WO2008014629A2 - Method and device for determining and presenting surface charge and dipole densities on cardiac walls - Google Patents

Method and device for determining and presenting surface charge and dipole densities on cardiac walls Download PDF

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Publication number
WO2008014629A2
WO2008014629A2 PCT/CH2007/000380 CH2007000380W WO2008014629A2 WO 2008014629 A2 WO2008014629 A2 WO 2008014629A2 CH 2007000380 W CH2007000380 W CH 2007000380W WO 2008014629 A2 WO2008014629 A2 WO 2008014629A2
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Prior art keywords
surface charge
dipole
electric potential
densities
density
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WO2008014629A3 (en
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Christoph Scharf
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Priority to AU2007281009A priority Critical patent/AU2007281009B2/en
Priority to EP19184148.5A priority patent/EP3603500B1/en
Priority to US12/376,270 priority patent/US8417313B2/en
Priority to CA2659898A priority patent/CA2659898C/en
Priority to EP07785075.8A priority patent/EP2051625B1/en
Application filed by Individual filed Critical Individual
Publication of WO2008014629A2 publication Critical patent/WO2008014629A2/en
Publication of WO2008014629A3 publication Critical patent/WO2008014629A3/en
Anticipated expiration legal-status Critical
Priority to US13/858,715 priority patent/US8700119B2/en
Priority to US14/189,643 priority patent/US8918158B2/en
Priority to US14/547,258 priority patent/US9167982B2/en
Priority to US14/865,435 priority patent/US9610024B2/en
Priority to US15/435,763 priority patent/US10376171B2/en
Priority to US16/014,370 priority patent/US10413206B2/en
Priority to US16/533,028 priority patent/US11013444B2/en
Ceased legal-status Critical Current

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    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/316—Modalities, i.e. specific diagnostic methods
    • A61B5/318—Heart-related electrical modalities, e.g. electrocardiography [ECG]
    • A61B5/346—Analysis of electrocardiograms
    • A61B5/349—Detecting specific parameters of the electrocardiograph cycle
    • A61B5/363—Detecting tachycardia or bradycardia
    • A—HUMAN NECESSITIES
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    • A61B5/02—Detecting, measuring or recording for evaluating the cardiovascular system, e.g. pulse, heart rate, blood pressure or blood flow
    • A61B5/0205—Simultaneously evaluating both cardiovascular conditions and different types of body conditions, e.g. heart and respiratory condition
    • A—HUMAN NECESSITIES
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    • A61B5/103—Measuring devices for testing the shape, pattern, colour, size or movement of the body or parts thereof, for diagnostic purposes
    • A61B5/107—Measuring physical dimensions, e.g. size of the entire body or parts thereof
    • A61B5/1075—Measuring physical dimensions, e.g. size of the entire body or parts thereof for measuring dimensions by non-invasive methods, e.g. for determining thickness of tissue layer
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    • A61B5/25—Bioelectric electrodes therefor
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    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H20/00—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance
    • G16H20/10—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance relating to drugs or medications, e.g. for ensuring correct administration to patients
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    • G16H20/40—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance relating to mechanical, radiation or invasive therapies, e.g. surgery, laser therapy, dialysis or acupuncture
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    • G16H20/60—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance relating to nutrition control, e.g. diets
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H50/00—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics
    • G16H50/50—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics for simulation or modelling of medical disorders
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16Z—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS, NOT OTHERWISE PROVIDED FOR
    • G16Z99/00—Subject matter not provided for in other main groups of this subclass
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B90/37—Surgical systems with images on a monitor during operation
    • A61B2090/374—NMR or MRI
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B90/37—Surgical systems with images on a monitor during operation
    • A61B2090/376—Surgical systems with images on a monitor during operation using X-rays, e.g. fluoroscopy
    • A61B2090/3762—Surgical systems with images on a monitor during operation using X-rays, e.g. fluoroscopy using computed tomography systems [CT]
    • A—HUMAN NECESSITIES
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    • A61B2562/00—Details of sensors; Constructional details of sensor housings or probes; Accessories for sensors
    • A61B2562/02—Details of sensors specially adapted for in-vivo measurements
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    • A61B2562/0214—Capacitive electrodes

Definitions

  • the invention discloses a method, a system, a computer program and a device for determining the surface charge and/or dipole densities on heart walls in order to locate the ori- gin(s) of cardiac arrhythmias.
  • Electrodes catheters can be inserted into the heart and moved around while recording cardiac potentials during normal heart rhythm or cardiac arrhythmia. If the arrhythmia has a regular activation sequence, the timing of the electric activation measured in voltages at the site of the electrode can be integrated when moving the electrode around during the arrhythmia, to create a threedimensional map of the electric activation. By doing this, information on the localization of the source of arrhythmia ⁇ ) and mechanisms, ie. reentry circuits, can be diagnosed to initiate or guide treatment (radiofrequency ablation).
  • This mapping procedure is often aided by computer systems generating three dimensional maps of catheter positions by localizing the catheter with the help of magnetic fields (the so called Carto System) or transthoracic impedances (by Lo- calisa and NavX). Because all the points of such maps are obtained by electrode positions in contact with the cardiac surface, this mapping system is called contact mapping. It has the inherent limitation that cardiac activation can only be assessed simultaneously at the points in contact with the myocardium. Hence, an instant map of the entire cardiac activation is impossible because the entire heart chamber cannot be contacted without compromising blood circulation.
  • An instant mapping of the simultaneous electric activation of the heart chamber might be of advantage in unstable arrhythmias of short duration, rendering the mapping procedures (moving the electrode around during the arrhythmia) too long.
  • an instant map of cardiac electric activation might be of advantage during irregular arrhythmias or arrhythmias with non-constant activation sequences that render integration of activation times from contact mapping impossible.
  • instant maps of cardiac activation are probably also faster and easier obtained, than a contact map gener- ated by time consuming catheters movements to different areas of the heart in all sorts of cardiac arrhythmias.
  • non-contact mapping which ⁇ allows for mapping cardiac activation of a heart chamber simultaneously without contact to the cardiac wall.
  • a multi electrode array mounted on an inflatable balloon can be inserted into the heart.
  • the geometry of the heart chamber is obtained either (i) by reconstruction of a contact map, which is obtained from integration of movements with an electrode catheter within the heart chamber, or (ii) by importing imaging data from computed tomography or MRI (magnetic resonance imaging).
  • imaging data from computed tomography or MRI (magnetic resonance imaging).
  • This non-contact mapping has the advantage that it provides the entire electric activation measured by farfield unipolar potentials either in sinus rhythm or during arrhythmia without the need for moving an electrode catheter around the cardiac chamber. This allows for a beat to beat analysis of cardiac activation and, therefore, unstable, irregular or multifocal arrhythmias can be tracked and treated.
  • the disadvantage of non-contact mapping is that it relies on farfield potentials, which do not allow for the same precision in localization as contact mapping (i.e. measuring local electrograms (potentials) of cardiac activation by touching the endocardium at the site of interest with a mapping electrode).
  • non-contact mapping i.e. the instant cardiac activation maps
  • disadvantages i.e. the decreased spatial resolution due to recording of far field signals, filtering of artifacts, etc.
  • Another method for the non-invasive localization of cardiac arrhythmias is body surface mapping.
  • multiple electrodes are attached to the entire surface of the thorax and the information of the cardiac electrograms (surface ECG) is measured in volt- ages integrated to maps of cardiac activation.
  • Complex mathematical methods are required in order to determine the electric activation in a heart model, for instance, one obtained from CT or MRI imaging giving information on cardiac size and orientation within the thoracic cavity.
  • mapping methods i.e. contact and non-contact types
  • the disadvantage of both mapping methods is the representation of the electric activity of the heart by means of potentials, that are the result of a summation of electric activities of many cardiac cells.
  • the integration of all these local electric ion charges generated by the cardiac cells provides for the potentials that are measured by current mapping systems.
  • the electric potential(s) V e is (are) determined by contact mapping. Equally pre- ferred the electric potential(s) V e is (are) determined by non-contact mapping.
  • the above mentioned algorithm method for transforming said V e into surface charge density (p) or dipole densitiy (v) in step b) above employs the boundary element method (BEM).
  • the geometry of the probe electrode is ellipsoidal or spherical.
  • said measured potential(s) V e is (are) transformed into surface charge densities p using the following equation:
  • said measured potential(s) V e is (are) transformed into dipole densities v using the following equation:
  • a further aspect of the present invention relates to a system for determining a table of sur- face charge densities or dipole densities of a given heart chamber, comprising : a) one unit for measuring and recording at least one electric potential V e at a given position P on the surface of a given heart chamber, b) one a/d-converter for converting the measured electric potentials into digital data, c) one memory to save the measured and/or transformed data, d) one processor unit for transforming the digital voltage data into digital surface charge density data.
  • the unit for measuring and recording the electric potential V comprises elec- trodes, which are in contact with at least one part of the heart chamber.
  • the unit for measuring and recording the electric potential V e comprises electrodes, which are not in contact with at least one part of the heart chamber.
  • the system of the invention comprises a unit for representing the surface charge densities p(P, t) and/or dipole densities v(P, t) as a 2-dimensiona! picture or time-dependent sequence of pictures (film).
  • system of the invention comprises a unit for representing the surface charge densities p(P, t) and/or dipole densities v(P, t) as a 3-dimensional picture or time-dependent sequence of pictures (film).
  • system of the invention is capable of implementing the above cited methods of the invention.
  • the present invention is directed to a computer program comprising instructions for implementing a method of the present invention.
  • the computer program of the invention comprises instructions implementing a system of the invention.
  • the computer program of the present invention comprises a computer readable programming-code, starting program after booting a computer and/or a system of the invention to use a method of the invention.
  • a further aspect of the invention relates to a device for implementing a method according to the invention, comprising at least one an electrode for measuring the electrode potential V 6 using the method of contact mapping and/or using the method of non-contact mapping, at least one processing unit for generating and transforming V e into said surface charge density p(P, t) and/or dipole density v(P, t) for presenting on a display.
  • the method of the present invention may be described as a method for determining a database table of surface charge densities of at least one given heart chamber, the surface charge density information comprising at least one triple (data values) (W(P,t,L), wherein i) P defines the position P(x,y,z) in x, y and z-coordinates of a given surface charge density of the at least one heart chamber, ii) t is the time of measurement for said surface charge density, and iii) L is the surface charge density at said time t and said position P derived from a measured electric potential of cardiac cells from a given heart chamber, comprising the following steps: a) measuring and/or calculating one or more electric potential(s) V e of cardiac cells in one or more position(s) P(x,y,z) at the cardiac wall of at least one given heart chamber at a given time t, b) generating at least one triple W(P,t, V e ) for each given time, position and potential,
  • the method of the present invention may be described as a method for determining a database table of dipole densities of at least one given heart chamber, the dipole density information comprising at least one triple (data values) (W(P,t,D), wherein i) P defines the position P(x,y,z) in x, y and z-coordinates of a given surface charge density of the at least one heart chamber, ii) t is the time of measurement for said dipole density, and iii) D is the dipole density at said time t and said position P derived from a measured electric potential of cardiac cells from a given heart chamber, comprising the following steps: a) measuring and/or calculating one or more electric potential(s) V e of cardiac cells in one or more position(s) P(x,y,z) at the cardiac wall of at least one given heart chamber at a given time t, b) generating at least one triple W(P,t, V e ) for each given time, position and potential,
  • the measured and/or calculated potential V e will be recorded in a database in the form of a table.
  • the position P und the time of measurement t will be used.
  • This triple W(P, t, V e ) is the basis for generating a 2 or 3-dimensional map of the surface charge density and/or the dipol density. Therefore, the triple W(P,t, V e ), comprising the values and data of measurement or preliminary calculations is transformed into another triple comprising the surface charge and/or dipol charge.
  • the triple W(P,t, V e ) (e.g.
  • LD comprises the information of the surface charge and the dipol charge at position P at time t.
  • the process and method for the transformation is preferably based on an algorithm based on formula 4 and/or 5 and/or a BEM-algorithm for the discretisation of the wall of a heart chamber.
  • the surface charge density means surface charge (Coulombs) per unit area (cm 2 ).
  • a dipol as such is a neutral element, wherein a part comprises a positive charge and the other part comprises the same but negative charge.
  • a dipol might represent the electric nature of cellular membranes better, because in biological environment ion charges are not macroscopi- caily separated.
  • the geometry of the given heart chamber must be known.
  • the 3D geometry of the cardiac chamber is typically assessed by currently available and common mapping systems (so-called locator systems) or, alternatively, by integrating anatomical data from CT/MRI scans.
  • locator systems commonly available and common mapping systems
  • a probe electrode will be used.
  • the probe electrode may be a multielec- trode array with elliptic or spherical shape. The spherical shape has certain advantages for the subsequent data analysis.
  • V is the potential and x,y,z denote the three dimensional coordinates.
  • the solution is an integral that allows for calculating the potential V(x'y'z') at any point x'y'z' in the whole volume of the heart chamber that is filled with blood.
  • BEM boundary element method
  • the boundary element method is a numerical computational method for solving linear integral equations (i.e. in surface integral form). The method is applied in many areas of engineering and science including fluid mechanics, acoustics, electromagnetics, and fracture mechanics.
  • Boundary element formulations typically give rise to fully populated matrices after discretisation. This means, that the storage requirements and computational time will tend to grow according to the square of the problem size.
  • finite element matrices are typically banded (elements are only locally connected) and the storage requirements for the system matrices typically grow quite linearly with the problem size.
  • VJP — f ⁇ (F)— — d ⁇ (P) (5)
  • the boundary element method again provides a code for transforming the potential V e in formula 4 and 5 into the desired surface charge densities and dipole densities , which can be recorded in the database
  • the electric potential(s) V e is (are) determined by contact mapping. In this case the steps for calculating the electric potential V e are not necessary, because the direct contact of the electrode to the wall of the heart chamber already provides the electric potential V e .
  • the probe electrode comprises a shape that allows for calculating precisely the electric potential V e and, thus, simplifies the calculations for transforming V e into the desired charge or dipole densities.
  • This preferred geometry of the electrode is essentially ellipsoidal or spherical.
  • a system comprising at least: a) one unit for measuring and recording electric potentials V at a given position P(x,y,z) on the surface of a given heart chamber (Contact mapping) or a probe electrode posi- tioned within the heart, but without direct wall contact (non-contact mapping) b) one a/d-converter for converting the measured electric potentials into digital data, c) one memory to save the measured and/or transformed data, d) one processor unit for transforming the digital data into digital surface charge density or dipole density data.
  • the method, system, and devices of the present invention do not require any particular new electrodes for implementing the best mode for practicing the present invention.
  • the invention provides a new and advantageous processing of the available data that will allow for an increase in precision, accuracy and spatial resolution of cardiac activation mapping when compared to prior art systems based on electric surface potentials in the heart only.
  • the present invention will allow for providing superior diagnostic means for diagnosing cardiac arrhythmias and electric status of heart cells including metabolic and func- tional information.

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Abstract

The invention discloses a method, a system, a computer program and a device for determining the surface charge and/or dipole densities on heart walls in order to locate the origin(s) of cardiac arrhythmias.

Description

Method and Device for determining and presenting surface charge and dipole densities on cardiac walls
The invention discloses a method, a system, a computer program and a device for determining the surface charge and/or dipole densities on heart walls in order to locate the ori- gin(s) of cardiac arrhythmias.
For localizing the origin(s) of cardiac arrhythmias it is common practice to measure the electric potentials located on the inner surface of the heart by electrophysiological means within the patient's heart. For example, for this purpose electrode catheters can be inserted into the heart and moved around while recording cardiac potentials during normal heart rhythm or cardiac arrhythmia. If the arrhythmia has a regular activation sequence, the timing of the electric activation measured in voltages at the site of the electrode can be integrated when moving the electrode around during the arrhythmia, to create a threedimensional map of the electric activation. By doing this, information on the localization of the source of arrhythmia^) and mechanisms, ie. reentry circuits, can be diagnosed to initiate or guide treatment (radiofrequency ablation). This mapping procedure is often aided by computer systems generating three dimensional maps of catheter positions by localizing the catheter with the help of magnetic fields (the so called Carto System) or transthoracic impedances (by Lo- calisa and NavX). Because all the points of such maps are obtained by electrode positions in contact with the cardiac surface, this mapping system is called contact mapping. It has the inherent limitation that cardiac activation can only be assessed simultaneously at the points in contact with the myocardium. Hence, an instant map of the entire cardiac activation is impossible because the entire heart chamber cannot be contacted without compromising blood circulation. An instant mapping of the simultaneous electric activation of the heart chamber, however, might be of advantage in unstable arrhythmias of short duration, rendering the mapping procedures (moving the electrode around during the arrhythmia) too long. In addition, an instant map of cardiac electric activation might be of advantage during irregular arrhythmias or arrhythmias with non-constant activation sequences that render integration of activation times from contact mapping impossible. Finally, instant maps of cardiac activation are probably also faster and easier obtained, than a contact map gener- ated by time consuming catheters movements to different areas of the heart in all sorts of cardiac arrhythmias.
The disadvantage of contact mapping can be overcome by "non-contact mapping", which ■ allows for mapping cardiac activation of a heart chamber simultaneously without contact to the cardiac wall. For this purpose, for instance, a multi electrode array mounted on an inflatable balloon can be inserted into the heart. The geometry of the heart chamber is obtained either (i) by reconstruction of a contact map, which is obtained from integration of movements with an electrode catheter within the heart chamber, or (ii) by importing imaging data from computed tomography or MRI (magnetic resonance imaging). Once the geometry of the cardiac chamber is outlined in a map the information of a simultaneous recording of cardiac farfield potentials (unipoles) by the multi electrode array can be extrapolated to the desired cardiac map using advanced mathematical methods. This non-contact mapping has the advantage that it provides the entire electric activation measured by farfield unipolar potentials either in sinus rhythm or during arrhythmia without the need for moving an electrode catheter around the cardiac chamber. This allows for a beat to beat analysis of cardiac activation and, therefore, unstable, irregular or multifocal arrhythmias can be tracked and treated. However, the disadvantage of non-contact mapping is that it relies on farfield potentials, which do not allow for the same precision in localization as contact mapping (i.e. measuring local electrograms (potentials) of cardiac activation by touching the endocardium at the site of interest with a mapping electrode). Furthermore, non-contact mapping is more prone to artifact generation and interference from potentials generated by cardiac repolarization and adjacent heart chambers (atria/ventricles). These drawbacks can be overcome to a certain extent with several filtering techniques. One the other side, in many cases these drawbacks also render the localization of cardiac arrhythmias a time-consuming frustrating intervention.
Therefore, the advantages of non-contact mapping, i.e. the instant cardiac activation maps, have to be balanced against the disadvantages, i.e. the decreased spatial resolution due to recording of far field signals, filtering of artifacts, etc.
Finally, another method for the non-invasive localization of cardiac arrhythmias is body surface mapping. In this technique multiple electrodes are attached to the entire surface of the thorax and the information of the cardiac electrograms (surface ECG) is measured in volt- ages integrated to maps of cardiac activation. Complex mathematical methods are required in order to determine the electric activation in a heart model, for instance, one obtained from CT or MRI imaging giving information on cardiac size and orientation within the thoracic cavity.
The disadvantage of both mapping methods, i.e. contact and non-contact types, is the representation of the electric activity of the heart by means of potentials, that are the result of a summation of electric activities of many cardiac cells. The integration of all these local electric ion charges generated by the cardiac cells provides for the potentials that are measured by current mapping systems.
Therefore, it is an object of the present invention to provide a method, a system, a program and a device for improving precision, accuracy and spatial resolution of cardiac activation mapping, when compared to prior art systems.
It was surprisingly found that the use of surface charge and/or dipole densities and in particular their distribution in a heart chamber is a much better indicator of cardiac arrythmias than electric potentials in the heart.
In a first aspect, the present invention relates to a method for determining a database table of surface charge densities (p) of at least one given heart chamber, the surface charge density information comprising a table (data values) p(P, t), wherein: i) the position P=(x,y,z ) of a point at the wall of the heart is defined in x, y ,z- coordinates, ii) t is the time of measurement for said surface charge density, and iii) p is the surface charge density at said time t and said position P derived from a measured electric potential from a given heart chamber, comprising the following steps: a) measuring and/or calculating one or more electric potential(s) Ve in one or more position (s) P at the cardiac wall at a given time t, b) transforming Ve into said charge density p(P,t) by using an algorithm suitable for transforming an electric potential into surface charge density.
In an alternative aspect, the present invention relates to a method for determining a data- base table of dipole densities v(P,t) of at least one given heart chamber, the dipole density information comprising a table (data values) v(P, t), wherein: i) the position P=(x,y,z ) of a point at the wall of the heart is defined in x, y ,z- coordinates, ii) t is the time of measurement for said dipole density, and iii) v is the dipole density at said time t and said position P derived from a measured electric potential from a given heart chamber, comprising the following steps: a) measuring and/or calculating one or more electric potential(s) Ve in one or more position(s) P at the cardiac wall at a given time t, b) transforming Ve into said dipole density v(P,t) by using an algorithm suitable for transforming an electric potential into dipole density.
Preferably, the electric potential(s) Ve is (are) determined by contact mapping. Equally pre- ferred the electric potential(s) Ve is (are) determined by non-contact mapping.
In a preferred embodiment, the above mentioned algorithm method for transforming said Ve into surface charge density (p) or dipole densitiy (v) in step b) above employs the boundary element method (BEM).
It is preferred that the geometry of the probe electrode is ellipsoidal or spherical.
In preferred embodiment, said measured potential(s) Ve is (are) transformed into surface charge densities p using the following equation:
Figure imgf000005_0001
In an alternative preferred embodiment, said measured potential(s) Ve is (are) transformed into dipole densities v using the following equation:
Fe(P) = — ta(P')~ - dσ(F) (5)
A further aspect of the present invention relates to a system for determining a table of sur- face charge densities or dipole densities of a given heart chamber, comprising : a) one unit for measuring and recording at least one electric potential Ve at a given position P on the surface of a given heart chamber, b) one a/d-converter for converting the measured electric potentials into digital data, c) one memory to save the measured and/or transformed data, d) one processor unit for transforming the digital voltage data into digital surface charge density data.
Preferably, the unit for measuring and recording the electric potential V comprises elec- trodes, which are in contact with at least one part of the heart chamber.
Equally preferred is that the unit for measuring and recording the electric potential Ve comprises electrodes, which are not in contact with at least one part of the heart chamber.
Preferably, the system of the invention comprises a unit for representing the surface charge densities p(P, t) and/or dipole densities v(P, t) as a 2-dimensiona! picture or time- dependent sequence of pictures (film).
It is also preferred the system of the invention comprises a unit for representing the surface charge densities p(P, t) and/or dipole densities v(P, t) as a 3-dimensional picture or time- dependent sequence of pictures (film).
In a preferred embodiment, the system of the invention is capable of implementing the above cited methods of the invention.
In a further aspect, the present invention is directed to a computer program comprising instructions for implementing a method of the present invention.
Preferably, the computer program of the invention comprises instructions implementing a system of the invention.
It is also preferred that the computer program of the present invention comprises a computer readable programming-code, starting program after booting a computer and/or a system of the invention to use a method of the invention. A further aspect of the invention relates to a device for implementing a method according to the invention, comprising at least one an electrode for measuring the electrode potential V6 using the method of contact mapping and/or using the method of non-contact mapping, at least one processing unit for generating and transforming Ve into said surface charge density p(P, t) and/or dipole density v(P, t) for presenting on a display.
Alternatively, the method of the present invention may be described as a method for determining a database table of surface charge densities of at least one given heart chamber, the surface charge density information comprising at least one triple (data values) (W(P,t,L), wherein i) P defines the position P(x,y,z) in x, y and z-coordinates of a given surface charge density of the at least one heart chamber, ii) t is the time of measurement for said surface charge density, and iii) L is the surface charge density at said time t and said position P derived from a measured electric potential of cardiac cells from a given heart chamber, comprising the following steps: a) measuring and/or calculating one or more electric potential(s) Ve of cardiac cells in one or more position(s) P(x,y,z) at the cardiac wall of at least one given heart chamber at a given time t, b) generating at least one triple W(P,t, Ve) for each given time, position and potential, c) transforming at least one triple W(P,t, Ve) into said triple W(P,t,L) using an algorithm method suitable for transforming an electric potential into surface charge density.
Also, the method of the present invention may be described as a method for determining a database table of dipole densities of at least one given heart chamber, the dipole density information comprising at least one triple (data values) (W(P,t,D), wherein i) P defines the position P(x,y,z) in x, y and z-coordinates of a given surface charge density of the at least one heart chamber, ii) t is the time of measurement for said dipole density, and iii) D is the dipole density at said time t and said position P derived from a measured electric potential of cardiac cells from a given heart chamber, comprising the following steps: a) measuring and/or calculating one or more electric potential(s) Ve of cardiac cells in one or more position(s) P(x,y,z) at the cardiac wall of at least one given heart chamber at a given time t, b) generating at least one triple W(P,t, Ve) for each given time, position and potential, c) transforming at least one triple W(P,t, Ve) into said triple W(P,t,D) using an algorithm method suitable for transforming an electric potential into dipole density.
The other aspects and embodiments described above (also described by claims 3 to 19) may also be applied analogously the directly above mentioned alternatives.
In a typical but non-limiting embodiment, the measured and/or calculated potential Ve will be recorded in a database in the form of a table. For generating the triple W(P, t, Ve) the position P und the time of measurement t will be used. This triple W(P, t, Ve) is the basis for generating a 2 or 3-dimensional map of the surface charge density and/or the dipol density. Therefore, the triple W(P,t, Ve), comprising the values and data of measurement or preliminary calculations is transformed into another triple comprising the surface charge and/or dipol charge. In a preferred embodiment, the triple W(P,t, Ve) (e.g. after storing) can be used to be transformed into a triple W(P, t , L) and/or a triple W(P, t, D) and/or a triple W(P, t, LD), wherein LD comprises the information of the surface charge and the dipol charge at position P at time t. The process and method for the transformation is preferably based on an algorithm based on formula 4 and/or 5 and/or a BEM-algorithm for the discretisation of the wall of a heart chamber.
Research has indicated that the use of the surface charge densities (i.e. their distribution) or dipole densities (i.e. their distribution) to generate distribution map(s) will lead to a more detailed and precise information on electric ionic activity of local cardiac cells than potentials. Surface charge density or dipole densities represent a precise and sharp information of the electric activity with a good spatial resolution, whereas potentials resulting from integration of charge densities provide only a diffuse picture of electric activiy. The electric nature of cardiac cell membranes comprising ionic charges of proteins and soluble ions can be precisely described by surface charge and dipole densities. The surface charge densities or dipole densities cannot be directly measured in the heart, but instead must be mathe- matically and accurately calculated starting from measured potentials. In other words, the information of voltage maps obtained by current mapping systems can be greatly refined when calculating surface charge densities or dipole densities from these.
The surface charge density means surface charge (Coulombs) per unit area (cm2). A dipol as such is a neutral element, wherein a part comprises a positive charge and the other part comprises the same but negative charge. A dipol might represent the electric nature of cellular membranes better, because in biological environment ion charges are not macroscopi- caily separated.
In order to generate a map of surface charge densities (surface charge density distribution) according to the present invention, the geometry of the given heart chamber must be known. The 3D geometry of the cardiac chamber is typically assessed by currently available and common mapping systems (so-called locator systems) or, alternatively, by integrating anatomical data from CT/MRI scans. For the measurement of potentials the non-contact mapping method a probe electrode will be used. The probe electrode may be a multielec- trode array with elliptic or spherical shape. The spherical shape has certain advantages for the subsequent data analysis. For example, when considering, for example, the ventricular cavity within the endocardium and taking a probe electrode with a surface SP, which is lo- cated in the blood, it is possible to measure the potential V(x,y,z) at point x,y,z on the surface Sp. In order to calculate the potential at the endocardial surface Se the Laplace equation
ΔF = (iL+il+ iL)κ =o (l) dx oy dz
needs to be solved, wherein V is the potential and x,y,z denote the three dimensional coordinates. The boundary conditions for this equation are V(x,y,z) = VP(x,y,z) on SP, wherein VP is the potential on surface of the probe.
The solution is an integral that allows for calculating the potential V(x'y'z') at any point x'y'z' in the whole volume of the heart chamber that is filled with blood. For calculating said integral numerically a discretisation of the cardiac surface is necessary and the so called boundary element method (BEM) has to be used. The boundary element method is a numerical computational method for solving linear integral equations (i.e. in surface integral form). The method is applied in many areas of engineering and science including fluid mechanics, acoustics, electromagnetics, and fracture mechanics.
The boundary element method is often more efficient than other methods, including the finite element method. Boundary element formulations typically give rise to fully populated matrices after discretisation. This means, that the storage requirements and computational time will tend to grow according to the square of the problem size. By contrast, finite element matrices are typically banded (elements are only locally connected) and the storage requirements for the system matrices typically grow quite linearly with the problem size.
With the above in mind, all potentials Vp (xi'yl'zV) on the surface of the probe can be measured . To calculate the potential Ve on the wall of the heart chamber, the known geometry of the surface of the heart chamber must be divided in discret parts to use the boundary element method . The endocardial potentials Ve are then given by a linear matrix transformation T from the probe potentials VP : Ve = T VP .
After measuring and calculating one or more electric potential(s) Ve of cardiac cells in one or more position(s) P(x,y,z) of the at least one given heart chamber at a given time t . The surface charge density and the dipol density is related to potential according to the following two Poisson equations:
AVe = p(P)δs (P) (2)
Figure imgf000010_0001
wherein ρ(P) is the surface charge density in position P=x,y,z, δs (P) is the delta- distribution concentrated on the surface of the heart chamber Se and υ is the dipol density.
There is a well known relationship between the potential Ve on the surface of the wall of the heart chamber and the surface charge (4) or dipole densities (5). (4)
Figure imgf000011_0001
Λ ^ 1
VJP) = — fϋ(F)— — dσ(P) (5)
(For a review see Jackson JD. Classical Electrodynamics, 2nd edition, Wiley, New York 1975.)
The boundary element method again provides a code for transforming the potential Ve in formula 4 and 5 into the desired surface charge densities and dipole densities , which can be recorded in the database In another embodiment of the method of the present invention the electric potential(s) Ve is (are) determined by contact mapping. In this case the steps for calculating the electric potential Ve are not necessary, because the direct contact of the electrode to the wall of the heart chamber already provides the electric potential Ve.
In a preferred embodiment of the method of the present invention the probe electrode comprises a shape that allows for calculating precisely the electric potential Ve and, thus, simplifies the calculations for transforming Ve into the desired charge or dipole densities. This preferred geometry of the electrode is essentially ellipsoidal or spherical.
In order to employ the method for determining a database table of surface charge densities of at least one given heart chamber in the context of the present invention, it is preferred to use a system comprising at least: a) one unit for measuring and recording electric potentials V at a given position P(x,y,z) on the surface of a given heart chamber (Contact mapping) or a probe electrode posi- tioned within the heart, but without direct wall contact (non-contact mapping) b) one a/d-converter for converting the measured electric potentials into digital data, c) one memory to save the measured and/or transformed data, d) one processor unit for transforming the digital data into digital surface charge density or dipole density data.
It is noted that numerous devices for localising and determining electric potentials of cardiac cells in a given heart chamber by invasive and non-invasive methods are well known in the art and have been employed by medical practitioners over many years. Hence, the method, system, and devices of the present invention do not require any particular new electrodes for implementing the best mode for practicing the present invention. Instead, the invention provides a new and advantageous processing of the available data that will allow for an increase in precision, accuracy and spatial resolution of cardiac activation mapping when compared to prior art systems based on electric surface potentials in the heart only. In the near future, the present invention will allow for providing superior diagnostic means for diagnosing cardiac arrhythmias and electric status of heart cells including metabolic and func- tional information.

Claims

Claims
1. Method for determining a database table of surface charge densities (p) of at least one given heart chamber, the surface charge density information comprising a table p(P, t) wherein i) the position P=(x,y,z ) of a point at the wall of the heart is defined in x, y ,z- coordinates, ii) t is the time of measurement for said surface charge density, and iii) p is the surface charge density at said time t and said position P derived from a measured electric potential from a given heart chamber, comprising the following steps: a) measuring and/or calculating one or more electric potential(s) Ve in one or more position(s) P at the cardiac wall at a given time t, b) transforming Ve into said charge density p(P,t) by using an algorithm suitable for transforming an electric potential into surface charge density.
2. Method for determining a database table of dipole densities v(P,t) of at least one given heart chamber, the dipole density information comprising a table v(P, t), wherein i) the position P=(x,y,z ) of a point at the wall of the heart is defined in x, y ,z- coordinates, ii) t is the time of measurement for said dipole density, and iii) v is the dipole density at said time t and said position P derived from a measured electric potential from a given heart chamber, comprising the following steps: a) measuring and/or calculating one or more electric potential(s) Ve in one or more position(s) P at the cardiac wall at a given time t, b) transforming Ve into said dipole density v(P,t) by using an algorithm suitable for transforming an electric potential into dipole density.
3. Method according to any of the preceding claims, where the electric potential(s) Ve is (are) determined by contact mapping.
4. Method according to any of the preceding claims, where the electric potential(s) Ve is (are) determined by non-contact mapping.
5. Method according to any of the preceding claims, wherein the algorithm method for transforming the Ve into surface charge density (p) or dipole densitiy (v) in step b) em- ploys the boundary element method (BEM).
6. Method according to claim 4, where the geometry of the probe electrode is ellipsoidal.
7. Method according to claim 4, where the geometry of the probe electrode is spherical.
8. Method according to claims 1 and 3 to 7, wherein said measured potential(s) Ve is (are) transformed into surface charge densities p using the following equation:
Figure imgf000014_0001
9. Method according to any of claims 2 to 7, wherein said measured potential(s) Ve is (are) transformed into dipole densities v using the following equation:
Figure imgf000014_0002
10. System for determining a table of surface charge densities or dipole densities of a given heart chamber, comprising : a) one unit for measuring and recording at least one electric potential Ve at a given position P on the surface of a given heart chamber, b) one a/d-converter for converting the measured electric potentials into digital data, c) one memory to save the measured and/or transformed data, d) one processor unit for transforming the digital voltage data into digital surface charge density data.
11. System as claimed in claim 10, where the unit for measuring and recording the electric potential V comprises electrodes, which are in contact with at least one part of the heart chamber.
12. System as claimed in claim 10, where the unit for measuring and recording the electric potential Ve comprises electrodes, which are not in contact with at least one part of the heart chamber.
13. System as claimed in any of claims 10 to 12, comprising a unit for representing the surface charge densities p(P, t) and/or dipole densities v(P, t) as a 2-dimensional picture or time-dependent sequence of pictures (film).
14. System as claimed in claim 8 to 11, comprising a unit for representing the surface charge densities p(P, t) and/or dipole densities v(P, t) as a 3-dimensional picture or time-dependent sequence of pictures (film).
15. System, capable of implementing the methods of any one of claims 1 to 9.
16. Computer program comprising instructions for implementing a method of any one of claims 1 to 9.
17. Computer program comprising instructions implementing a system as claimed in claim 10 to 15.
18. Computer program comprising a computer readable programming-code, starting program after booting a computer and/or a system as claimed in claim 8 to 13 to use a method of any one of claims 1 to 9.
19. Device for implementing a method according to any one of claims 1 to 9, comprising at least one an electrode for measuring the electrode potential Ve using the method of contact mapping and/or using the method of non-contact mapping, at least one processing unit for generating and transforming Ve into said surface charge density p(P, t) and/or dipole density v(P, t) for presenting on a display.
PCT/CH2007/000380 2006-08-03 2007-08-03 Method and device for determining and presenting surface charge and dipole densities on cardiac walls Ceased WO2008014629A2 (en)

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US12/376,270 US8417313B2 (en) 2006-08-03 2007-08-03 Method and device for determining and presenting surface charge and dipole densities on cardiac walls
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US13/858,715 US8700119B2 (en) 2006-08-03 2013-04-08 Method and device for determining and presenting surface charge and dipole densities on cardiac walls
US14/189,643 US8918158B2 (en) 2006-08-03 2014-02-25 Method and device for determining and presenting surface charge and dipole densities on cardiac walls
US14/547,258 US9167982B2 (en) 2006-08-03 2014-11-19 Method and device for determining and presenting surface charge and dipole densities on cardiac walls
US14/865,435 US9610024B2 (en) 2006-08-03 2015-09-25 Method and device for determining and presenting surface charge and dipole densities on cardiac walls
US15/435,763 US10376171B2 (en) 2006-08-03 2017-02-17 Method and device for determining and presenting surface charge and dipole densities on cardiac walls
US16/014,370 US10413206B2 (en) 2006-08-03 2018-06-21 Method and device for determining and presenting surface charge and dipole densities on cardiac walls
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US8700119B2 (en) 2014-04-15
US20130226017A1 (en) 2013-08-29
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US20150196219A1 (en) 2015-07-16
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US8918158B2 (en) 2014-12-23
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