MXPA97008090A - Apparatus and method for cardi ablation - Google Patents

Abstract

A system and method for cardiac mapping and ablation that includes a multi-electrode catheter inserted percutaneously into the heart of a subject and deployable adjacent to several endocardiac sites; The electrodes are connected to a mapping unit, an ablation power, a unit of passage, all of which are under control of a computer, intercardiac electrogram signals emanating from a site of origin of the tachycardia are detectable by the electrodes, their arrival times are processed to generate several visual maps to provide a guide of real time to direct the catheter to the site of origin of the tachycardia, in another aspect, the system also includes a system of physical image formation that is capable of providing different physical views on the image of the catheter and the heart; are incorporated into the different visual maps to provide a more physical representation; electrodes are above the site of origin of the tachycardia, electrical power is supplied by means of the ablation power unit to effect the ablation

Description

APPARATUS AND METHOD FOR CARDIAC ABLATION BACKGROUND OF THE INVENTION This invention relates to median devices and in particular to a system and technique for using inul-t electrode catheters for cardiac mapping and cardiac ablation. Cardiac dysrhythmias are commonly known as irregular heartbeats or accelerated heart. Two of these irregularities in heart rhythm are the symmetry of -Poll- 1 nson-Uhi te and t-aquicardThe nodal reentrant a + n n ol rnicular (RV). These conditions are caused by an outer band of conductive fibers in the heart that provides an abnormal short-circuit path for electrical impulses that are usually conducted in the heart. For example, in a type of Wol i t-Parkinson-Uihi te syndrome, the v? The electrical impulses that normally travel from the upper chamber to the inner chamber of the heart are fed from the chamber to the upper chamber. Another common type of cardiac dysrhythmias is ventricular tachycardia (VT), which is a complication of a heart attack or reduction of blood supply to an area of the heart muscle, and is a life-threatening arrhythmia. All these types of dysrhythmias are usually traced to one or more pathological "sites of origin" or foci of tachycardia in the heart. In the treatment of cardiac dysrhythmias, non-surgical procedures such as drug management are favored. However, some heart dysrhythmias can not be treated with drugs. These patients are then treated with surgical reception of the site of origin or with an automatic implantable cardioverter disfibplator (RICD). Both procedures have increased morbidity and mortality and are extremely costly. Even PICD needs major surgical intervention, and some patients of advanced age or disease can not tolerate invasive surgery to remove the tachycardia outbreak caused by the disrm. (- i have developed techniques to locate tachycardia sites and to deactivate their short-circuit function.) The site of origin of the tachycardia is determined by - surface electrocardiogram analysis or inter-cardiac electrogram sera during arrhythmia stages. They can occur spontaneously or they can be induced by a programmed step.Once the source site or focus has been located, the cardiac tissues around the SLtio are removed surgically or with electrical energy to interrupt the abnormal conduction. However, several methods of collecting and analyzing elec- trocardiography or electrocardiogram signals are commonly used.The surface electrocardiogram is a tool in which electrocardiograms are collected from as many as twelve surface electrodes fixed to several electrodes. External parts of a subject's body The general electrocardiogram training It has a definite signature that can be matched to the generally established pair to associate with a site of origin in a given place of the heart. In this way, it is possible to determine the approximate location of a tachycardia site in the heart. The cardiac electrogranin allows a tachycardia site of the focus to be localized in a more accurate manner. It is obtained by detecting electrical signals inside the heart by means of readings fixed directly to it. Gallayher et al., "Techniques o rntraoperative ELectrophysiologí c flapping", The American Journal of C rdiology, volume 49, Jan. 1982, pp. 221-240, describe and review various methods of intra-operative mapping in which the heart is exposed by surgery and has electrodes fixed directly to the ism. In one technique, the electrodes in a former ambulatory catheter oar are placed in a series of epicardial or endocardic sites to obtain elect rogranas for the earlier site of acivation with reference to surface electrocardiograms. For endocardial mapping, a cardiotomy may also be necessary to open the heart in order to have access to the endocardium. Gallagher et al., Mentioned above, also describe a simultaneous simultaneous global shearing technique of the outer surface of the heart (epicardial ripping). A grid of approximately 100 electrodes in the form of a sock is worn over the heart, thus allowing multiple sites to be recorded simultaneously. This technique is particularly useful for those cases in which the induced ventpular tachycardia is unstable or polyunorphic. The global rnapeo by means of a large electrode arrangement has also been described in The following two articles of specialized journal; Louise Hams, M.D., and others, "Activation Sequence of Vent for Tachycardia: Endoocardial and Epicardial Mapping Stud is m the Human Venture," Journal of the American College of Cardiology (JACO, Vol. 10, November 1987, pp. 1040-1047; Eugene Downar, et al., "Tnt Raoperative Electrical Ablation of Ventpular Arrhythmias: A" Closed Heart "Procedure," JACO, Vol. 10, No. 5, November 1987, pp. 1048-1056. For the mapping of the inner surface of the heart (endocardial mapping), a grid of approximately 100 electrodes in the form of an inflatable balloon is placed inside the heart after cutting it to open it. Under certain situations, a variation of "closed heart" may be possible without the need for ventilatory and surgical excision. For example, with the subject in cardiopulmonary bypass, a disposition of the deflated balloon is inserted into the left ventricular cavity through the rnitral valve. Once inside the ventricle, the balloon is inflated so that the electrodes in the same or contact the endocardium. Although the arrangements of sock or balloon electrodes allow a global mapping by acquiring electrograin signals in a broader area of the heart in a simple manner, they can only be installed after open chest surgery. The endocardial endocardium with catheter is a technique to map the eLec rich signals within the heart without the need for open chest or open heart surgery. It is a technique that typically involves the percutaneous conduction of an electrode catheter in the patient. The elec- trode catheter is passed through a blood vessel, such as the femoral vein or the aorta, and from there to an endocardial site such as the aureus or in the heart's excision, tachycardia is induced. and a continuous simultaneous recording is made with a multi-channel recorder while the electrode catheter is moved to different endocardial positions. When a tachycardia focus is located as indicated in the intracardiac electrogra- ros record, it is marked by a fl anoscopy image. Endocardial catheter mapping is described in the following articles: M.. Josephson and C.ü. Gottlieb, and others, "Ventilation Tachyc rdias Associated i h Coronary Disease," Chapter 63, pp. 571-580, CARDIAC ELECTRQPHYSIOI QGY -frorn cell to bebside, D.P. Zipes and others, Editors, W.íí. Saunders, PhiLadephia, 1990. M.E. Jo ephson and o r-os, "Role of Catheter Mapping m the Preoperative ive Ev Luat on of Ventpcular rachycardia," The American Journal of Cardiology, Vol. 49, January 1982, p. 207-220. In the preoperative endocardial mapping, linear ipolar rnul t electrode catheters are used. F. Morady et al., "Catheter-Ablation of Ventrieular rachycardia Uit h rn racardiac Shocks: ResuKs in 33 Patients," GRCULATION, Vol. 75, No. 5, May 1987, p. 1037-1049. Kadish and others, "Vector Mappi g of Myocardial Activation," CIRCULA riON, Vo L. 7., No. 3, September 1986, | > p. 603-615. The patent of E.U.A. No. 4,940,064 to Desai discloses an orthogonal electrode catheter arrangement (OECA). Desai et al., "Orthogonal Elect Rode Catheter- Array for Mapping of Endocardiac Focal Site f Venticular Activa ion," PACE, Voi. April 14, 1991, pp. 557-57 .. This specialized journal article describes the use of an electrode catheter arrangement for locating problem sites in a heart. Once a tachycardia focus is located, the removal of cardiac arrhythmias is typically done by means of a normal electrode catheter. Electrical energy in direct current or radiofrequency form is used to create a lesion in adjacent endocardial tissues (ie, below) to the normal electrode catheter. By creating one or more lesions, the tachycardia focus can pass into a region of necrotic tissue, thus incapacitating any 'malfunctioning.

The existing catheter tip techniques are typically based on analysis of recorded electrograms.

Locating the site of origin and tracking The sites where the cat goes are at best deceptive and time-consuming, and often show no success. Therefore, it is convenient to have a mapping system (with catheter and ablation with precision and speed and that can provide a complete guide on a real time basis.

OBJECTS AND BRIEF DESCRIPTION OF THE INVENTION Accordingly, a general object of the present invention is to bind ventricular tachycardia and cardiac dysrhythmias by improved catheter mapping and excision. It is an object of the present invention to provide a system that is capable of rapid and accurate cardiac scanning. Another object of the present invention is to provide a system that is capable of locating efficiently and accurately and extirpating a site of origin of tachycardia. Another object of the present invention is to provide an accurate guide to efficiently and accurately remove an endocardial site by filling it with successive catheter ablations of a smaller area. Another object of the present invention is to provide real-time visual maps indicating the relative positions of the electrodes, the tachycardia site of origin, the cobalt. These and other objects are achieved by a system that includes a multi-electrode catheter selectively and connectable to an unappearance unit, an ablation unit and a passage unit. The system also includes a computer-to-couple with Lar the various functional components. In one embodiment, the system also includes a physical imaging unit that is capable of providing different views of a physical image of the catheter-of multiple electrodes percutaneanent and injected into the heart of a subject. The signals of elect rograin emanating from a site of origin of tachycardia in the endocardium are detectable by the electrode arrangement. Their arrival time is processed in order to generate several visual maps to provide real-time guidance to manipulate the catheter to the site and origin of t cardi. In the modality, the visual map includes a fingerprint of the disposition. n of electrodes in a site of the endocardium. The arrival time recorded in each electrode is displayed in association with it. A member of the medical staff can therefore manipulate the catheter in the direction of arrival time earlier and earlier until the location of the tachycardia is located. In another modality, the visual map also includes isochrones that are equal arrival time contours. These chronos are constructed by Linear interpolation of arrival time recorded in the electrode arrangement and cover the area covered by the electrode arrangement. When the electrode arrangement is far from the site (origin of the tachycardia), the isochrones are characterized by parallel contours. When the electrode arrangement is near or above the upper part of the site of the tachycardia origin, • Isochrones are characterized by elliptical contours that circle the site of origin of the tachycardia.

Thus, isochrones provide additional visual aids and confirmation to manipulate the catheter to the site of origin of the tachycardia. In another preferred mode, the visual map also includes an estimated location of the site of origin of the L5 tachycardia in relation to the disposition of electrodes. This provides direct visual guidance for rapid catheterization of the catheter to the site of origin of the tachycardia. The site of origin of the tachycardia is in the weighted direction of eLect with the early arrival times. The distance e calculates to pair of the speed and travel time between the origin site and the central electrode. The speed is estimated from a local velocity calculated from the separations between electrodes and the differences in arrival time. In accordance with another aspect of the invention, the ?F. The system also includes a physical imaging system that is able to provide different physical views in the LO image. heart catheter These physical views are incorporated into the various visual maps to provide a more physical representation. In one modality, two visual maps display two b views (v.gr., X, Y axes) of a physical image of the disposition of eLetrodes in the heart with a relative position for the origin site of the tachycardia. In another mode, a visual display shows three-dimensional perspective of the electrode arrangement in the heart with a relative position for the site of origin of the tachycardia. In another modality, the visual map also marks previous sites or traces visited by the electrode arrangement. Ib With the help of visual maps, the electrode arrangement can locate the source site of the tachycardia quickly and accurately. The system then directs electrical power from the power of ablation to the electrode arrangement to perform ablation. Additional objects, features and advantages of the present invention will be understood from the following description of the preferred features, and said description should be made in conjunction with the accompanying drawings. 1 L BRIEF DESCRIPTION OF THE DRAWINGS Figure L is a schematic block diagram of an electrophoresis catheter ablation and ablation system of the invention; Figure 2A illustrates the proxirnal end of the orthogonal electrode catheter arrangement (OECA) in its fully retracted position or mode; Figure 21 illustrates the OECA in its open mode in the form of analogue, Figure 2C shows the traces of the OECA electrodes of the electrode, and Figure 3A illustrates the five electrodes of the electrode. OFCA located on a pair of orthogonal axes, each passing through a pair of peripheral electrodes and the center electrode; Figure 3JJ shows an illustrative measurement of the OF.cn from an endocardial site; 3C illustrates the linear interpolation scheme applied to quadrant I of the example shown in Figure 3B; Figure 3D shows the construction of a complete isochronic local map for the entire area covered by OECA as shown in Figure 3D; Figure 4 shows illustrative traces of surface electrocardiogram and intracardiac eLectrogram; Figure 5 i Schematically illustrates the ventricle or another coradic chamber divided into four segments, and the isochronic maps obtained from various sites; Figure 6A illustrates by way of example the construction of the displacement vector of the electrode arrangement to the estimated origin site; Figure 6B is an arrangement on the video monitor showing the relative positions of the electrode arrangement and the illus- trated origin site, in accordance with a preferred embodiment of the invention; Figure 7A is a display synthesized on the video monitor of a digital image of the heart and the arrangement of electrodes in the same tornado along a first axis by the physical image formation system, and also showing The relative position of the estimated origin LO, according to another preferred modality of the invention; Figure 7B is a display on the video monitor 20 which shows an image similar to that of Figure 7A but turned on a second axis by the system (physical image formation); display of the video monitor showing the images of Figures 70 and 7B in the form ') V. simultaneous, according to another preferred modality of the invention; Figure 9 is a display on the video monitor showing a relative position of the estimated origin site against a perspective image of the heart and the electrode arrangement that is synthesized from images recorded along several axes by the system of physical image formation, in accordance with another preferred embodiment of the invention.

DETAILED DESCRIPTION OF THE PREFERRED MODALITIES lü SYSTEM Figure 1 is a schematic block diagram of a ripping and ablation system with electrode catheter multiples 10 in accordance with a preferred embodiment of the invention. The system 10 essentially comprises three functional units, namely an unappearance unit 20, an ablation unit 30 and a step unit 40. A computer 50 The operation of each of the units and their cooperations is controlled through a control interface 52. The computer receives inputs from the operator from an input device 5. such as a keyboard, a mouse and a control panel. The output of the computer can be displayed on a monitor (eg, video 56 or other output devices (not rnost i -ado). In the preterm mode, system 10 also includes a physical image training system 60. The physical imaging system 60 is preferably a fluoroscope (ie, an ultrasonic imaging system 5. The imaging system 60 is controllable by the computer 50 through the control interface 52. In one embodiment, the computer triggers the physical image formation system to render "photographic" images of a patient's heart 100 (body not shown.) The image is detected by a detector 62 along the length of the body. each eye of the image, it includes a silhouette of the heart as well as inserted catheters and electrodes and is deployed by means of a physical imaging monitor 64. Monitors can be used to display the two Ib Lrnagenes obtained along each of the double axes. lnternately, the two images can be displayed from side to side in the monitor- ism. Imageized imaging data are also fed to the computer 50 to be processed and integrated into computer graphics that are going to are displayed on the video monitor 56. A multi-electrode catheter 70 is selectively directed to each of the three functional units 20, 30 and 41 to r-birds from a catheter guide-connector 72 to an ultipix 80. Auxiliary catheters 90 or auxiliary electrodes - > . 92 can also be connected to the iplexor 80 router through one or more additional connectors such as 9., 96.

During cardiac procedures, the multi-electrode catheter 70 is typically inserted percutaneously into the LOO heart. The catheter is passed through a blood vessel (not shown), such as the femoral or aortic vein, and then into an endocardial site such as the atrium or ventricle of the heart. In a similar manner, catheters 90 can also be introduced into the heart and / or additional surface electrodes 72 can be attached to the skin of the patient. When the system 10 is in operation in an unappealable state, the multi-electrode catheter 70 as well as optional auxiliary catheters 90 functions as rocardiac mtraelect signal detectors. The surface electrodes 92 serve as surface electrocardiogram signal detectors. The analog signals from these multiple electrode catheters and surface electrodes are directed by the ultiplexer 00 and a multi-channel amplifier 22. The Amplified signals are displayed by an electrocardiogram monitor (EKG). 24. Analogous sera are also digitized through an A / D 26 interface and are entered into the computer at 50 for data processing and graph display. Additional details of data acquisition, analysis, and deployment related to intracardiac shunting will be described in more detail. When the system 10 is operating in an ablation mode, the ultiplex electrode catheter 70 is energized by the ablation unit 30 ba or the control of the computer 50. An operator issues a command through the device of en 5 The computer 50 controls the ablation unit 30 through the inter- phase control 52. b This initiates a programmed series of electric energy pulses to the endocardium to cathode 70 triads. Preferred method and ablation device is described in the US Patent Application copending and commonly assigned No. 07 / 762,035 filed on July 5, 1991 for Desai et al., The complete description of which is incorporated herein by reference. When the system 10 is operating in a through mode, the multiple electrode catheter 70 is energized by the step 1 unit under the control of the computer 50. A L5 operator issues a command through the input device . whereby the computer 50 controls through the control interface 52 and inult plexor 00 and initiates a programmed series of electrical simulator pulses to the endocardium through the catheter 70 or one of the auxiliary catheters 90.

Preferred insertion of the step ode is described in M. E.

Josephson et al., "VEN. RLCULAR F. NDOCHRDTAI, PACING L. The Role of Pace Mapping to Localize Opgen of Vent pular i chycardia," The American Journal of Cardiology, vol. 50, November, L9B2, a relevant portion of the description of the same is incorporated herein by reference, In an alternative embodiment, the ablation unit 30 is not controlled by the computer 50 and is manually operated. Directly under operator control. Similarly, the unit (step 40) can also be manually operated directly under operator control. The connections of the various components of the system 10 to the catheter 7, the auxiliary catheters 90 or the surface electrodes 92 can also be manually switched through the ultiplexer 80.

MAPEO An important advantage of the present invention is the ability to allow the medical professional to use a walking catheter to quickly and precisely locate the site of myocardial tachycardia, the need for open heart and chest surgery. open. This is achieved by the use of a multi-electrode catheter 70 in combination with real-time data processing and interactive deployment by the system 10. Essentially, the multi-electrode catheter 70 must be capable of deploying at the same time. less a bidimensional arrangement of electrodes against the site of the endocardium that is going to be detected (the intracardiac signals detected by each electrode) provide the data sampling of the electrical activity at the local site encompassed by the electrode arrangement These data are processed by the computer for L8 will produce r-eal time display including arrival times of intracardiac signals at each electrode, and a local isochronous map of the sampled site. Graphing the contours of the same time of arrival of the intracardiac signals, the local Lsoorono map is an appropriate way to indicate how close and where the electrode arrangement is from the origin site. Likewise, at each site surveyed, the computer calculates and displays in real time an estimated location of the source site with respect to the electrodes, so that the The medical professional can interactively and quickly move the patients to the place of origin. A multiple electrode catheter suitable for use in the present invention is a five electrode orthogonal electrode catheter arrangement (OECA) (described in U.S. Patent No. 4,940.06) by osala.The relevant portions of said description are incorporated herein by reference to leferoncy, Figure 20 shows the proximal end of the disposition of the present invention. orthogonal electon catheter (OECA) in its position or fully retracted mode. Because the catheter material has a "game" or "memory", it will usually return to its retracted position. The OECA comprises a five-pole electrostatic catheter 70. It has a central stylet 102 with four peripheral or circumferential electrodes 112, 113, 114 , > r and 115. A fifth electrode 111 is centrally located at the tip of the stylet 102. The five electrodes are hemispherical and have individual terminals 116 connected thereto. Each peri-directional electrode is 2 min in diameter, while the center electrode is 2.7 in. In diameter, slots 120 are opened longitudinally near where the electrodes are located, Figure 2B shows the OECA in its When the proxirnal end (not shown) of the catheter is pulled, the slots 120 of the stylet allow four Lateral arms 122 to be opened from the stylet body in an orthogonal configuration, with each of the four arms 122 extending? Radial peripheral electrode from the stylet, so that the four peripheral electrodes form a cross with the fifth electrode 111 at its center.The distance between the electrodes of the central electrode to each peripheral electrode is 0.5 ern, and the distance between the electrodes Peripherals is 0.7 crn The surface area of the catheter tip in an open position is 0.8 crn2"Figure 2C shows the traces of the OECA Ja co electrodes. The cuat r * or peri-directional electrodes 112, 113, 11. and 115 or (2) - (5) form a cross configuration.

The fifth electrode 111 or (l) is located on the center of the cross. Therefore, the orthogonal arrangement of the electrodes provides five points of sampling over the area 130 on the site of the endocardium encompassed by the electrodes.

ISÓCRONOS MAPS Generally, when a patient's heart is in a state of tachycardia, the one of origin becomes the source of endocardial activation., emanating a series of wave fronts of actuation from the ism. Electrodes such as those deployed by the catheter 70 in the endocardium and located near the site of origin, will detect these wave fronts before those farther away. The surface electrodes 92 being the furthest away from the origin site, generally record the arrival times of the wave fronts at the latest. When an endocardial cell is being filled with OECA bead, an individual measurement of an activation wavefront will provide arrival times at the five electrodes at. real time. A local Lsocrono map par-to the localized site can then be constructed from these arrival times, thus showing contours of equal arrival times. Isochrones are easily calculated by the computer using a linear interpolation scheme, as shown below. Figure 3A shows the five electrodes of the OECA located on a pair of orthogonal axes. Each orthogonal axis passes through? N pair of peripheral electrodes and the central electrode, that is, 112-111-114 (or (2) - (l) - (4)) and 113-L11-L15 (or ( 3) - (l) - (5)). In order to implement the linear interpolation scheme, the area covered by the five electrodes is divided into four triangular quadrants t to IV. Quadrant 1 is limited by electrodes (1), (2) and (3) ,. Quadrant 11 is limited by electrodes (1), (3) and (4). Quadrant 111 is limited by 'the electrodes (1), (4) and (5). 11 quadrant EV is limited by the electrodes (1), (5) and (2). The local isochrones are then calculated for each quadrant separately using Linear mterpoLaeion along each side of the triangle. Figure 3B shows an example of measuring the OECA made from an endocardial site. The five electrodes C (l), (2), (3), (4), (5) J each have an arrival time of ft (i), t (2), t (3), t (respectively). 4), t (5) J = C-lh, -6, -8, -20- -141 msec. Figure 3C shows the linear interpolation scheme applied to quadrant E from the example shown in Figure B. Quadrant 1 is a triangle defined by electrodes Hl), (2), (3)], each having respectively times of arrival of Lt (l), t (2), t (3)] - C-16, -6, 0] rnsec. By turning a stage of an inilisecond, the side defined by the electrodes (1) and (2) can be divided into ten stages equal to par-tir- from t - -6 to -16 rnsec. Also, the side defined by the electrodes (2) and (3) can be divided into two equal stages from (Je t - -6 to -8 rnsec, and the side defined by the electrodes (1) and (3) can be divided in eight equal stages starting from t - -8 to -16 msec ASL, it is not time for the time of 1 arrival of -10 rni Liseconds can be easily traced by joining a line from the -10 msec coordinate along each Side. In this case, the coordinate (Je -10 rnseg is found only along two sides defined by the electrodes (1) and (2) and the electrodes (1) and (3), Figure 3D shows the construction of a local isochronous map complete for the entire area covered by the OECA.

The map is complete Local time is obtained by applying the method of Linear Intelation to all the quadrants for all the desired arrival times. The arrival time of the activation wavefront at each electrode is measured with respect to a reference time.

Reference time is often provided by early deflection in a surface electrocardiogram that is monitored throughout the cardiac procedure. L figure. shows typical examples of surface ECG tracings and eleven ograms in raeardiacs. The three upper traces are three electrocardiograms of surface I, AVF and VI, representing three planes (right to left, upper-lower and ant in or-postepor). These are continuously monitored, and the earlier deflection in any of these electrocardiograms serves as the reference time point. In this example, a perpendicular dotted line (zero reference time) is plotted starting with the most empirical surface ECG that happens to be terminal 1. The next five lines are unipolar mT racardia electograms as detected by a catheter. Orthogonal electrode arrangement It can be seen that electrode number b, having the arrival time early of -36 rnsec, is closer to the origin site than the others, it has been determined that n arrival time of 40 a -. 5 msec indicates that the detection electrode is located substially in the origin site, in this case, the OECA produces a local time delay characterized by elliptical contours centered on the central electrode, on the other hand, when the OECi. is substi- tionally farther from the origin site, its local isochronous map is characterized by parallel contours.The characteristic arrival time, and the associated isochronous signal, are useful for locating the site of origin. The FCGs intr card and surface are digitally enhanced, preferably using a simple signal digitizer of 0 or lb channels. When the system 10 is in the unappearance mode, the elective intracardiac branches and the surface ECGs obtained from the multi-electrode catheter 70 and the surface electrodes 92 are digi talized by the entr-eface A. / D 26. The ckgitalized waveforms are analyzed by the computer to find the arrival times of the activation wavefront in real time. Now we will describe the method of operation of the system of the invention in the rnapean mode (for example, as in Fig. 70.) The cable 70 of the multiple electrodes is first used in the survey. The catheter is inserted through the artery of the leg (right femoral) and advanced to the aortic arch and then to the left ventricle using a fl iesoscopic guide provided by the physical imaging system 60. The fi lure 5 schematically shows the ventricle or another cardiac chamber arbitrarily divided into four segments, the upper right (RUS) and lower right (RLS), and upper left (LUS) and lower left (LLS) segments. In the example shown, a source site 200 is LocaLiza in the segment (LLS). Catheter 70 (OECA) is used for each of the segments to identify the segment that contains the origin site 200. OECA is located first in the upper right segment, and its electronic layout -Orth orthogonal displays to measure the arrival times of the activation of the wavefront to par-tir of the origin site. Then, instructions are given to system 10 to initiate tachycardia by means of the electrical stimulation protocol programmed from the pacer unit 40 to an electrode inserted in the endocardium. After the quLcardi is mduced, the OECA selects the arrival times of the intracardiac activation wavefront that are analyzed by the computer-a, and a local LSO is displayed on the video-monitor 56. In the example In Figure 5, when the OECA is in the segment (RUS), all the electrodes register a very late arrival time, which indicates that the origin site is not in the segment (RUS). Then, the catheter electrodes are retracted and the catheter moves to the lower segment (RLS). In this way, the four segments are removed. In the example shown, the catheter is once again placed in or 1 segment (for example, LLS) that shows the arrival times as tem- poral. After the segment with the origin site has been identified, other manipulations of the catheter are carried out in that segment with the interactive help of the display on the video monitor 56. The Legue map shows the map in real time local isochrone, the electrode arrangement and the estimated position of the origin site relative to it. Figure 6A shows by example the construction of the displacement vector of the electrode array towards the estimated site of origin 201. Shown in Figure 6A are the five OECA electrons that are identical to those most commonly found in Figure 3A. The example shown has the five e lect roclos C (L), (2), (3), (4), (5) J, each one detecting n arrival time of the activation wave front respectively of Ct (L), t (2), t (3), t (4), t (5) J - [- 36, -27, -32, -40, -31] rnsec. In this case, the separation between the orthogonal electrodes is R = 5rnrn. As explained above, the objective is to locate the electrode array centrally around the original r-eal site. Since the source is the source of the activation wave fronts, an electrode located at the site will detect the possible arrival time early (typically from -40 to 44 insec with respect to the first deflection (jel ECG The objective is achieved by making the central electrode (1) detect the possible arrival time early.In the opposite way, when the disposition of e Lec rodos moves to go from the place of origin, those electrodes Away from the origin site will detect the arrival times later (less negative) than those that are close (negative). Thus, the electrode arrangement must move along the direction of the negative arrival time. The address in which the displacement vector that joins the center of the electrode array to the estimated origin site 201 is determined by linear interpolation. respective arrival times detected at the location of the five electrons. This can be easily carried out by treating each time of 1 Legacy as an "equivalent mass" located on each electrode and calculating the "center of mass" for the electrode arrangement. The position of the "center of mass" is then given by '..

The OECA conveniently defines a set of orthogonal axes with a coordinate system (x, y), that is to say-: The direction along the electrodes (l) - (2) being the y axis, and the dilection in the long of the electrodes (l) - (3) being the x axis. The data in the example give the position of the "mass center" with respect to the eLectrode (1): R? -lRy]: • 32 * RA -31) * (-R), -27 * R + (¡ü) * (R (2) J -32 »(-31) 27-» (- 40). 1 016, ^ - 0.19 R where R - separation between the orthogonal elect (for example - 5 rnrn) "The estimated origin site 201 then lies at along a direction D? defined by a line through the centr-al electrode (L) and the "center of mass", ÍR ^ ^]. According to one aspect of the invention, the distance | Dj, between the central elect (1) and the origin site, is estimated by first determining the velocity (Jel. _ > »_ Local wave, VD, along the direction DA Asi, (D | - VD 11 (f) - 1 (L) ¡(3) where t (f) - time of arrival measured at the place of origin, t (?) - time of arrival. measured in the central electrode (1) "In the case of the OECA, it is conveniently achieved by first calculating the wavefront velocities along the y-axes.This is estimated by the speed of displacement of the wavefront of an electrode to another along the oje xyy: Or in Dondo R - separation between the electrodes, and the appropriate? T ^,? Tjj_, are given by the box shown below which corresponds to the quadrant containing the address Ü? . 5 0 b The velocity of the local wave front VD is estimated by adding the component e V * and Vy along the direction D say: O VD-V "COSB + V and Sen? (5) where T - tan - i (R? / Ry) is the angle between D? and the x axis. In the example given in Figure 6A, the address D? it lies within the quadrant (l) - (3) - (4). So, equation (4) gives LV ", Vy] = L_L. lR / rns -4 and equation (5) gives VD -0.25RÍ cosü- * sin?) /? Nsec "-0.25R /? Nsec, If it is assumed that the origin site has an arrival time edited and (f). ~ -44 insec, then from equation (3) or the central elec- rode moves from the estimated origin site 201 through? na distance: D - VD (44-36) - R or Lü imn.

Figure 6B shows a computer graphic display on the video monitor 56 (see Figure 1) in the preferred embodiment. The display shows, in time and simultaneously, the arrangement of electrodes with their local isochronous map and the relative position of the estimated origin site 201. This will help the medical professional to quickly direct the catheter arrangement of the patient. electrodes to the place of origin. As the electrode catheter arrangement moves toward the estimated origin site 201, the isochrones should be more elliptical and more. When the central electrode 111 is at the top of the estimated origin site, the isochrones must be ellipses that wind around the central electrode 111. If this is not the case, t (f) needs to be revised and preferably changed in a time in the stages of 2 msec, until the event in which the coincidence of the centriole electrode with the site of estimated origin is accompanied by elliptical isochrones and around the electiodo centr-al,.

INTEGRATION OF PHYSICAL IMAGE The computer video display shown in Figure 6B is constructed essentially from the information obtained by processing the arrival time data of the wavefront sampled by the electrode catheter arrangement 70. Is the deployment? A field of time of arrival (I exist in a bidirectional space on the surface of the endocardium For the purpose of locating the catheter at the site of origin, it provides adequate and effective guidance in coitus. In the invention, the information obtained by the physical image system 60 (see Figure 1) is also integrated with the information obtained from the data of the arrival time of the wavefront.

The two types of information are synthesized by the computer 50, and are displayed on the video monitor 56 as a physical image of the heart 100 and showing in it the relative positions of the electrode catheter arrangement 5 70 and the site of estimated origin 201., In this way, a more physical presentation of the catheter and the heart is possible. Figure 7A is a display synthesized in the video monitor of a digital image of the heart 100 and the disposition of electrodes 70 thereon, taken along Ll) of a first axis by the physical imaging system, and Also, the relative position of the estimated origin Lt. 201, according to another preferred embodiment of the invention. In one embodiment, the physical imaging system 60 (see also Figure L) comprises two x-rays rotated from two perpendicular directions. The vidoo output of both x-ray maes is digitized, for example, using two separate video frames integrated in the x-y detector-es 62. Since the arrangement of electrodes 70 such as the OECA (see also Figures 2 and 3) has a second opaque dart x-ray (not shown) on one of the arms of the electrode, it is relatively easy for the computer-a identify each electrode appropriately and associate the correct arrival time with each electrode. In this way, the positions of the five electrodes of the OECA can be tracked by the computer 50 in real time. The estimated origin site 201 may be located by the method described above, except that the coordinate system may be non-orthogonal, depending on the orientation of the electrode arrangement. Figure 7B is a display on the video monitor showing a similar image - as in Figure 7A, but taken over a second and by the physical image system. The views of the two axes can be displayed in two separate video monitors or on a monitor. Figure 0 is a display on the video monitor showing the images of Figures 7A and 7B simultaneously, in accordance with another preferred embodiment of the present invention. In accordance with another embodiment of the invention, the video display is a perspective interpretation of a three-dimensional image of the heart and the arrangement of electrodes. Figure 9 is a display synthesized on the video monitor of a perspective image of the coron 100 and the electrode arrangement 70 together with the estimated origin site 201, in accordance with another preferred embodiment of the invention. The image of the heart 100 and the electrode arrangement 70 is interpreted from a three-dimensional image database which is collected from the formation of an axis along several axes by the physical image formation system. Each ee provides a view (Jel cor-azon and the disposition of electo rs.) The procedure for locating the estimated origin site in each view is similar to that described above. The data obtained from the different views are processed. In an introduction, the sites previously visited by the catheter 70 are also deployed as a trace 211 in the endocardium.The novel system of the present invention is advantageous because it allows the The medical professional will graphically track the relative positions of the electrode array relative to the heart and the estimated site of origin, and allow the ability to accurately position and replace the catheter in the endocardium and the likelihood of follow the course of the previous positions of the catheter.

GLOBAL MAPPING In studies and preparatory diagnoses or in medical research, a global mapping of the heart is valuable. A global isochronous map for the entire endocardium is assembled by the catheter that scans over the entire endocardium, and The computer that collects maps is local chronos in each site scrutinized. The deployment includes the traces traversed by the catheter to provide a guide, so that the endocardium can be mapped systematically. This will not only allow the computer to produce and display local isochronous maps in real time, but also separate isochronous maps from a larger area to the entire endocardium, storing the actual positions of the electrons for each measurement and the arrival times. As each additional measurement is taken, the isochronous (nonlocal) map can be updated to more accurately cover a larger area.This would allow the medical professional to perform a medical procedure to determine where to place the OECA. After the measurement, and decide whether or not there has been a fairly precise isochronous map for the entire endocardium, after which a fairly precise isochronous map of the activation wavefront has been produced, a treatment procedure can then be determined. suitable.

MULTIPLE PHASE RADIO FREQUENCY ABLATION Prior implementation of the ablation method and device is described in the co-pending and commonly assigned US Patent Application No. 07 / 762,035 filed on July b, 1991 by Desai and others, the entire description of which is incorporated in FIG. the present invention as a reference. After the origin site is located by the electrode arrangement, system 10 (Figure 1) is changed to ablation mode. The electrical energy is transmitted from the ablation energy unit 30, through the multiplexer 80, to the catheter 70 of the electrode arrangement. In the preferred embodiment, the ablation energy unit 30 is programmable and is under control of the computer 50, so that a predetermined amount of electrical energy is released to subject the endocardium to ablation. In the catheter ablation, the lesion formed is approximately the size of the energized electrode or the electrode arrangement. Conventional ablation techniques, such as the catheter, have typically used a catheter with an individual electrode at its tip as an electrical pole. The other electrical pole is formed by means of a support plate in contact with an external part of the body (the patient.) In most cases, these techniques have been used to prevent the site of origin of the patient. For example, they have been successfully used to interrupt or modify the conduction of atrioventricular (AV) atrio atrial septal defects in the AV nodal tachycardia, or to interrupt the accessory pathway in patients with tachycardia due to atrial tachycardia. Uol-f-Pai'l-'inson-Uhi te syndrome, and to produce ablation in some patients with ventricular tachycardia (VT), however, in VT, the endocardial rnapeo with a normal catheter Electrodes can locate the exit site of the ventricular tachycardia to within 4-8 crn2 of the first site recorded by the catheter.A normal electrode catheter typically has a maximum electrode tip area of approximately 0.3 rnrn2. Therefore, the injury The technique created by the simple RF technique provided through a normal electrode catheter should not be long enough to remove the venting tachycardia. Attempts to increase the size of the lesion have been achieved with partial success by regulating power and duration by increasing the power of the electrode or by regulating the temperature of the tip electrode. To increase the size of the lesion, the orthogonal arrangement of the elective catheter (OECA) with four peripheral electrodes and a central electrode provides a greater spectrum. It typically produces lesions of 1 crn2. However, in the ablative treatment of ventricular tachycardia (VT), a lesion size in the order of more than one crn2 is probably required for an effective treatment. In this case, a large lesion is formed by successive ablation of adjacent sites. For example, a long lesion of 6 crn2-sized lesions can be created by six adjacent square-shaped lesions of 1 crn2. They can be formed by successive placements of the electrowinged OECPi using RF energy. After each ablation, the electrode catheter is removed norm Lrnen e to clean the blood clots on the electrons before the next attempt. It is critical that the locations of the next space (which will be removed, as well as the re-introduced cater, should be known accurately and quickly for this procedure to be successful.) This is accomplished by switching the system 10 alternately between the mode of operation. In the rimming phase, the system is preferably programmed to overlay a grid over the displayed tachycardia as shown in Figures 7, 8 or 9. The grid will be Possible and accurate positioning of the electrode arrangement is possible, Although the embodiments of the various aspects of the present invention that have been described are the preferred embodiment, those skilled in the art will understand that the variation of the symbols also The device and method described herein can be ap- plicable for ablation of biological tissues in general, therefore, the invention is protected either from the alc Complete ance of the claims falls adjoining ions.

Claims (6)

1. NOVELTY OF THE INVENTION CLAIMS L. ~ A cardiac ablation and ablation system for Locate and remove a site of origin of the tachycardia of origin in an endocardium of the heart of a subject, comprising: means of catheter to arrange a set of electrodes on the endocardium if thio-by-site, each electrode is capable of detect a discernible time of arrival of intracardiac elect rograrna signals that emanate from the site of origin of the tachycardia; means for displaying interactive map derived from said signals of arrival of signals of electrogranda and intracardiac, said map includes the set of elect rds and a presentation of the time of arrival associated with each eLectrode, with which those elec (They are close to the site of origin of the tachycardia that the others will record early arrival times than the others, and the electrodes that substantially coincide with the site of origin of the tachycardia will record a time of arrival. As early as possible, so that said map provides a guide to move said catheter in the direction of those electrodes earliest arrival times, and means to supply energy to said set of electrodes when said set of electrons is placed substantially I coincided with the site of origin of the tachycardia, with which the ablation to the tachycardia site was performed
2. 2.- A system of cardiac ablation and ablation according to claim 1, further including means for calculating equal arrival time profiles or isochronous, and wherein said map includes a local isochronous calculated from arrival times detected in the set of electrons, said local isochrones provide a guide and confirmation that when said set of electrodes is placed co-corresponding with the originating site of the tachycardia, said local isochrones are characterized by elliptical profiles surrounding the origin site. 3. A system of cardiac ablation and ablation in accordance with claim 2, which also includes means for calculating and displaying on the map the site of origin of the tachycardia relative to the set of electrodes, thus providing direct visual guidance. to direct the catheter to the site of origin. 4. A cardiac ablation and ablation system according to claim 3, in which: said int-radicular electrograrn signals emanating from the originating site of the tachycardia have definite definable velocities of the time of arrival detected in each electrocardiogram. odo; and said means for calculating and displaying include calculating a displacement vector from the set of electrons towards the origin site of the tachycardia, said displacement vector or being in a direction in which the local isochrones have the time of Arrival early, and said displacement vector has an estimated length from the speeds and times of arrival of the signals from the cardiac electrogram "b". 5. A cardiac ablation and ablation system according to claim 1, which it also includes means for calculating and displaying on the apa the site of origin of the tachycardia relative to the set and electrodes, thus providing a direct visual guidance to direct the catheter to the site of the gen. 6. A cardiac ablation and ablation system according to claim 5, wherein: said intracardiac electrograrn signals (emanating from the originating site of the tachycardia have definite velocities 5 depvables of the time of arrival detected in each electrode, and said means for calculating and deploying me Luyen calculate a displacement vector from the set of electrons to the origin site of the tachycardia, said displacement vector being in a direction in which the isochrone or local have the arrival time earlier, and said displacement vector has an estimated length based on the velocities and times of arrival of the lectrogram signals i ntraca r laco 7.- A system of cardiac ablation and ablation according to claim 1, which also includes means of physical image formation to display at least a view of a physical image of said set of electrons related to the coronet. 8.- A cardiac mapping and ablation system in accordance with claim 7, wherein said training means (ie physical image is a fluoroscope.) 9. A cardiac ablation and ablation system according to claim 7, wherein said means of physical image formation. they are a system of ultrasound image formation LO LO.- A cardiac ablation and ablation system according to claim 7, which also comprises: means-to calculate-the origin site of the tachycardia relative to said set Je electrodes; and means to produce one or more video presentations that reproduce said one or 15 views of said physical image of said set of electrodes relative to the heart and a site of origin of the calculated tachycardia, thus providing a direct visual guidance to direct the catheter to the site of origin of the tachycardia. 11. A cardiac ablation and ablation system according to claim 10, wherein: said intra-cardiac bundle signals emanating from the tachycardia origin site have defined velocities of the detected arrival time. in each electrode; Y '.) r, said means for calculating include calculating a displacement vector from the set of e Lectrodes to the origin site of the tachycardia, said displacement vector being in one direction in the of early arrival, and said deployment vector has an estimated length from the speeds and times of arrival of the signals of electrogranda int raeard Laco 12.- A system of cardiac ablation and ablation in accordance with the claim 10, in which said one or more views of said physical image of said set of electrodes relative to the heart and a source of the calculated tachycardia are seen in three-dimensional projections 13.- A system of cardiac ablation and ablation of With reference to claim 10, wherein said one or more views of said physical image of said set of electrodes relative to the corium and a location of the origin of the tachycardia are three-dimensional perspectives. 14. A cardiac ablation and ablation system according to the re Lvinel L falls Lon 10, wherein said means of physical image formation is a fluoroseo? O. 15. A cardiac ablation and cardiac ablation system with claim 10, wherein said physical image formation means is an ultra-oni image imaging system. 16. A cardiac ablation and ablation system according to claim 3, further comprising means for displaying an over-presented presentation of said physical image with said map for said set of electrodes and the estimated local focus of tachycardia are from Legacy in relation to the heart 17. A system (cardiac ablation and ablation in accordance with claim 16, wherein said means for physically forming the image is a fluoroscope. A cardiac ablation and cardiac ablation according to claim 16, wherein said means to form a physical image is a system of ultrasoiuoo formation.-A system of cardiac ablation and ablation in accordance with the claim. l, which further includes: one or more additional electrode means for detecting cardiac signals external to the corium, said cardiac signals capable of providing a reference time relative to time of arrival of intracardiac elective signals that emanate from the site of origin of the tachycardia. 20. A system of cardiac ablation and ablation to locate and remove a site of origin of the tachycardia in the endocardium of a subject's heart, comprising: catheter means to provide a set of electrodes on the endocardium site; per site, each electrode is capable of detecting a discernible arrival time of mtracardiac electgram signals emanating from the site of origin of the t-cardiac pathway; means to calculate starting from said arrival times (with the signs of electrogrann .4 estimated position of the site. of origin of the tachycardia in relation to each electrode; means for interactively displaying a map of said estimated position of the or-i gene site of the tachycardia relative to each electrode; and eeds to supply energy to said set of electrodes when said set of electrodes is placed substi- tially adjacent to the site of origin of the tachycardia, so as to effect ablation at the site of the tachycardia. 21, - A cardiac arrest system par-a loe Lizar? N site of origin of tachycardia in the endocardium of the heart of a subject (jue comprises: means of catheter par-to dispose a set of electodes on the endocardium site- By-SLt, each electorate is able to detect a discernible time of arrival of eletra rograrna mtracardiac signals that emanate from the site of origin of the tachycardia.; means for calculating from said arrival times the signals of the intracardiac olect branch at an estimated position of the origin site of the tachycardia in relation to each electrode; and means for interactively deleting a map of said estimated position from the site of origin of the tachycardia relative to each electrode. 22.- A method for the cardiac ablation and ablation that involves the steps of: placing a set of electrodes on the endocardium sit Lo?? Or-s? T? O, each electrode is able to detect- a time of The discernible arrival of electi-ogra signals to int racardiaco (emanating from the source of the tachycardia) interactively display a map derived from said arrival times of electrocardiogram signals i nt racardLaco, said map includes the set of electrodes and a visual presentation of the arrival time associated with each electrode, whereby said electrodes which are close to the origin site of the tachycardia than the others, will record arrival times as early as the others, and the electrodes that are substantially biased with the site of origin of the tachycardia will record a time of arrival as early as possible, thus providing the map provides a guide to move said catheter in the direction of those electrodes that They have the earliest arrival times; and supplying energy to said set of electrons when said set of electrodes is placed substantially commidente with the site of origin of the tachycardia, [thus making the ablation to the site of La quicardia. 23. A method for cardiac ablation and ablation according to claim 22, which also includes the step of calculating equal or isochronous arrival time parameters, and wherein said map includes a local isochronic calculated from the arrival times detected in the set of electrodes, said local isochrots provide a guide and confirmation that when said set of electrodes is placed substically comfident with the originating site of the tachycardia, said local isochrones are characterized by perfl ellipticals that surround the place of origin. 24. - A method for cardiac ablation and ablation of conmmunity with claim 23, which also includes the step of calculating - and displaying on the map the source of the tachycardia relative to the set of electrodes , thus providing a direct visual guidance to direct the catheter to the site of origin. 25.- A method for mapping and cardiac ablation in accordance with claim 24, in which the said signals of elect ro m racardiaco branch (th e emanating from the site of origin of the tachycardia have definite velocities depvables the time of arrival detected at each electrode, and said means for calculating and deploying include calculating a vector of descending from the set of electrodes to the site of origin of the tachycardia, said displacement vector being in place at the that the local isochrons have the earliest arrival time, and that the displacement vector has an estimated length at par Lr of the speeds and times of arrival (ie the signals of the cardiac electrogram.) 26.- A method for the rnapeo and the cardiac ablation according to claim 22, which further includes the step of calculating and displaying the map on the site (Je opgen (Je The tachycardia relative to the set of electrodes, prov thus, a direct visual guide is directed to direct the catheter towards the origin site. .7 27. - A method for unappearance and cardiac ablation according to claim 26, wherein: said electrocardiogram int racardiaco emanating from the site (origin of the tachycardia) have defined speeds derivable from the arrival time detected in each electrode and said means for calculating and displaying include calculating a displacement vector from the set of electrodes to the originating site of the tachycardia, said vector of being placed in a direction in which the local isochrots have the vector. This means that the displacement vector has an estimated length based on the velocities and times of arrival of the elect rog ral signal, which is a 28-minute method for cardiac ablation and cardiac ablation. according to claim 22, further includes the step of physical image formation to display at least one view of a physical image of said set of the eccles relative to the heart. 29. A method for cardiac ablation and ablation according to claim 28, wherein said physical imaging step employs a pharoscope. 30. A method for cardiac ablation and ablation in accordance with claim 20, wherein said physical image formation step employs a final imaging system. 31.- A method for the unapepeo and cardiac ablation .8 according to claim 28, further including the steps of: calculating the site of origin of the tachycardia relative to said set of elect; and produce or more video presentations reproducing said one or more views of said physical image of said set of electrodes relative to the heart and a site of origin of the calculated tachycardia, thus providing a direct visual guidance to direct the catheter towards the origin site of the tachycardia. 32.- A method of unappearance and cardiac ablation of conorrnity with claim 31, wherein: said signals from the int-i-diagram program that emanate (ie, the origin of the tachycardia have velocities of f midas der vables of the arrival time detected in each electrode, and the step of calculating- includes calculating- a vector of displacement from the set of electrodes to the origin site of the tachycardia, said displacement vector being in one direction in which the local isochrones have the arrival time early, and said displacement vector has an estimated length from the speeds and times of arrival of the signals of the electrocardiogram int rardiaco 33.- A method of rnapeo and ablation Confound cardiac card with claim 31, wherein said one or more views of said physical image of said set of electrodes relative to the heart and a site of origin of the calculated tachycardia are viewed in three-dimensional projection.
3. 3. . - A method of cardiac ablation and ablation according to claim 31, wherein said one or more views of said physical image of said set of e Readings relative to the heart and a source site of the calculated tachycardia b are viewed in three-dimensional perspective. 35. A cardiac ablation and ablation method according to claim 31, wherein said physical imaging step employs a fl uoroecope. 36. A method of cardiac ablation and ablation of 0 in accordance with claim 31, wherein said step (ie, physical imaging employs an ultrasonic signal for- mation system.) 37.- A method for cardiac ablation and ablation. according to claim 24, further including the step of displaying an overlay presentation of said physical image with said map so that said set of electrodes and the locator, estimated from the tachycardia focus, are deployed in relation to the heart. 38. A method of cardiac ablation and ablation of 0 according to claim 37, in which said step of forming- the Lrnagen physically employs fl? oroscop o. 39. A method of ablation and cardiac ablation of confo mi with claim 37, wherein said step of forming an image physically employs a training system (Je b irnagen u11 r-ason co 40). for the ablation and cardiac ablation according to claim 22, further including the step of: displaying one or more additional electrode means for detecting cardiac signals external to the heart, said cardiac signals capable of providing a reference time relative to the time of arrival of electgram signals in radars emanating from the site of origin of La t here cardia 41.- A method of ablation and cardiac ablation to locate and remove an origin site of the tachycardia in the heart endocardium of a subject, comprising the steps of: disposing by means of a catheter a set of electrodes on the endocardium sit 10 -by-if-uncle, each electrode is able to detect a time of arrival discermble of rograrna ales elect rntracardiaco emanating from the site of origin of tachycardia l; calculating from said times of arrival of the cardiac electrogram signals an estimated position of the originating site of the tachycardia in relation to each eLectrode; interactively display a map of said estimated position of the originating site of the tachycardia relative to each electorate; and supplying energy to said set of electrodes when said set of electrons is placed substantially coment with the site of the tachycardia, thus ablating the tachycardia site. of cardiac rnapeo for Locate and remove a site of origin of the tachycardia in the endocardium of the heart of a subject, comprising the steps of: disposing by means of a catheter a set of electrodes on the endocardium site-by-site, each eLectrode is capable of detecting a t? ern? o (The discernible arrival of signals from the electronic rarity of the heart (emanating from the site of origin of the tachycardia calcuLar from said times of arrival of the signals of electrocardiogram int racardiaco an estimated position of the origin site of the tachycardia in relation to each electron, and interactively display a map of said estimated position of the originating site of the tachycardia relative to each electrode 43. A method for the ripping and ablation cardiac according to claim 42, comprising, in addition, passing the (locating the locator, of each electrode relative to the tachycardia focus.) 4
4. 4. - A method for truncation and cardiac ablation of conrornida. d with Re vindication 42, which also comprises the step of forming a physical image of the localization izaciori of each electrode relative to the cardiac body. 4
5. 5. A method for cardiac ablation and ablation according to claim 43, further comprising the step of forming a physical image of the locator, of each relative electrode L cardiac body. 4
6. 6. A method for truncation and cardiac ablation according to claim 43, in which said electrode, cardiac body and tachycardia focus are! .1 sobropo i Cloned in a visual presenter, showing their Loca Reliable LizacIons.