these points on each electrogram When the time durations between individual electrodes are analyzed, a picture of the propagation across the chamber walls emerges Slow rates of pacing signal propagation may indicate ischemic or necrotic tissue, since this type is less conductive than viable tissue
  • both anatomical location and electrical signal data are gathered simultaneously and saved for analysis as a self-consistent data set
  • Anatomical location data for each catheter electrode is derived by image processing of the fluoroscopic images and electrical data is provided by standard analysis means though computer data reduction. Therefore, many data points are captured simultaneously, each providing location and electrical signal data. This means the data set in inherently self-consistent and is captured more rapidly than by single-point means.
  • the present invention provides a mapping system useful to both interventional and electrophysiological cardiologists.
  • the systems of the present invention are currently designated ZIP (Zynergy Interventional Product/Program) and ZEP (Zynergy Electrophysiology Product/Program).
  • the present invention relates to a catheter system for aiding in the acquisition of electrograms from the human cardiac chambers, both atria and ventricles, as well as cardiac vessels, in real time.
  • the catheters of the present invention advantageously conform to the unique shape of the internal walls of the cardiac chamber or vessel of the patient under examination Generally, these chambers or vessels may be viewed as a simple tube, egg-shaped, or cone-shaped spaces.
  • the straightened catheter inserted into a major blood vessel takes on a geomet ⁇ c form that is a close approximation to the chamber or (space) shape when deployed inside the target chamber, and is thus anchored in the target chamber
  • the device ' s multipole electrode/marker complement is in intimate contact with the chamber walls at multiple locations, e ⁇ enly distributed across the internal surface of the chamber, or across a portion of the internal surface of the chamber.
  • Prototype multipole electrode/marker complements include as many as 64 electrodes and/or markers, although a greater or lesser number may be employed. In the cardiology application, this is a major advantage in obtaining multitude of electrograms quickly and consistently for later processing. When properly processed and interpreted as a group, these electrograms can be used to determine the form and site of electrical dysfunction.
  • Competitive systems such as those discussed in U.S. Patent No 6.066,094, use single or quad-pole catheters to laboriously obtain electrograms from a number of sites within the chamber by repetitively moving and recording individual datum
  • the mapping system of the present invention can also provide mechanical data on chamber dimensions and mo ⁇ hology changes during the cardiac cycle by simply noting the size and shape of the deployed catheter fluoroscopically at multiple times during chamber movement
  • the location of the catheter's electrodes may be traced on sequential radiographs taken over one or more cardiac cycles to determine total range of motion of smaller segments of the cardiac tissue, directly related to tissue viability.
  • Competitive products using a single location catheter take a number of position readings and reconstruct the chamber mo ⁇ hology by connecting these data with geometric planes. The more points taken, the closer the physical definition becomes.
  • the multipole conformal catheter largely eliminates, or at least greatly reduces, the need to re-deploy the catheter.
  • the conformal catheter nevertheless may be re- deployed more than once, and data sets combined to form an arbitrarily detailed picture of the chamber/vessel as desired.
  • cardiac mapping The procedure of acquiring and analyzing these electrograms and mechanical motion and shape data to locate specific problem sites is called cardiac mapping.
  • cardiac mapping A logical extension of this capability is an instrument that uses the conformal catheter as a therapeutic catheter for ablation or drug delivery.
  • the conformal catheter while oriented toward cardiac mapping applications, can also be used in other medical applications using the same mapping methods described herein. Alternatively, the same methods may be used to determine the three- dimensional location of any radiopaque markers on any device that may be made to conform to the internal shape of a chamber or space in the body. Gastrointestinal mapping may be performed, with or without actual electrical signal acquisition, using these methods. Mapping of cranial sinuses are another application. In general, if the internal shape of a space or cavity in the body must be determined, the methods and devices described herein may be used in conjunction with a standard fluoroscope. DETAILED DESCRIPTION OF THE EMBODIMENTS
  • the ability to acquire and display both maximum voltage and mechanical motion loops is key to providing the interventional cardiologists with the data they need for diagnosis
  • the present invention provides the tools needed for this acquisition and display.
  • Two types of data aie useful to interventional cardiologists ( 1 ) electrogram peak-to-peak voltages of activation corresponding to the heart's intrinsic QRS pacing impulse, and (2) time-sequential changes in each catheter electrode position over a cardiac cycle
  • the best way to display these types of information is in the form of maps projected onto a virtual model of the cardiac chamber being diagnosed. Maximum voltage levels obtained from each electrode of the catheter are graded by color and projected onto the model
  • the model also contains the virtual conformal catheter tor spatial reference Thus the user may rotate the model in three-dimensional space and note areas where low voltage electrograms have been obtained.
  • a second map will concurrently display the wall motion map.
  • This map will indicate the mechanical movement of each catheter electrode in three-dimensional space over a single cardiac cycle by drawing small, often closed-boundary, loops that trace the path of motion of each electrode on the model chamber. While this is a static image, it may also be of benefit to allow the viewing of the entire sequence of images from which the electrode position data was de ⁇ ved in a film-clip fashion. This may give the physician a more realistic sense of decreased motion in problem areas of the chamber.
  • This data is developed from a sequence of discrete radiological images captured at stable time increments over the cardiac cycle, possibly taking such a sequence from three or more fluoroscopic beam angles. This is discussed in detail below.
  • Ancillary displays must be included to allow the viewing of standard ECG lead waveforms. The physician may want to refer to standard lead-set views to verify his diagnosis.
  • Data useful to electrocardiologists is based on the same raw data used to obtain the voltage and position data described in the previous paragraphs, i.e., the electrograms and the radiological images of the deployed catheter. This information, however, is processed and presented in a different way
  • the electrogram data In electrocardiological applications, the electrogram data must be available for display in the form of both isochronal and isopotential maps.
  • the isochronal map is projected onto a model chamber, with various graded colors showing the activation times of each electrogram relative to the time zero pacing source, either a pacing electrode or the heart's natural sinoat ⁇ al node pacer.
  • the virtual catheter may or may not be present in this view for spatial reference, since anatomical features will be present on the model chamber and have already been correlated to catheter electrode positions Rapid or slow conductance pathways will show up readily on such a display.
  • This map may be a static display or a dynamic picture of waveform propagation across the chamber.
  • the isopotential map displays the voltage present at each electrode at any given time in the cardiac cycle, graded by color to represent voltage. Again, this may be dynamic or static, but following a potential wavefront across the chamber over the course of the cardiac cycle is valuable.
  • the individual electrogram waveforms themselves should be available for display whenever the user moves the pointing device over a particular electrode on the model This may be used for a quick validation method when problem areas are located Alternatively, the user may use a pointing device to group electrodes together and display a group electrogram display in a strip-chart style
  • the conformal catheter electrodes may also be used singly or in groups for locuscd ablation at specific sites.
  • the same fluoroscopic image capture and analysis techniques used for the ZIP systems are used in the ZEP system
  • the electrophysiologist may deliberate for several days before a therapy is initiated, the length of the data acquisition procedure is not as critical. In these applications, therefore, more emphasis will be put on obtaining additional images from additional viewing angles before the virtual catheter and its multiple electrodes ai e created and located ithin the chamber Taking multiple data sets from more than one cathetei location and deployment, and merging these data sets to reduce positional error, will further augment this procedure
  • Electrodes are used only when electrical information is required from the catheter.
  • the catheter can be used only as a means of determining the three-dimensional shape of the cavity or chamber it is inserted into
  • radiopaque markers are used to determine the catheter geometry and electrodes are not used at all. The process of finding the three- dimensional position of these markers is the same as for finding electrodes.
  • any geometry can be used to support the fluoroscopic markers that are used to determine the final three-dimensional shape of the deployed device.
  • a balloon or basket type of device fitted with radiopaque markers could be deployed m an anatomical cavity or chamber, and the two-dimensional marker information reduced to three-dimensional location information as it is done for the spiral catheter, as described below All that need be known is the manner in which the device is constructed and the physical relationship between markers that is determined by the device design This mechanical relationship information is used to determine the location of markers that cannot necessarily be seen at all, but whose location may be derived irom the locations ol related markers that are visible and whose three- dimensional locations can be located by the method described later in this document.
  • Marker locations are chosen prudently to allow determination of all geometrical information necessary to recreate the true geometry of the deployed device For instance, if the deployed device is simply a straight linear catheter, then markers need only be placed on the distal and proximal ends, and perhaps in the middle From the two-dimensional fluoroscopic images, finding any two of these markers allows the reconstruction of the entire catheter in thiee dimensions because the spacing of the markers is already known, as is the geometry of the catheter, i.e . a straight line.
  • the material properties and the spacing between the proximal, distal, and middle markers in several two-dimensional views may be used to reconstruct the three-dimensional shape of the deployed device by computing bending rad ⁇ , etc of the mate ⁇ al.
  • the true location of the electrodes on the catheter is a priori information, and the intermediate electrode positions can be computed by knowing the spacing of the electrodes on the catheter; this spacing was determined when the device was manufactured.
  • the need is to identify the key electrodes on the image and to compute separation distances between them as input to a function that creates a first pass approximation of the spiral model
  • the distances computed from the image must yield enough information to determine the radius of the spiral at each coil, and the overall length of the spiral.
  • the second approach is to have the user interact w ith the system to match a virtual spiral image to the actual image Letting the user move numbered target icons over whichever corresponding key electrodes that he can visually identify in the image does this The user can position other generic targets over any other intermediate electrodes that he can easily find. Given the location of at least a few key electrodes and several intermediate electrodes, the system software will then attempt to generate a spiral equation or set of equations that is used to overlay a virtual spiral on the catheter image
  • Creating and fitting a mathematical model of the spiral catheter onto the image of the actual catheter is a mathematically complex operation
  • a method of identifying key electrodes on the catheter is provided as follows
  • the catheter is constructed in such a way that every fifth electrode is uniquely marked so as a show up in the fluoroscopic image easily.
  • Other types of electrode markers may be used besides simply changing the electrode length, such as making a series of bands or radiopaque marks periodically along the catheter.
  • a feature that has tremendous value to the user is that of including one or more anatomical landmarks that can be associated with the virtual catheter or other device to aid the human eye in determining the true anatomical location of various electrodes on the catheter, and thus its location in the cardiac chamber or other space.
  • the AV groove, coronary sinus, pulmonary vein/artery, and the aortic root are all possible candidates for these markers in the case of the cardiac catheter application.
  • markers are tied to the virtual catheter m the same way key electrodes are and are processed with the other electrodes/markers for display with the virtual model
  • these ancillary markers are present in the fluoroscopic images along with the device electrodes/markers.
  • at least one marker must be present to position a virtual anatomical feature over the position of the identical location in the three-dimensional model.
  • Locations of additional features can assist the development of a more realistic model by forcing it to conform in these reference locations and then extrapolating intervening features and associating them with the catheter electrode positions.
  • these landmarks it is necessary that these landmarks not move relative to the device electrodes/markers if they are to be used to derive mechanical motion information as described elsewhere in this document.
  • the XY plane is "tipped" into the XZ or YZ plane, and the angle of tip must also be known for the true three- dimensional model to be located in space.
  • the angle ol the fluoroscope head in both XY lateral plane as well as the angle, if any, in the Z coronal/caudal plane must be known when the view is captured as two- dimensional imagery
  • a fictitious "ghost" chamber image is constructed around the deployed catheter model to aid the user in perspective and location of the device within the chamber or space in which it is deployed
  • the ghost chamber or space can also be graphically “sectioned” to display the chamber as a cutaway view or “unrolled” to form a flat plane in the same manner that world maps represent the truly spherical Earth.
  • This plane can be used as a physical background for the isopotential or isochronal map displays in the cardiac application or for other information display in other applications.
  • Electrograms (EGM) the cardiac signals from each catheter electrode, are acquired and displayed for the user, along with standard electrocardiograms (ECG).
  • ECG electrocardiograms
  • the preferred system contains analog-to-digital converter boards installed in the computer to capture this electrical data.
  • the preferred systems of the invention use multi-channel A/D boards that are equipped with bandpass filters for each input channel. These filters are configured under computer control, and are currently set for a DC to lKHz range. In general, the computer also configures gain and offset, as well as sample rate, but these abilities depend upon the ND board chosen. A sampling rate of 2000 samples per second is sufficient for EGM/ECG signals, but may differ for other applications. The conventional manner of displaying such signals as time graphs is followed. The maximum number of electrodes on the catheter determines how many of these signals there are to display Va ⁇ ous user controls customize the display as to the number of signals to display on a given page, the vertical screen area assigned to each signal, and whether there is horizontal and/or vertical scrolling allowed.
  • the number of heartbeats acquired for display determines the horizontal time axis length.
  • a typical number is probably about 2-3 beats, representing approximately 2-3 seconds at 60
  • the pacing rate will determine the numbci of beats captured
  • EGM data is acquired and displayed, it is quickly scanned by the computer system to determine if valid signals have been acquired for each electrode (channel). This is done by various standard methods such as frequency domain analysis, wavelet analysis, or other methods. Generally, noisy or non-existent capture results in only noise of greatly attenuated peak-to-peak values While not nccussiy, checking the validity of the captured data, both image and electrical signal inputs, is desirable to minimize asted time and poor reconstruction of the virtual model(s) later in the process
  • the instrument marks any bad channels so the user has the option of attempting to re-acquire the data to improve it.
  • Means is also provided to p ⁇ nt the signals themselves and store the raw data for future display or analysis. If only certain captured information is bad, the user marks it so it is not used in the subsequent analysis or three-dimensional virtual model construction, but it is still acquired along with all other signals and stored.
  • the user will first use several menus in the application to choose how he wishes to acquire image and signal data, and to document the doctor, patient, and procedure
  • These menus allow the following information to be inputted ( 1 ) patient history, personal information, attending/refer ⁇ ng phvsician. and prognosis, and procedure notes, (2) for image acquisition, the number and angle of the fluoroscopic views to acquire, (3) the number of cardiac cycles over which to obtain image and signal data, (4) the video frame rate at which image data is acquired (generally this will be the maximum rate at which the fluoroscopic camera will operate), and (5) sampling rate and filter characteristics with which signal data is acquired
  • the user is prompted to start the procedure by positioning the fluoroscope head at the first angle chosen for image acquisition
  • the doctor then activates the fluoroscope and simultaneously triggers the image/signal acquisition
  • the system automatically acquires the data for a time sequence over the number of cardiac cycles chosen du ⁇ ng system setup Each sequence begins at a common time point as determined by external synchronizing pulses such as the "R-wave" trigger from the ECG machine
  • the doctor deactivates the fluoroscope
  • the system presents image data m a "cme" moving picture style or one frame at a time as desired for review Additionally, the doctor may also display the EGM and ECG data captured for judgment of validity.
  • Example 3 Image/Signal Processing Following the procedures in Example 2, image data is now stored as a number of time-sequence images, one for each fluoroscopic viewing angle acquired.
  • the two-dimensional images In order to calculate the three-dimensional coordinates of each radiopaque electrode/marker, the two-dimensional images must be processed one at a time, to locate the markers. This is accomplished as follows- Starting with the first frame of the first time sequence of images, the system automatically processes the image and marks any electrodes found. The doctor confirms the success or failure of the marker locations.
  • the doctor uses the mouse to aid the system in identifying key markers
  • the system uses its own internally generated marker location data or the doctor ' s determination of marker location in the first fi ame of the sequence as a starting point in searching for markers in each successive frame of the sequence. In this manner, all visible electrodes/markers are located in each frame of the sequence.
  • This procedure is repeated for all the image time sequences captured over all of the fluoroscopic head angles.
  • the system processes this multitude of image XY marker location information to calculate the three-dimensional XYZ locations of all markers.
  • the location of those markers/electrodes that are hidden in all images may be inte ⁇ olated from the conformal device geometry. Standard projective geometry techniques are used for this step All the signal data captured is processed to determine time and voltage relationships as determined by the procedure.
  • a virtual model of the conformal device is generated and displayed using standard graph/curve-plottmg computer programs and software The user may view this three-dimensional model from any angle using a pointing device or other methods provided by the ZIP/ZEP system
  • a fictitious graphical ghost model of the chamber or space is built around the conformal device using the dimensions of the conformal device as a scaling guide Standard graphical construction computer applications software and techniques is
  • the resultant three- dimensional image of the ghost chamber with the conformal device inside it is displayed and may be viewed from various angles
  • the virtual ghost chamber/cavity model is used as a surface onto which signal data or text is superimposed.
  • this may be electrode voltage or electrogram relative timing information
  • the vicinity of each marker/electrode may be color- graded to represent this information in a color-coded manner.
  • electrode information pertaining to relative timing of the EGM signals and their propagation over the chamber surface du ⁇ ng a cardiac cycle may be displayed.
  • the mechanical motion or movement of individual electrode/markers over the time sequence of a cardiac cycle for instance, can be visualized using the ghost chamber surface.
  • each marker in each frame of the time sequence can be emphasized or highlighted in such a way as to show its apparent motion over time by playing a composite time sequence of image frames in a rapid fashion. Taking the three-dimensional marker location data from the series of fluoroscopic angle time sequences forms this composite time sequence. Since each time sequence at each fluoroscopic head angle starts at the same point m time relative to the cardiac cycle, they are themselves synchronized. In this way, the movement of each marker/electrode can be traced over a cardiac cycle and played as a movie to show that motion in a realistic manner.
  • the ghost chamber fo ⁇ ned around the conformal device may be regenerated for each frame of the time sequences over a card'ac cycle, thus also displaying the changes in chamber size and shape. This lends a more realistic view of the three-dimensional virtual chamber deformations as a function of time. After all the data is reviewed, the user may make a decision to redeploy the conformal device to acquire and append new two-dimensional image/signal data to the existing database to further improve, widen, or focus the area being studied.
  • Example 5 Data Archiving The user is prompted by the system to save all acquired and processed data to a suitable archiving means such as a CD-ROM or magnetic tape or disk Since all the data taken is sa ed, the entire procedure may be reviewed by using the system to re- play and review the data at a later time.
  • a suitable archiving means such as a CD-ROM or magnetic tape or disk Since all the data taken is sa ed, the entire procedure may be reviewed by using the system to re- play and review the data at a later time.
  • An Intel-based personal computer is adequate to accommodate all necessary control I/O, image capture hardware, and video terminal devices. It is immediately assumed that the machine will be dedicated to ZIP/ZEP system use, and all system l esources are available for software operation
  • a 900 MHz Pentium III processor with a PCI bus architecture and 512 MB of system RAM allows fast DMA storage of radiographic image sequences without processor intervention.
  • Example 7 Mass Storage Because large numbers of radiographic images from the fluoroscope will be captured and stored, it is necessary to be capable oi archiving these images on both hard disk and CD-ROM media At current hardwaie rates it is probably not possible to dump image sequences at 30 frames per second to the CD-ROM, so disk buffering is necessary.
  • the images aie all 8 bit monochrome VGA quality with 640 x 480 pel resolution, making a ⁇ 308kB file for each frame.
  • a standard 10-20 GB hard disk is adequate to accumulate images from several procedures before it is necessary to spool it off to the CD-ROM
  • Networking the display terminal(s) as clients is a major advantage gained at a relatively modest cost of the network adapter and server software.
  • the terminals may be added or deleted as the user desires, and other devices such as touch screens can be inco ⁇ orated. This versatility and ability to upgrade gradually may be greatly appreciated in today's crowded catheter labs.
  • the displays must of course have VGA (640x480) resolution at a minimum, but 600x800 or better can be had at a small incremental cost. Display size is also variable, but at least one of the working terminals should be 21 inches.
  • VGA 640x480
  • a technician can be located in the control/observation room several feet from the physician while monitoring and helping guide the data acquisition from his terminal. As the physician is placing the catheter and attending to the procedure, the technician is acquiring and processing the data for display on the doctor's terminal.
  • the doctor can also have two or more displays available to him for viewing two or more maps or data displays simultaneously.
  • biplane machines are becoming more common.
  • a biplane machine would speed up acquisition of frame sequences by acquiring two frame angles nearly simultaneously.
  • the image capture board is capable of streaming video to memory at the maximum 30 frames/second rate to avoid being a bottleneck, and to provide real-time view of fluoroscopic images on the computer terminal as an alternative to the doctor watching the fluoroscope monitor It may be desirable to add footswitch input capability that allow s the physician to trigger a single- or multiple- frame sequence capture Some type of pacing or R- wave trigger circuits is necessary, and is provided by the hospital pacing and ECG systems
  • Example 1 Software Fluoroscopic Image Capture and Storage The invention provides means for interacting with the user to capture and store monochrome grayscale images from a fluoroscope
  • this discussion will l efer to these images and the capture process as if only one fluoioscopic view is being captured and analyzed, but two or more, views are actually required Typically these will be at least one or more right and left anterior oblique views, left or right lateral views, or anterior/posterior views
  • the images to be captured are available as a standard RS-170 analog video output from the fluoroscopic imaging instrument. This standard specifies an image that is 640 pixels wide and 480 pixels high, at a frame rate of 30/second. Each frame then requires a bit more than 308 Kbytes of storage when digitized at a 256 level (8 bit) grayscale value. Catheter labs that have either a single or dual head can be accommodated. In the case of a single head fluoroscope, it is obvious that images from one view will be captured, the head angle changed by some amount, and the images from another view captured. In this way the user quickly builds a library of images that are processed to obtain true three-dimensional information on each electrode position and movement over an entire cardiac cycle.
  • the same trigger can be used, but the single frame grabber input multiplexer is used to switch between the two heads, since the heads are never active at the same time, but are triggered with a one-frame delay between them. In this case, frames captured in this staggered manner are useable.
  • the 30/second frame rate means a complete image every 33 milliseconds, or even every
  • the system must display the individual images as thumbnail views and have the ability to show one or more images in expanded form.
  • Facilities for auto-numbering images for disk storage and retrieval are also implemented. Finally, the user has the ability to select one of the images for further processing into the virtual spiral in the next module. The experienced user will select the image based on this judgment of how well certain electrodes show up on the image.
  • the software performs various types of image processing to enhance the image of the deployed catheter and its electrodes.
  • Region-of-interest (ROI) selection is applied first that encloses the portion containing the catheter image and the reference catheter to narrow the image area operated on.
  • Histogram equalization and particle (blob) analysis are then used, and the found blobs are sorted by size and perimeter to select only those blobs that are within the size range of one or two electrodes. This eliminates spurious blobs that may be misinte ⁇ reted as electrodes.
  • drivers for the image capture board must be written or integrated into the software and board programming done before the images are captured. This allows the specific proprietary hardware from various image capture manufacturers to be used to its fullest extent in preprocessing the images.

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  • Measurement And Recording Of Electrical Phenomena And Electrical Characteristics Of The Living Body (AREA)
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Abstract

La présente invention concerne un appareil utilisant des techniques standards médicales de fluoroscopie à rayons X afin d'obtenir des images de cavité, de vaisseau, ou de l'espace en question, un dispositif doté de repères de contraste étant inséré dans la cavité et d'une certaine façon épousant mécaniquement les parois internes de la cavité. En prenant deux ou plusieurs vues fluoroscopiques de l'espace sous des angles différents, on peut déterminer l'emplacement exact des repères et, après traitement, obtenir l'emplacement tridimensionnel de chaque repère. En raison du contact intime entre les repères et les parois entourant l'espace, on détermine aussi une forme tridimensionnelle de l'espace. Il est possible d'utiliser des techniques graphiques standards afin d'afficher un modèle virtuel de l'espace. La précision du modèle résultant s'améliore avec le nombre de vues prises depuis des angles fluoroscopiques différents, ainsi que par l'utilisation de repères plus contrastants.
EP00976883A 1999-11-05 2000-11-03 Systemes de cartographie cardiaque Withdrawn EP1233698A1 (fr)

Applications Claiming Priority (3)

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US16384299P 1999-11-05 1999-11-05
US163842P 1999-11-05
PCT/US2000/030316 WO2001034026A1 (fr) 1999-11-05 2000-11-03 Systemes de cartographie cardiaque

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EP1233698A1 true EP1233698A1 (fr) 2002-08-28

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JP (1) JP2003525663A (fr)
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WO2003049032A2 (fr) 2001-12-07 2003-06-12 Koninklijke Philips Electronics N.V. Systeme de visualisation medicale et procede de mise en valeur spatiale de structures contenues dans des images bruitees
WO2010084446A1 (fr) 2009-01-23 2010-07-29 Koninklijke Philips Electronics N.V. Traitement et analyse d'images cardiaques
CA2802507A1 (fr) 2010-06-13 2011-12-22 Angiometrix Corporation Kit de diagnostic et procede permettant de mesurer la dimension d'un ballon in vivo
US8897516B2 (en) 2011-03-16 2014-11-25 Biosense Webster (Israel) Ltd. Two-dimensional cardiac mapping
US9017320B2 (en) 2012-05-21 2015-04-28 Kardium, Inc. Systems and methods for activating transducers
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
CN103431858B (zh) * 2013-09-09 2015-01-21 重庆电子工程职业学院 基于分布式电极的窦房结电图获取方法及系统
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
US10888235B2 (en) * 2015-01-07 2021-01-12 St. Jude Medical, Cardiology Division, Inc. System, method, and apparatus for visualizing cardiac timing information using animations
CN116473566A (zh) * 2017-07-12 2023-07-25 科迪影技术股份有限公司 成像以确定电极几何形状
WO2019139884A1 (fr) * 2018-01-09 2019-07-18 St. Jude Medical, Cardiology Division, Inc. Système et procédé de tri de signaux électrophysiologiques sur des cathéters virtuels

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WO2001034026A1 (fr) 2001-05-17
AU1459501A (en) 2001-06-06

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