JP4550186B2 - Electrophysiological mapping device - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention evaluates the function of the heart in terms of both its electrical characteristics and anatomical contraction characteristics, and improves the diagnostic accuracy of various heart diseases, particularly tachyarrhythmia. The present invention relates to an electrophysiological mapping device.
[0002]
[Prior art]
The biggest challenge in arrhythmia treatment is persistent ventricular tachycardia or sudden death from ventricular fibrillation. This fatal condition is characterized by an abnormally high rate of ventricular beats and extreme damage to pumping oxygen-containing blood throughout the body. In the United States, there are about 350,000 sudden cardiac deaths per year, 80 to 90% of which are thought to be due to ventricular tachycardia or ventricular fibrillation. In the United States, most of the basic heart diseases of ventricular tachycardia are myocardial infarction, and about 30% of those who have survived myocardial infarction carry the risk of suffering ventricular tachycardia within one year after the onset of myocardial infarction. ing. In Japan, most ventricular tachycardia is non-ischemic, and its prevalence is lower than that in the United States. However, as the lifestyle has become westernized, the prevalence of ischemic heart disease has increased. Incidence of ventricular tachycardia is also expected to increase.
[0003]
Currently, treatments such as antiarrhythmic drugs and implantable cardioverter defibrillators have become mainstream, but none of them are radical treatments for ventricular tachycardia and have serious side effects.
Therefore, in the future, we will identify the source of ventricular tachycardia by mapping the electrical activation of the endocardial surface on a catheter basis, and causalize the site with catheter-based radiofrequency ablation. Expectations are rising. An electrophysiological mapping device is used in this treatment method. As the mapping display, polar coordinate display in which the outer periphery corresponds to the left ventricular base and the inner periphery corresponds to the apex is often used. Using the R wave of the body surface electrocardiogram as the reference time (zero), the time at which the action potential at each point is maximum (time difference from the R wave) is displayed in different colors.
[0004]
Catheter-based electrophysiological mapping of the heart is also evolving with catheter-based radiofrequency ablation, but at present both methods have been developed independently, mapping data and anatomical morphology of the heart It is very difficult to grasp the positional relationship (correspondence) of each other, and it is not easy to accurately identify the target site for ablation treatment and to navigate the treatment catheter accurately to that location.
[0005]
In addition, deepening the pathophysiological understanding of the relationship between myocardial electrical activation and mechanical contraction may lead to new diagnostic and therapeutic methods, but this is currently achieved. There is no functional diagnosis device for the function of the heart.
[0006]
[Problems to be solved by the invention]
As described above, the conventional electrophysiological mapping method has a drawback that it is difficult to accurately specify a target site for ablation treatment when used with a catheter-based radiofrequency ablation treatment method.
[0007]
The object of the present invention is to easily grasp the positional relationship between an electrophysiological mapping image of an organ and an image showing an anatomical form, and as a result, both the electrical characteristics of the organ and the anatomical contraction characteristics are obtained. It is possible to make a three-dimensional evaluation at the same time and with a spatial positional relationship, and to improve the diagnostic accuracy of various diseases, especially tachyarrhythmia, and to improve the treatment results It is to provide a physiological mapping apparatus.
[0008]
[Means for Solving the Problems]
In order to solve the above problems and achieve the object, the present invention uses the following means.
[0009]
An electrophysiological mapping device according to an aspect of the present invention includes:
Electrophysiological mapping means for measuring the voltage of the intimal surface of the organ with an electrode provided on the catheter and mapping the electrical characteristics data of the organ according to the shape of the organ;
Image creating means for obtaining an image showing the anatomical characteristics of the organ;
Display means for displaying the mapping image obtained by the electrophysiology mapping means and the image obtained by the image creation means in association with each other;
Comprising
The image creating means is an ultrasonic diagnostic apparatus,
The catheter comprises a first position sensor;
The probe of the ultrasonic diagnostic apparatus includes a second position sensor,
The display means obtains the positional relationship between the ultrasonic image and the mapping image based on the outputs of the first and second position sensors.
[0010]
An electrophysiological mapping device according to another aspect of the present invention comprises:
Electrophysiological mapping means for measuring the voltage of the intimal surface of the organ with an electrode provided on the catheter and mapping the electrical characteristics data of the organ according to the shape of the organ;
Image creating means for obtaining an image showing the anatomical characteristics of the organ;
Display means for displaying the mapping image obtained by the electrophysiology mapping means and the image obtained by the image creation means in association with each other;
Comprising
The image creating means is an ultrasonic diagnostic apparatus,
The catheter of the electrophysiological mapping means includes a member whose acoustic characteristics are different from those of the remaining part in a part,
The display means obtains the positional relationship between the ultrasound image and the mapping image by extracting the reflected signal from the member from the reflected signals received by the ultrasound diagnostic apparatus and obtaining the position of the catheter.
[0011]
An electrophysiological mapping device according to another aspect of the present invention comprises:
Electrophysiological mapping means for measuring the voltage of the intimal surface of the organ with an electrode provided on the catheter and mapping the electrical characteristics data of the organ according to the shape of the organ;
Image creating means for obtaining an image showing the anatomical characteristics of the organ;
Display means for displaying the mapping image obtained by the electrophysiology mapping means and the image obtained by the image creation means in association with each other;
Comprising
The catheter is a basket-type arm having a plurality of electrodes;
The image creating means is an ultrasonic diagnostic apparatus,
The display means obtains the positional relationship between the ultrasonic image and the mapping image by extracting the reflected signal from the basket type arm from the reflected signal received by the ultrasonic diagnostic apparatus and obtaining the position of the arm. .
[0037]
According to the present invention, it is easy to grasp the positional relationship between an electrophysiological mapping image of an organ and an image showing an anatomical form, and as a result, both the electrical characteristics of the organ and the anatomical contraction characteristics are obtained. Can be evaluated three-dimensionally at the same time and with a spatial positional relationship.
[0038]
DETAILED DESCRIPTION OF THE INVENTION
Hereinafter, an embodiment of an electrophysiological mapping device according to the present invention will be described with reference to the drawings.
[0039]
FIG. 1 is a block diagram showing a schematic configuration of an electrophysiological mapping device according to a first embodiment of the present invention. An electrophysiological mapping (EP mapping) apparatus main body 4 having a catheter electrode or an electrophysiological electrode (hereinafter referred to as EP electrode) 5 and an ultrasonic diagnostic apparatus main body 2 having an ultrasonic probe 1 composed of a two-dimensional array probe. Connected and the display unit 3 displays the cardiac EP mapping image and the ultrasound image in association with each other's positional relationship.
[0040]
Details of the ultrasonic diagnostic apparatus main body 2 and the electrophysiological mapping apparatus main body 4 will be described with reference to FIGS. 2 and 3. The ultrasonic diagnostic apparatus main body 2 is the same as a normal ultrasonic diagnostic apparatus main body for three-dimensional scanning, and as shown in FIG. 2, a three-dimensional scan controller 10, a pulser / preamplifier switch 11, a beam former 12, and various processors. (Echo processor 14, Doppler processor 15, 3D processor 16, application processor 17), host CPU 19, and display unit 20, and application processor 17 is connected to electrophysiological mapping device body 4. The pulser / preamplifier switch 11 includes a transmitter 11b, a transmission / reception switch 11a, and a preamplifier 11c. The ultrasonic diagnostic apparatus main body 2 may be compatible with a two-dimensional scan.
[0041]
As shown in FIG. 3, the electrophysiological mapping device main body 4 has an EP electrode 5.₁~ 5_NAnd the action potential signal from the EP electrode selected by the switching circuit 25 are supplied to the microcomputer 28 via the action potential signal amplifying unit 26 and the A / D conversion unit 27. The microcomputer 28 is also connected to a filter processing unit 29, an action potential analysis unit 30, a recorder unit 31, a display unit 32, and an external input / output unit 33. The external input / output unit 33 is connected to the ultrasonic diagnostic apparatus main body 2. . From the external input / output unit 33, the electrode number and its action potential are paired for each EP electrode and supplied to the ultrasonic diagnostic apparatus body 2 as a three-dimensional electrophysiological mapping image.
[0042]
EP electrode 5₁~ 5_NIs formed by folding a plurality of electrodes on each basket-shaped arm at the distal end of the catheter of the electrophysiological mapping device. However, if the catheter tip is sequentially scanned along the intima surface, a single electrode may be provided at the tip of one catheter. As shown in FIG. 4, the basket type catheter is inserted from the femoral artery, and the distal end of the catheter is inserted into the left ventricle via the abdominal aorta, descending aorta, ascending aorta, and aortic valve. Therefore, as shown in FIG. 5, the basket type arm folded at the distal end of the catheter is pushed out, and an EP electrode (not shown in FIG. 5) is brought into close contact with the left ventricular endocardial surface. And each EP electrode 5₁~ 5_NElectrophysiological mapping of the endocardial surface is performed based on the action potential measured in step (1). Note that the catheter may be inserted into the lumen of the organ by percutaneous, transarterial, or transvenous. In parallel with this mapping, the heart (left ventricle) is scanned by the ultrasonic probe 1 applied to the body surface.
[0043]
As specific examples of the basket type catheter, those described in the following documents can be used.
[0044]
Schalji M J, van Rugge F P, Siezenga M, van der Velde E T, "Endocardial activation mapping of ventricular tachycardia in patients: first application of a 32-site bipolar mapping electrode catheter", Circulation, 1998, 98: 2168-2179.
An example of the EP mapping image is shown in FIG. Here, the catheter has eight metal arms of equal length, each arm is provided with four bipolar electrodes at intervals of 1 to 1.5 cm, and the mapping image is displayed as an octagon by polar coordinate display. The The outer periphery corresponds to the left ventricular base, and the inner periphery corresponds to the apex. The R wave of the body surface electrocardiogram is set as a reference time (zero), and the time (the time difference from the R wave) at which the action potential at each point becomes maximum is displayed in different colors. This figure shows an example of sinus rhythm (normal heart rhythm in which electrical stimulation is transmitted from the sinoatrial result). Endocardial activation starts from the electrode near the center (near the ventricular septum) and radiates through the left ventricular endocardium. It can be seen that the activation of the area around the electrodes in the vicinity is delayed.
[0045]
The electrophysiological mapping device body 4 also includes an electrical stimulation device 34, and the EP electrode 5₁~ 5_NUsing this, electrical stimulation can be applied to the heart, and pacing of the heart can be performed. In general, an electrophysiology test for ventricular tachycardia involves a method of inducing ventricular tachycardia by performing frequent stimulation or extra-stimulation from the ventricle up to three times. FIGS. 7A to 7D show an example in which stimulation is applied through a basket electrode. The case where a stimulus is given from the star electrode is shown. (E) of FIG. 7 shows arrangement | positioning of the electrode corresponding to the display image of (a)-(d), From this, the electrodes C1-C3 respond | correspond to an infarct area | region, (a)-( It can be seen that the activation of this region is slow in both cases of d).
[0046]
Next, various examples of the alignment display between the electrophysiological mapping image and the ultrasonic tomographic image by the host CPU 19 of the ultrasonic diagnostic apparatus main body 2 will be described.
[0047]
In the first example, an ultrasonic transmitter is provided in a catheter (near an electrode), and the ultrasonic probe 1 is detected based on the time difference between signals received by a plurality (three or more) different transducers (vibrator groups) of the ultrasonic probe 1. The positional relationship between the vibrator surface and the electrode is obtained. For this reason, as shown in FIG. 8, an ultrasonic transmitter is provided near the EP electrode 5 at the tip (or midway) of a catheter (here, a basket-type arm catheter is simply shown as one catheter) 50. 52 is provided. The positional relationship of the transmitter 52 with respect to the EP electrode 5 is known. The position coordinate of the transmitter 52 is assumed to be P (x, y, z). The ultrasonic waves transmitted from the transmitter 52 are three or more (here, three) transducers (or transducer groups) E of the two-dimensional array transducers of the ultrasound probe 1.₁, E₂, E₃In FIG. 9, as shown in FIG.₁(X₁, Y₁, 0), E₂(X₂, Y₂, 0), E₃(X₃, Y₃, 0) depending on the time t₁, T₂, T₃Received at. Since the positional relationship of the transmitter 52 with respect to the EP electrode 5 is known, these reception times t₁, T₂, T₃Thus, the positional relationship between the EP mapping image obtained by the electrode and the ultrasonic tomographic image obtained by the ultrasonic probe 1 can be known, and both can be displayed in association with the positional relationship.
[0048]
FIG. 10 is a flowchart showing an operation for obtaining the position of the EP electrode 5 when the transmitter 52 can be regarded as being at the same position as the EP electrode 5. In step S11, three transducers having different positions in the two-dimensional array probe 1 are set, and their position coordinates E are set.₁(X₁, Y₁, 0), E₂(X₂, Y₂, 0), E₃(X₃, Y₃, 0). In step S12, the arrival time t of the ultrasonic waves transmitted from the transmitter 52 in the vicinity of the EP electrode 5 to the three transducers t₁, T₂, T₃Measure. In step S13, the following simultaneous equations are solved to determine the position P (x, y, z) of the EP electrode 5.
[0049]
(Xx₁)²+ (Y−y₁)²+ (Z−z₁)²= (C · t₁)²
(Xx₂)²+ (Y−y₂)²+ (Z−z₂)²= (C · t₂)²
(Xx₃)²+ (Y−y₃)²+ (Z−z₃)²= (C · t₃)²
Here, c is the velocity of ultrasonic waves in the living body.
[0050]
The second example relates to a modification of the first example, and is an example where a plurality of electrodes are arranged on the catheter 50. As shown in FIG. 11, an ultrasonic transmitter P is placed near each electrode.₁(X_p1, Y_p1, Z_p1), P₂(X_p2, Y_p2, Z_p2), P₃(X_p3, Y_p3, Z_p3), ... are provided. If each transmitter is sequentially driven as shown in FIG. 12, the same operation as that of the first example in which one transmitter is provided at the time of each driving.
[0051]
Contrary to the first example, the third example is provided with an ultrasonic receiver in the catheter (near the electrode) and transmitted from a plurality (three or more) different transducers (vibrator group) of the ultrasonic probe 1. The positional relationship between the transducer surface of the ultrasonic probe 1 and the electrode is obtained from the difference in signal arrival time. For this reason, as shown in FIG. 13, an ultrasonic receiver is provided near the EP electrode 5 at the tip (or midway) of a catheter (here, a basket-type arm catheter is simply shown as one catheter) 50. 54 is provided. The positional relationship of the receiver 54 with respect to the EP electrode 5 is known. The position coordinate of the receiver 55 is assumed to be Q (x, y, z). Three or more (here, three) transducers (or transducer groups) E of the two-dimensional array transducer of the ultrasonic probe 1 E₁, E₂, E₃Are sequentially driven to transmit an ultrasonic wave, as shown in FIG.₁(X₁, Y₁, 0), E₂(X₂, Y₂, 0), E₃(X₃, Y₃, 0) depending on the time t₁, T₂, T₃The receiver 54 is reached. Since the positional relationship of the receiver 54 with respect to the EP electrode 5 is known, these reception times t₁, T₂, T₃Thus, the positional relationship between the EP mapping image obtained by the electrode and the ultrasonic tomographic image obtained by the ultrasonic probe 1 can be known, and both can be displayed in association with the positional relationship.
[0052]
FIG. 15 is a flowchart showing an operation for obtaining the position of the EP electrode 5 when the receiver 54 can be regarded as being at the same position as the EP electrode 5. In step S21, three transducers having different positions in the two-dimensional array probe 1 are set, and their position coordinates E are set.₁(X₁, Y₁, 0), E₂(X₂, Y₂, 0), E₃(X₃, Y₃, 0). In step S22, each transducer E₁, E₂, E₃The ultrasonic waves are sequentially transmitted from and the arrival time t to the receiver 54 in the vicinity of the EP electrode 5 (t)₁, T₂, T₃Measure. In step S23, simultaneous equations (described in step S13 in FIG. 10) similar to those in the first example are solved to obtain the position P (x, y, z) of the EP electrode 5.
[0053]
The fourth example relates to a modification of the third example, and is an example where a plurality of electrodes are arranged on the catheter 50. As shown in FIG. 16, an ultrasonic receiver Q is placed near each electrode.₁(X_p1, Y_p1, Z_p1), Q₂(X_p2, Y_p2, Z_p2), Q₃(X_p3, Y_p3, Z_p3), ... are provided. As shown in FIG.₁, E₂, E₃Are sequentially driven to transmit ultrasonic waves, as in the third example. However, in this case, the simultaneous equations to be solved are₁, Q₂, Q₃This is different from the third example in that it is increased to three sets.
[0054]
In the fifth example, the position of the electrode is obtained by utilizing the property of ultrasonic waves. As is well known, ultrasonic waves are reflected at the interface between different media. The ultrasonic tomography method utilizes the characteristic that this ultrasonic wave is reflected. As shown in FIG. 18, when an ultrasonic wave enters perpendicularly to a boundary surface between different media, a part of the ultrasonic wave is reflected and becomes an echo signal, and the rest is transmitted and further propagated. Is obtained as follows.
[0055]
R = (z₂-Z₁) / (Z₁+ Z₂)
Where z₁, Z₂Is given by the acoustic impedance of the media 1 and 2 as follows.
[0056]
z₁= Ρ₁・ C₁
z₂= Ρ₂・ C₂
ρ₁, Ρ₂Is the density of media 1 and 2, c₁, C₂Is the speed of sound of media 1 and 2.
[0057]
Therefore, the acoustic impedance z₁And z₂The greater the difference, the greater the reflectivity R and the stronger the echo signal. This means that a high-brightness boundary line (surface) is displayed on the ultrasonic tomographic image. The medium 1 is the heart wall (myocardium) or blood in the heart chamber, the medium 2 is a catheter, and a part of the medium 2 is an acoustic characteristic impedance z.₃= Ρ₃・ C₃It is assumed that the medium 3 is replaced. FIG. 19 shows a catheter 50 (acoustic impedance Z₂In the vicinity of the EP electrode of the medium 2) or the electrode itself, the acoustic impedance Z₃The case where it comprises with the medium 3 of this is shown.
[0058]
Reflectance between medium 1 and medium 2: R₁₂= (Z₂-Z₁) / (Z₁+ Z₂)
Reflectance between medium 1 and medium 3: R₁₃= (Z₃-Z₁) / (Z₁+ Z₃)
The medium 3 is assumed to be an electrophysiological mapping electrode or a member disposed in the vicinity thereof. It is desirable to select a material (medium 2) for the catheter arm whose acoustic characteristic impedance is as close as possible to that of the soft tissue of the living body such as myocardium and blood, and to reduce the reflectance and increase the transmittance. When the reflectance is high and the transmittance is low, the ultrasonic wave does not pass through the tip, causing the problem of acoustic shadows. On the other hand, by using a material (medium 3) having an acoustic characteristic impedance sufficiently different from that of the electrophysiological electrode or a point-like living soft tissue in the vicinity thereof, as shown in FIG. It becomes sufficiently larger than the surroundings, and it is displayed as a bright spot on the image.
[0059]
Therefore, by extracting a characteristic echo signal (bright spot in FIG. 20) from the medium 3 and performing image processing, the position of the EP electrode can be known, and as a result, an EP mapping image and an ultrasonic tomographic image are obtained. Can be associated with each other.
[0060]
In the sixth example, as shown in FIG. 21, a position sensor (magnetic sensor) S is placed on the transducer surface of the catheter (near the electrode) 50 and the ultrasonic probe 1.₁, S₂Separately from this, three magnetic field generating coils L are arranged at spatially different positions.₁, L₂, L₃Place. An example of the arrangement of the coils is shown in FIG. FIG. 22 shows a case where the coils L1 and L2 are embedded in the couch top. Although not shown, the coil L3 is similarly provided in the top plate. Coil L₁, L₂, L₃Magnetic field generated from the magnetic sensor S₁, S₂Measured by the sensor S from the degree of attenuation₁And coil L₁~ L₃And each distance D₁₁, D₁₂, D₁₃And sensor S₂And coil L₁~ L₃Each distance D₂₁, D₂₂, D₂₃Ask for. From this, since the positional relationship between the EP electrode and the transducer surface of the ultrasonic probe is known, the positional relationship between the EP mapping image and the ultrasonic tomographic image can be associated.
[0061]
As an endocardial mapping catheter using a magnetic sensor, those described in the following documents can be used.
[0062]
(1) Gepstein L, Hayam G, Ben-Haim S A, "A novel method for nonfluoroscopic catheter-based electroanatomical mapping of the heart: in vitro and in vivo accuracy results", Circulation, 1997, 95: 1611-1622.
(2) Kornowski R, Hong MK, Gepstein L, Goldstein S, Ellahham S, Ben-Haim SA, Leon MB, "Preliminary animal and clinical experiences using an electromechanical endocardial mapping procedure to distinguish infarcted from healthy myocardium", Circulation, 1998, 98: 1116-1124.
(3) Kornowski R, Hong M K, Leon M B, "Comparison between left ventricular electromechanical mapping and radionuclide perfusion imaging for detection of myocardial viability", Circulation, 1998, 98: 1837-1841.
In the seventh example, in the case of a catheter having a basket-type arm, as shown in FIG. 23, a reflection signal from the basket-type arm is extracted from an ultrasonic tomogram, and the position of each electrode is obtained from its shape.
[0063]
Next, an example of electrophysiological mapping will be described.
[0064]
FIG. 24 is called an activation map of atrial tachycardia, and the part where electrical excitation is fast is displayed in red, the slow part is purple, and the middle is displayed in order of yellow, yellow-green, and blue. When 3D mapping is performed while the EP electrode is moved in the heart chamber during a sustained tachycardia, the excitation propagation process during arrhythmia is displayed on the 3D heart image (2D projection image), and the earliest excitable part is red. Indicated by As a result, the earliest excitement of tachycardia and the reentry circuit are recognized.
[0065]
FIG. 25 is called a substrate (voltage) map of atrial tachycardia, which is a method of measuring the magnitude of the intracardiac potential recorded at each site by mapping and displaying it on a stereoscopic image. Cardiomyocytes are injured in the conduction-disruption site or the reluctance conduction site of the reentry circuit, and the intracardiac electrocardiogram becomes a low potential in such a place. Therefore, by determining the distribution of low-potential tissue in the heart, it is possible to accurately grasp the location of the damaged myocardium, moderately conducting site, conduction-disrupted site, scar tissue, and upper and lower aorta, which are important for arrhythmia. I can do it. Scar tissue, an atrial incision scar at the time of surgery, and the like have a low potential, and are displayed in red on a stereoscopic heart image.
[0066]
FIG. 26 is called a dynamic propagation map, where the depolarized (excited) region of the myocardium is shown in red, and the polarized (stationary) region is shown in blue. This is an image that dynamically displays a direction in which excitement propagates.
[0067]
The above mapping displays the action potential itself of the endocardial surface, but as shown in FIG. 27, the maximum action voltage max V within the heartbeat cycle of each point of the intimal surface or the maximum value max dV of the slope of the action voltage. / dt may be mapped, or the time from the reference time (R wave timing) until the maximum active voltage appears, or the time until the maximum value of the slope of the active voltage appears may be mapped.
[0068]
Next, a specific example in which the EP mapping image and the ultrasonic image are displayed in association with the positional relationship will be described.
[0069]
FIG. 28 shows a polar coordinate display EP mapping image and an ultrasonic two-dimensional tomographic image showing organ morphology information or motion information. FIG. 29 shows the EP mapping image and ultrasonic two-dimensional tomographic image of FIG. In the ultrasonic image, a mark indicating the position of the EP electrode is shown, and in the EP mapping image, a mark indicating a cross section of the ultrasonic scanning is shown. Here, the ultrasonic waves are scanned along a cross section including the electrodes B1 to B4 and F4 to F1. 30 shows the EP mapping image of the three-dimensional projection image display and the ultrasonic three-dimensional projection image showing the organ morphological information or motion information side by side, and FIG. 31 shows the EP mapping image of FIG. It shows the positional relationship with a three-dimensional projection image. A tomographic image of an arbitrary cross section (here, the left ventricular short axis image of the heart) is also displayed along with the ultrasonic three-dimensional projection image. A mark indicating a cross section corresponding to the left ventricular short-axis image is displayed in the ultrasonic three-dimensional projection image and the EP mapping image.
[0070]
FIG. 32 shows an example in which a 3D image showing the form or movement of an organ and an EP mapping image are combined and displayed as a single 3D image. Here, as the EP mapping image, an activation map of the time from the timing of the R wave until the maximum active voltage appears is used. On the other hand, a projected image of the heart is used as the ultrasonic image. Then, the left ventricular surface of the heart is automatically extracted from the ultrasound image, and the EP mapping image is pasted in a color having transparency on the projected image of the endocardial surface at the end diastole. This projection image is preferably updated every predetermined heart rate. As a result, a state in which the endocardial surface repeatedly contracts / expands is displayed on the rear side of the EP mapping image as a projection image in real time.
[0071]
FIG. 33 synthesizes and displays an ultrasonic tomogram of an arbitrary cross section of the heart (or a two-dimensional myocardial perfusion image obtained by a combination of an ultrasonic contrast agent and an ultrasonic tomographic image) with the EP mapping image of FIG. An example is shown. The ultrasonic tomographic image or the two-dimensional myocardial perfusion image is preferably displayed in real time rather than displaying the image at a certain point in time. Further, the position of the cross section is arbitrarily variable.
[0072]
FIG. 34 shows a two-dimensional composite display example. Therefore, an ultrasonic tomographic image of an arbitrary cross section of the heart (or a two-dimensional myocardial perfusion image obtained by a combination of an ultrasonic contrast agent and an ultrasonic tomographic image) and the R wave timing until the maximum active voltage appears. The activation map display of time is synthesized and displayed on this section.
[0073]
FIG. 35 is a composite display in which a region of abnormal myocardial contraction or dilation (wall motion abnormal region) obtained by the ultrasonic echo method or the ultrasonic Doppler method is superimposed on the EP mapping image including the activation map as shown in FIG. This is an example.
[0074]
FIG. 36 shows a display example when the electrical stimulation device 34 is used in combination with the electrophysiological mapping device. During the potential measurement for mapping, electrical stimulation is applied to the heart from one of the EP electrodes. At that time, a marker (black star) indicating the stimulation application electrode is set as an activation map and an ultrasonic three-dimensional as shown in FIG. By superimposing and displaying on the composite image with the projection image, the causal relationship between the application of the stimulus and the propagation of the excitement can be grasped, which is useful for diagnosis. This position display is also realized by measuring the position of the electrodes as shown in FIGS.
[0075]
FIG. 37 shows the function of designating the electrical stimulation application position on the screen or navigating the stimulation application electrode to an appropriate position, contrary to FIG. That is, when a point on the composite image of the activation map and the ultrasonic three-dimensional projection image as shown in FIG. 32 is designated, the electrophysiology is applied so that the electrical stimulation is applied from the EP electrode located closest to the designated place. The switching circuit 25 of the mapping apparatus body 4 is controlled. Alternatively, the insertion position of the stimulation application device may be navigated from the image. That is, when a locus is drawn on the ultrasonic image with a mouse or the like, the EP catheter 50 may be automatically inserted as it is.
[0076]
Next, after EP mapping by an electrophysiological mapping device, non-drug treatment, for example, when performing treatment to cauterize a site causing arrhythmia by ablation catheter using high frequency, laser, or microwave, An example will be described in which a marker indicating the position where the therapeutic action is performed is superimposed on the image.
[0077]
FIG. 38 shows the position of the distal end of the treatment device (ablation catheter) by measurement similar to the position measurement of the electrodes as shown in FIGS. 8 to 23, and a marker (black star) indicating the position at which treatment is performed is shown in FIG. This is an example of superimposing and displaying on a composite image of such an EP mapping image and an ultrasonic three-dimensional projection image.
[0078]
FIG. 39 shows a marker (black circle) indicating a place where treatment has already been performed and a marker (black star) indicating a position for performing a therapeutic action, which is the tip position of the treatment device. It is an example of being superimposed and displayed on a composite image with a projection image.
[0079]
FIG. 40 superimposes and displays a marker (black star) indicating the position for performing the therapeutic action, which is the tip position of the therapeutic device, on the composite image of the EP mapping image and the ultrasonic three-dimensional projection image as shown in FIG. The example which designates the movement destination of a therapeutic device above, or navigates a stimulus application electrode to an appropriate position is shown. That is, the therapeutic device automatically moves to the location designated by the double circle marker on the screen.
[0080]
As described above, according to the present embodiment, the catheter (its EP electrode) of the electrophysiological mapping device that obtains a mapping image of the electrical characteristic data of the organ of the subject, and an image showing the anatomical data of the organ are obtained. Since the relative positional relationship with the ultrasonic probe of the ultrasonic diagnostic apparatus can be known, the mapping image and the ultrasonic image can be displayed in association with each other. For this reason, in catheter-based radiofrequency ablation treatment, the target site can be accurately identified, and the treatment catheter can be accurately navigated to that location. Furthermore, it is possible to deepen the pathophysiological understanding of the relationship between the electrical activation mode of the myocardium and the mechanical contraction mode, which is useful for the development and research of new diagnostic methods and therapeutic methods.
[0081]
【The invention's effect】
As described above, according to the present invention, it is easy to grasp the positional relationship between an electrophysiological mapping image of an organ and an image showing an anatomical form. It is possible to evaluate both contractile characteristics at the same time and spatially in a three-dimensional manner, improving the diagnostic accuracy of various diseases, especially tachyarrhythmia, and the results of treatment It is possible to provide an electrophysiological mapping device that can improve the above.
[Brief description of the drawings]
FIG. 1 is a block diagram showing a schematic configuration of a first embodiment of an electrophysiological mapping device according to the present invention.
2 is a block diagram showing a detailed configuration of the main body of the ultrasound diagnostic apparatus in FIG.
3 is a block diagram showing a detailed configuration of the electrophysiological mapping device main body of FIG.
FIG. 4 is a diagram for explaining an electrophysiological mapping procedure using an EP catheter.
FIG. 5 is a diagram for explaining an outline of an ultrasonic scan.
FIG. 6 is a photograph showing an intermediate image (an example of an EP mapping image) displayed on a display.
7 (a), (b), (c), and (d) are photographs showing an intermediate image (another example of an EP mapping image) displayed on a display, and (e) is an EP mapping image and an electrode. The figure which shows a relationship.
FIG. 8 is a diagram showing the principle of an example of alignment between an EP mapping image and an ultrasonic image by obtaining the position of an EP electrode.
FIG. 9 is a diagram showing transmission / reception timings of ultrasonic waves in an example of alignment.
FIG. 10 is a flowchart illustrating a procedure example of alignment.
FIG. 11 is a diagram showing the principle of a second example of alignment between an EP mapping image and an ultrasonic image by obtaining the position of the EP electrode.
FIG. 12 is a diagram showing transmission / reception timings of ultrasonic waves in a second example of alignment.
FIG. 13 is a diagram showing the principle of a third example of the positioning of the EP mapping image and the ultrasonic image by obtaining the position of the EP electrode.
FIG. 14 is a diagram showing transmission / reception timings of ultrasonic waves in a third example of alignment.
FIG. 15 is a flowchart showing the procedure of a third example of alignment;
FIG. 16 is a diagram showing the principle of a fourth example of the alignment of the EP mapping image and the ultrasonic image by obtaining the position of the EP electrode.
FIG. 17 is a diagram showing transmission / reception timings of ultrasonic waves in a fourth example of alignment.
FIG. 18 is a diagram showing the principle of a fifth example of alignment between an EP mapping image and an ultrasonic image.
FIG. 19 is a view showing a catheter used in a fifth example of alignment.
FIG. 20 is a diagram showing a display image of a fifth example of alignment.
FIG. 21 is a diagram showing the principle of a sixth example of alignment between an EP mapping image and an ultrasonic image.
FIG. 22 is a view showing the arrangement of magnetic field generating coils in a fifth example of alignment;
FIG. 23 is a diagram showing the principle of a seventh example of alignment between an EP mapping image and an ultrasonic image.
FIG. 24 is a photograph showing an intermediate image (activation map image as an example of an EP mapping image) displayed on the display.
FIG. 25 is a photograph showing an intermediate image (substrate map image as a second example of EP mapping image) displayed on the display;
FIG. 26 is a photograph showing an intermediate image (dynamic propagation map image as a third example of EP mapping image) displayed on the display;
FIG. 27 is a diagram showing the maximum action potential, the differential value of the action potential, and the time when they appear as other examples of parameters for EP mapping;
FIG. 28 is a photograph showing an intermediate image (EP mapping image (polar coordinate display) and ultrasonic two-dimensional tomographic image displayed side by side) displayed on the display;
29 is a diagram showing a positional relationship between the EP mapping image of FIG. 28 and an ultrasonic two-dimensional tomographic image.
FIG. 30 is a photograph showing an intermediate image (EP mapping image (three-dimensional projection image) and ultrasonic three-dimensional tomographic image displayed side by side) displayed on the display;
31 is a diagram showing a positional relationship between the EP mapping image of FIG. 30 and an ultrasonic two-dimensional tomographic image.
FIG. 32 is a diagram showing a first example of a combined display of an EP mapping image and an ultrasound image.
FIG. 33 is a diagram showing a second example of a combined display of an EP mapping image and an ultrasound image.
FIG. 34 is a diagram showing a third example of a combined display of an EP mapping image and an ultrasound image.
FIG. 35 is a diagram showing a fourth example of a combined display of an EP mapping image and an ultrasound image.
FIG. 36 is a diagram showing a fifth example of a combined display of an EP mapping image and an ultrasound image.
FIG. 37 is a diagram showing a sixth example of a combined display of an EP mapping image and an ultrasound image.
FIG. 38 is a diagram showing a seventh example of a combined display of an EP mapping image and an ultrasound image.
FIG. 39 is a diagram showing an eighth example of a combined display of an EP mapping image and an ultrasound image.
FIG. 40 is a diagram showing a ninth example of a composite display of an EP mapping image and an ultrasound image.
[Explanation of symbols]
1 ... 2D array probe
2 ... ultrasonic diagnostic equipment
3 ... Display section
4. Electrophysiological mapping device body
5 ... EP electrode
34 ... Electrical stimulator

Claims (27)

Electrophysiological mapping means for measuring the voltage of the intimal surface of the organ with an electrode provided on the catheter and mapping the electrical characteristics data of the organ according to the shape of the organ;
Image creating means for obtaining an image showing the anatomical characteristics of the organ;
Display means for displaying the mapping image obtained by the electrophysiology mapping means and the image obtained by the image creation means in association with each other;
Equipped with,
The image creating means is an ultrasonic diagnostic apparatus,
The catheter comprises a first position sensor;
The probe of the ultrasonic diagnostic apparatus includes a second position sensor,
The electrophysiological mapping apparatus, wherein the display means obtains a positional relationship between an ultrasonic image and a mapping image based on outputs of the first and second position sensors . The first sensor comprises an ultrasonic transmitter;
The second sensor includes three or more vibrators,
The display means obtains a positional relationship between an ultrasonic image and a mapping image based on a difference in time when ultrasonic waves transmitted from the ultrasonic transmitter are received by the three or more transducers. Item 2. The electrophysiological mapping device according to Item 1. The image creating means is an ultrasonic diagnostic apparatus,
The first sensor comprises an ultrasonic receiver;
The second sensor includes three or more vibrators,
The said display means calculates | requires the positional relationship of an ultrasonic image and a mapping image from the difference in the time which the ultrasonic wave transmitted from the said 3 or more vibrator | oscillator was received by the said ultrasonic receiver. 2. The electrophysiological mapping device according to 1. Electrophysiological mapping means for measuring the voltage of the intimal surface of the organ with an electrode provided on the catheter and mapping the electrical characteristics data of the organ according to the shape of the organ;
Image creating means for obtaining an image showing the anatomical characteristics of the organ;
Display means for displaying the mapping image obtained by the electrophysiology mapping means and the image obtained by the image creation means in association with each other;
Comprising
The image creating means is an ultrasonic diagnostic apparatus,
The catheter of the electrophysiological mapping means includes a member whose acoustic characteristics are different from those of the remaining part in a part,
The display means and characterized by determining the positional relationship between the ultrasonic image and the mapping image by obtaining the position of the extracted said catheter reflected signal from the member from the reflected signals received by the ultrasonic diagnostic apparatus Electrophysiological mapping device . Electrophysiological mapping means for measuring the voltage of the intimal surface of the organ with an electrode provided on the catheter and mapping the electrical characteristics data of the organ according to the shape of the organ;
Image creating means for obtaining an image showing the anatomical characteristics of the organ;
Display means for displaying the mapping image obtained by the electrophysiology mapping means and the image obtained by the image creation means in association with each other;
Comprising
The catheter is a basket-type arm having a plurality of electrodes;
The image creating means is an ultrasonic diagnostic apparatus,
Wherein the display means to determine the positional relationship between the ultrasonic image and the mapping image by determining the position of said arm to extract the reflected signal from the basket arm from the reflected signal received by the ultrasonic diagnostic apparatus An electrophysiological mapping device . Claim 1 electrophysiology mapping means, characterized in that to measure the action potential of the endocardium surface by applying a direct electrode to intimal surface of the organ, according to claim 2, claim 3, claim 4, claim 5 The electrophysiological mapping device according to any one of the above. 2. The electrophysiological mapping means performs measurement with an electrode disposed at a distal end of a catheter intended to be inserted into a heart lumen percutaneously, transarterially, or transvenously. The electrophysiological mapping device according to claim 1, claim 2, claim 3, claim 4, or claim 5 . The electrophysiological mapping means is composed of a plurality of electrodes provided on a basket-shaped arm provided at the distal end of a catheter intended for percutaneous, transarterial, or transvenous insertion into an organ lumen. The electrophysiological mapping device according to any one of claims 1, 2, 3, 4, and 5, wherein measurement is performed.   The electrophysiological mapping means further includes an electrical stimulation device, and applies electrical stimulation to the heart from any one of the plurality of electrodes or a plurality of electrodes, thereby enabling pacing of the heart. The electrophysiological mapping device according to claim 4. 2. The ultrasonic diagnostic apparatus according to claim 1 , wherein the image creating means is an ultrasonic diagnostic apparatus that obtains a two-dimensional tomographic image of an organ in real time by scanning an ultrasonic beam two-dimensionally . The electrophysiological mapping device according to any one of claims 4 and 5 . 2. The ultrasonic diagnostic apparatus according to claim 1 , wherein the image creating means is an ultrasonic diagnostic apparatus that three-dimensionally scans an ultrasonic beam and obtains three-dimensional shape information or motion information of an organ in real time. The electrophysiological mapping device according to any one of claims 2, 3, 4, and 5 . The electrophysiological mapping means maps the maximum action voltage within the heartbeat cycle of each point on the intimal surface of the organ, or the maximum value of the slope of the action voltage . The electrophysiological mapping device according to any one of claims 4 and 5 . The electrophysiological mapping means maps, for each point on the intimal surface of the organ, a time from a reference time until a maximum value of the maximum action voltage or the slope of the action voltage appears . The electrophysiological mapping device according to any one of claims 2, 3, 4, and 5 . Claim 1 wherein the electrophysiological mapping means for distinguishing between a range that is polarized in a range that depolarization of the heart muscle, cardiac excitation site and displaying the manner in which moves with time dynamically, claim The electrophysiological mapping device according to any one of claims 2, 3, 4, and 5 . The electrophysiological mapping device according to any one of claims 12, 13, and 14 , wherein the display means displays the image obtained by the image creation means and the mapping image side by side. . The electrophysiology according to any one of claims 12, 13, and 14 , wherein the display means combines and displays the image obtained by the image creation means and the mapping image. Mapping device. The electrophysiological mapping means generates a mapping image by pasting electrical characteristic data on a three-dimensional projection image of the endocardial surface,
The image creating means generates a real-time three-dimensional projection image of the endocardial surface,
Claim wherein the display means is characterized by displaying a state in which the endocardial surface on the rear side of the mapping image by superimposing display and said mapping image and a three-dimensional projected image is repeated contraction / expansion in real time 16. The electrophysiological mapping device according to 16 . The electrophysiological mapping means generates a mapping image by pasting electrical characteristic data on a three-dimensional projection image of the endocardial surface,
The image creating means is an ultrasonic diagnostic apparatus for obtaining an ultrasonic tomographic image of an arbitrary cross section of the heart or a two-dimensional myocardial perfusion image,
The display means according to claim 12, wherein the displaying by synthesizing the said mapping image and the ultrasonic tomographic image, or 2D myocardial perfusion image, claim 13, according to any one of claims 14 Electrophysiological mapping device. The electrophysiological mapping means generates a mapping image by pasting electrical characteristic data on a three-dimensional projection image of the endocardial surface,
The image creating means is an ultrasonic diagnostic apparatus for obtaining an ultrasonic tomographic image of an arbitrary cross section of the heart or a two-dimensional myocardial perfusion image in real time,
15. The display device according to claim 12, wherein the display unit synthesizes and displays the mapping image and an ultrasonic tomogram or a real-time image of a two-dimensional myocardial perfusion image. The electrophysiological mapping device according to Item. The electrophysiological mapping means generates a mapping image by pasting electrical characteristic data to a tomographic image of an arbitrary cross section of the heart,
The image creating means is an ultrasonic diagnostic apparatus for obtaining an ultrasonic tomographic image of an arbitrary cross section of the heart or a two-dimensional myocardial perfusion image,
The said display means superimposes and displays the said mapping image and an ultrasonic tomogram, or a two-dimensional myocardial perfusion image, It is any one of Claim 12, 13, 14 characterized by the above-mentioned. Electrophysiological mapping device. The electrophysiological mapping means generates a two-dimensional or three-dimensional mapping image by pasting electrical characteristic data on a two-dimensional tomographic image or a three-dimensional projection image,
The image creating means is an ultrasonic diagnostic apparatus of ultrasonic echo method or ultrasonic Doppler method,
The display means synthesizes and displays a parameter indicating the contraction or expansion ability of the myocardial region obtained by an ultrasonic echo method or an ultrasonic Doppler method and the two-dimensional or three-dimensional mapping image. The electrophysiological mapping device according to any one of claims 12, 13, and 14 . 10. The electrophysiological mapping device according to claim 9 , wherein when the electrical stimulation is applied to the heart by the electrical stimulation device, the display unit superimposes and displays a marker indicating the stimulation position on the image. When the display means providing electrical stimulation to the heart by the electrical stimulation device, in claim 9 that specifies the stimulus application position on the image, or wherein the navigating device stimulus applied from the image The electrophysiological mapping device described. The display means superimposes and displays on the image a marker indicating a position where the therapeutic action is performed when performing a non-drug therapeutic action for treatment on a part of the heart . The electrophysiological mapping device according to any one of claims 2, 3, 4, and 5 . 2. The display means, when performing a non-drug treatment for treating a part of the heart, a marker indicating a place where the treatment has already been performed is superimposed on the image. The electrophysiological mapping device according to claim 1, claim 2, claim 3, claim 4, or claim 5 . When the non-drug treatment action for the purpose of treatment is performed on a part of the heart, the display means designates a place to perform the treatment action on the image, or navigates the device for treatment from the image The electrophysiological mapping device according to any one of claims 1, 2, 3, 4, and 5 . 27. Any one of claims 24, 25, and 26 , wherein the non-drug treatment cauterizes a site causing arrhythmia by an ablation catheter using high frequency, laser, or microwave. The electrophysiological mapping device according to Item.

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