WO2009129475A1 - Procédé et appareil de cartographie d'une structure - Google Patents

Procédé et appareil de cartographie d'une structure Download PDF

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Publication number
WO2009129475A1
WO2009129475A1 PCT/US2009/040979 US2009040979W WO2009129475A1 WO 2009129475 A1 WO2009129475 A1 WO 2009129475A1 US 2009040979 W US2009040979 W US 2009040979W WO 2009129475 A1 WO2009129475 A1 WO 2009129475A1
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WO
WIPO (PCT)
Prior art keywords
volume
position element
patient
instrument
determining
Prior art date
Application number
PCT/US2009/040979
Other languages
English (en)
Inventor
H. Toby Markowitz
Mustafa Karamanoglu
Pooja Mehta
Ioana Fleming
David A. Scanlon
Michael Kryger
Sean Campbell-Massa
Chad Giese
Steven L. Waldhauser
Shangqian Peter Zhang
Jeff Jannicke
Phillip Falkner
Don Hefner
Eduardo N. Warman
James Steeves
Rogier Receveur
Koen Michels
Olaf Eick
Vincent Larik
Original Assignee
Medtronic, Inc.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from US12/117,549 external-priority patent/US8457371B2/en
Priority claimed from US12/421,332 external-priority patent/US8532734B2/en
Priority claimed from US12/421,364 external-priority patent/US8494608B2/en
Priority claimed from US12/422,689 external-priority patent/US8340751B2/en
Application filed by Medtronic, Inc. filed Critical Medtronic, Inc.
Priority to EP09733463.5A priority Critical patent/EP2273919B1/fr
Priority to CN200980118467.3A priority patent/CN102036606B/zh
Publication of WO2009129475A1 publication Critical patent/WO2009129475A1/fr

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/05—Detecting, measuring or recording for diagnosis by means of electric currents or magnetic fields; Measuring using microwaves or radio waves 
    • A61B5/053—Measuring electrical impedance or conductance of a portion of the body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/05—Detecting, measuring or recording for diagnosis by means of electric currents or magnetic fields; Measuring using microwaves or radio waves 
    • A61B5/053—Measuring electrical impedance or conductance of a portion of the body
    • A61B5/0538—Measuring electrical impedance or conductance of a portion of the body invasively, e.g. using a catheter
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/06—Devices, other than using radiation, for detecting or locating foreign bodies ; determining position of probes within or on the body of the patient
    • A61B5/061—Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body
    • A61B5/062—Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body using magnetic field
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/25—Bioelectric electrodes therefor
    • A61B5/279—Bioelectric electrodes therefor specially adapted for particular uses
    • A61B5/28—Bioelectric electrodes therefor specially adapted for particular uses for electrocardiography [ECG]
    • A61B5/283—Invasive
    • A61B5/287—Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00017—Electrical control of surgical instruments
    • A61B2017/00022—Sensing or detecting at the treatment site
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00017—Electrical control of surgical instruments
    • A61B2017/00022—Sensing or detecting at the treatment site
    • A61B2017/00026—Conductivity or impedance, e.g. of tissue
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00017—Electrical control of surgical instruments
    • A61B2017/00022—Sensing or detecting at the treatment site
    • A61B2017/00039—Electric or electromagnetic phenomena other than conductivity, e.g. capacity, inductivity, Hall effect
    • A61B2017/00044—Sensing electrocardiography, i.e. ECG
    • A61B2017/00048—Spectral analysis
    • A61B2017/00053—Mapping
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00017—Electrical control of surgical instruments
    • A61B2017/00022—Sensing or detecting at the treatment site
    • A61B2017/00084—Temperature
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00238—Type of minimally invasive operation
    • A61B2017/00243—Type of minimally invasive operation cardiac
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22051—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with an inflatable part, e.g. balloon, for positioning, blocking, or immobilisation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
    • A61B2034/101—Computer-aided simulation of surgical operations
    • A61B2034/105—Modelling of the patient, e.g. for ligaments or bones
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B90/37—Surgical systems with images on a monitor during operation
    • A61B2090/376—Surgical systems with images on a monitor during operation using X-rays, e.g. fluoroscopy
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B90/37—Surgical systems with images on a monitor during operation
    • A61B2090/378—Surgical systems with images on a monitor during operation using ultrasound
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/25—User interfaces for surgical systems
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/05—Detecting, measuring or recording for diagnosis by means of electric currents or magnetic fields; Measuring using microwaves or radio waves 
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/06—Devices, other than using radiation, for detecting or locating foreign bodies ; determining position of probes within or on the body of the patient
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/06—Measuring blood flow

Definitions

  • Fig. 13B is an illustration on a display for tracking a lead with a guide wire
  • FIG. 34A is a schematic view of a heart with a mapping catheter and a flexible portion, according to various embodiments
  • Fig. 36 is a flowchart for utilization of position data.
  • the map data can be generated without other imaging information, such as image data that might be acquired with a fluoroscopic system, magnetic resonance imaging (MRI) System, computed tomography (CT) Imaging System, three-dimensional echo, ultrasound (2D, 3D, or 4D), or other imaging systems such as the imaging system 28.
  • imaging information such as image data that might be acquired with a fluoroscopic system, magnetic resonance imaging (MRI) System, computed tomography (CT) Imaging System, three-dimensional echo, ultrasound (2D, 3D, or 4D), or other imaging systems such as the imaging system 28.
  • the controller 34 can control the imaging device 28 and can store images generated with the imaging device 28 or transmit data or receive instructions via a data transmission line 36 to or from a processor and/or memory, such as one that may be included in a workstation 38. While the optional imaging device 28 illustrated here is a fluoroscopic c-arm other imaging devices, such as CT, MRI, ultrasound, etc., can also be employed. Moreover, it will be understood that the communication line 36 can be any appropriate communication line such as a wired communication line, a wireless communication system, or any other data transfer mechanism.
  • a first x-axis patch 48a and a second x- axis patch 48b can be connected with the patient 26 to create a x-axis (such as an axis that is generally medial-lateral of a patient) with a voltage gradient substantially along the x-axis between the patches 48a and 48d and a corresponding x-axis current flowing between patches 48a and 48b.
  • the reference patches can be used to reorient or register the mapping data 194 to the patient 26 at a second time, such as during a later procedure. Therefore, the reference patch 52a can be a substantially fixed reference patch for reference regarding the voltage generated by the PSU 40.
  • a procedure 180 is illustrated that can use the position sensing unit 40, its associated patches interconnected with the PSU I/O box 42, the mapping catheter 100, and the lead 120 to map and determine a position of the lead 120 in the patient 26 without the need to employ an external imaging device.
  • the procedure 180 can include creating a map of a portion of the patient 26 and positioning leads within a portion of the patient 26. It will be understood that although the procedure 180 is discussed relating to a cardiac procedure, other appropriate procedures can be performed by positioning the mapping catheter 100, current patches and reference electrodes in different portions of the patient 26.
  • each of the data points 198 of the mapping data 194 can include information collected with the mapping catheter 100.
  • the mapping catheter 100 can be used for electrogram recording and display. For example, equal atrial and ventricular contributions to the endocardial electrogram could help confirm a location proximal to the tricuspid or pulmonic valves. Therefore, each of the data points 198 of the mapping data 194 can have information associated therewith other than a position of the catheter 100.
  • the additional information can be used in conjunction with the position information to assist in identifying various regions of the heart 80, such as landmarks.
  • different portions of the heart such as valves, chambers and the like can be identified using the electrograms, pressure information, and the like.
  • This information which is associated with the data points 198, can be used to identify landmarks in the mapping data 194 of the heart 80.
  • the landmarks can be illustrated on the display device 58 to assist a physician in identifying or recalling selected regions of the heart 80 determined with the mapping catheter 100.
  • the landmarks 204, 206 can be identified using the physician's knowledge, information collected from the mapping catheter 100, and information collected from other instruments such as an electrocardiogram (ECG).
  • ECG electrocardiogram
  • a first surface rendering technique for block 200 can include a "swept surfaces".
  • the swept surfaces rendering technique can include a swept surface process 240 illustrated in Fig. 9 that can render the swept surfaces image data 241 illustrated in Fig. 10.
  • the swept surfaces process 240 can begin in a start block 242.
  • the mapping catheter 100 can be prepared and introduced in the patient 26 as a part of the start block 242.
  • the swept surfaces process 240 can include selecting a sphere size in block 244.
  • the sphere size selected in block 244 can be any appropriate size, such as a relative diameter of the electrode, such as the electrode 108 or 1 10. According to the swept surfaces process 240, the size of the electrode can be determined or estimated to be a sphere.
  • a guide wire 125 can also be tracked. As illustrated in Fig. 13A, a guide wire 125 can be positioned within the patient 26, such as relative to the heart 80, a vein of the patient 26, or any appropriate portion.
  • the guide wire 125 can include a metal portion, or be substantially all metal and be guidable within the patient 80.
  • the guidewire can be any appropriate guide wire, such as silverspeedTM guidewire.
  • the guide wire 125 can include a distal end that is blunt, bent, or very flexible to resist or reduce possibly perforating the heart 80.
  • the guide wire 125 can be used to assist in positioning the lead 120, including the lead electrode 126, relative to the heart 80 of the patient.
  • a voltage can be sensed and/or a bioimpedance can be determined at the guide wire 125.
  • the position of the guide wire 125 can be determined from with the PSU 40, as discussed above including sensed voltages or determined impedances. Also, the position of the guidewire can be illustrated as a single point or a path or surface can be illustrated to show the past path and positions of the guide wire 125.
  • mapping data generated regarding the patient 26 can be substantially three dimensional. As illustrated in Fig. 2, three axis, x, y, and z, can be generated relative to the patient 26 through the use of the various electrode patches 46a - 50b.
  • a method 370 illustrated in a flowchart can be used to illustrate a three dimensional nature of a data, such as the mapping data acquired of the patient 26, on a substantially two dimensional display.
  • a rotating virtual camera VC
  • the rocking procedure can begin in block 372.
  • display of the mapped data including either or both of the points or surfaces, can be done in block 374, as illustrated in Fig. 15A.
  • a circle or arc, as illustrated in Fig. 15A can be defined around a y-axis, generated or defined relative to the map data displayed in block 374, or a center at the focal point selected in block 378.
  • a radius R, as illustrated in Fig. 15A can also be defined based upon a current location of the camera or at any selected radius in block 380. It can be selected, for example if the rocking is not to interfere or be substantially seamless with viewing of the map data, that the radius of the circle defined in block 380 be equal to the distance defined from the focal point to the current view point of the virtual camera for viewing the map data.
  • the user 22 can determine whether rocking should be stopped in block 390.
  • the query for stopping rocking can occur at any time such as after a set number of repetitions of rocking, a set number of time steps, or at any appropriate time. Therefore, manual input from the user 22 may or may not be necessary to follow the YES routine to the stop block 378. Similarly, manual input from the user 22 may or may not be necessary to follow the NO routine to the decision block 392 of whether the camera has reached the end of the arc.
  • map data may be distorted because of various effects. Correction for the distortion, as discussed herein and illustrated in Figs. 17-19B, can assist in displaying the map data points and determining a position for implanting leads or the IMD 600.
  • map data can be generated and used to illustrate map data points 198 or a surface 281 on a display 58.
  • the lead 120 can then be tracked or guided with the PSU 40 or any appropriate tracking system relative to the patient 26.
  • various corrections can be made to the data or calibrations to the system 40 to ensure correct and plausible illustration of the data on the display 58.
  • NO routine 660 can be followed to optionally render the map data points 198 or the surface
  • the scaling factor is a difference, such as a mathematical ratio, between the determined position in the acquired map data points of the electrodes and the known position of the electrodes. If the map data points determine that the two electrodes are 3 cm apart, but it is known that they are 2 cm apart then the scaling factor serves to normalize the measured data. Further, because the data can be collected in three spatial dimensions the scaling factor can be determined and applied in all three spatial dimensions.
  • the map data points 198 illustrated on the screen or display 58 can be points that are generated based upon a sensed or measured impedance within the patient 26, as discussed above.
  • the data that is illustrated as the map data points 198 is based upon map data 194 collected with the PSU 40.
  • the map point 194 can be based upon an actual measurement of a voltage or bioimpedance at selected locations within the patient 26.
  • the impedance measured at the tip electrode 108 and the ring electrode 1 10 can be used to determine a position of the specific location or relative location of the tip and ring electrodes 108, 1 10.
  • the pathway icon 456 can be a substantially three dimensional icon generated relative to the mapping data, such as the surface 281.
  • the three dimensional nature of the pathway 456 can be used to assist the user 22 in guiding the lead 120 back to the position of the implantation represented with the icon 450.
  • removal of the mapping catheter 100 from the patient 26 can be performed after identifying the location for implantation and representing it with the icon 450.
  • the path of removal of the mapping catheter 100 can represent at least one pathway, which can include the most efficient pathway, to return to the implantation site represented by the icon 450.
  • the lead 120 represented by the icon 120'
  • the pathway icon 456 can be followed or moved along the pathway icon 456 by the user 22.
  • the substantially three dimensional nature of the data can be more easily visualized in Fig. 22C that illustrates that the icon 120', representing the position of the lead 120, can be illustrated within a three dimensional tube of the pathway icon 456.
  • a single display such as the display 58, can illustrate perspective views of the pathway icon 456 and the lead icon 120', as illustrated in both Figs. 22B and 22C. Accordingly, more than one view of the lead icon 120' relative to the pathway icon 456 can be illustrated on the display 58.
  • the subtracted region 486 can be viewed from the interior of the surface 281.
  • the subtracted region 486 can be used for identifying anatomical portions of the patient 26, such as the coronary sinus ostium.
  • the coronary sinus ostium or other portions can be used for landmark identification and performing a selected procedure relative to the patient 26.
  • Other anatomical depressions or crevices can also be identified.
  • a volume can be generated relative to any portion, as selected by the user 22 or automatically. This can allow the user 22 to explore any selected region for a depression or crevice as selected by the user 22. For example, the user can examine an area of an infarct for diseased or necrotic tissue.
  • the user 22 can identify a region of the temperature differential.
  • the region of the temperature differential can help identify the anatomical structure.
  • the anatomical structure can be further displayed on the display 58, such as with the removed region 486, as illustrated in Fig. 23B. Therefore, it will be understood, that multiple information can be displayed on the display 58 to assist in identifying anatomical structures and features. It would be further understood that measuring a temperature in any appropriate location of the anatomy can assist in identifying anatomical structures in that portion of the anatomy.
  • a processor such as a processor of the PSU 40, can be used to identify anatomical structures based on the temperature differential.
  • the user 22 either alone or with the assistance of the processor can identify anatomical features based upon the measured temperature.
  • STATE OR LOCATION DETERMINATION SYSTEM [00295]
  • the heart 80 of the patient can include one or more measurable features or characteristics that can be used to identify or determine a state or a location of the instrument measuring the feature.
  • the mapping catheter 100 or the lead 120 can be used to measure pressure or an electrogram (EGM) within the patient 20 to assist in identifying a specific location within the patient 26.
  • EMM electrogram
  • a smaller spike 581 a 2 may also be measured in the EGM line 580a which is coincident with the R-wave 583a 2 even when the EGM is measured in the SVC or RA.
  • the smaller spike 581 a 2 can represent a ventricular activity.
  • the physical location of the mapping catheter 100 can be determined to be further inferior relative to the patient 26. This indicates that the mapping catheter 100 has moved inferiorly relative to the heart 80.
  • a further query can be whether a pulse pressure is measured. If a pulse pressure is non-existent or determined to not be present, such as less than or equal to about 1 mmHg, then the instrument can be determined to still be in the SVC. It will be understood that if either the three conditions discussed above and illustrated in block 594 in Figs. 29C and 29C, or any other appropriate conditions, are determined to not have been measured or to have not occurred then the NO routine 600 can be followed to determine that the mapping catheter 100 remains within the SVC in block 592. It will be understood, above and herein, that the measured changes may be weighted when determining a state change.
  • the flow chart 590 can be used to determine a state or position of the mapping catheter 100 as discussed above. A signal to make a determination can be based upon manual input, a change in a measurement, or a time step or time differential. For example, the user 22 can move the mapping catheter 100 and an initial a determination of whether the mapping catheter 100 is within the patient 26, such as within the heart 80, can be made.
  • the reference impedance Z52a52b determined between the two reference patches 52a, 52b changes as the heart 80, for example the ventricles, fill and then empty of blood.
  • the blood of the patient 26 is highly conductive relative to surrounding tissues and other body constituents, such as skeletal muscle, bone and air. So, as the heart 80 beats and the blood travels in and out of the heart 80, the conductance of the portion of the patient 26 in the vicinity of the heart 80 changes as a function of time due to the shift in position of the bolus of blood being pumped. Accordingly, the change in the reference impedance Z52a52b can be used to determine or follow the cardiac cycle.
  • map data can be collected and classified as (1 ) in systole and during exhalation, (2) in systole during inhalation, (3) in diastole during exhalation, and (4) in diastole during inhalation. Other classifications can also be provided or selected to further segment the map data during collection.
  • the map data need not be classified, but can be classified in any appropriate number of classes for reasons or purposes discussed herein.
  • a position in three- dimensional space or patient space, of a portion of the heart, such as an interior wall position of the right ventricle, is based upon at least the cardiac rhythm and respiration of the patient 26. Accordingly, the map data 194 that is collected with the mapping catheter 100 can be identified or classified to classify the map data relating to the position of the various portions being mapped, such as the wall of the heart 80. This can allow for a substantially precise anatomical map of the heart 80 at the various contraction, relaxation, and respiration positions.
  • Classifying, saving, and rendering only or substantially only similarly classified map data can also allow for a plurality of surfaces to be determined, rendered, and displayed on the display 58.
  • the technique of assigning map data to different classes can be used to provide at least a 1 ) stable display of the heart, 2) video or motion "image" synchronized to the patient's 26 physiology, or 3) slow motion video or motion image without reference to any current patient 26 physiology.
  • the motion of the heart 80 and the various instruments, such as the mapping catheter 100 within the heart 80 imparts information utilized by the user 22.
  • the motion can be generated by display successive images of map data that are classified as successive parts of a respective cycle or multiple cycles.
  • map data points or surface can be used to illustrated a natural and true position and movement of the heart 80. It will be understood, however, that map data can be collected for any appropriate region of the patient 26 and the heart 80 is merely an example. Nevertheless, the image on the display 54 need not be a static image that relates only to an average of maximum distance within the heart 80, but can be a moving image based on a successive display of multiple renderings of the map data classified from the patient 26.
  • a slow motion video of the heart 80 and instruments could help the user 22 understand the data being presented. This could be a replay of the saved map data so the relative positions of the heart and instruments can be easily seen. Such video could be selected from recently saved map data and replayed during an implantation procedure. In addition, the map data can be replayed for training, review, or planning purposes.
  • map data can be gathered for any appropriate portions of the cardiac cycle and respiratory cycle.
  • the different classified data can then be displayed on the display 58, as illustrated in Figs. 3OA and 3OB, to illustrate the surface rendering 700, 720 of the heart 80 at different cardiac cycle positions.
  • a selected number, such as 2, 4, 16, or any appropriate number, of renderings can then be displayed in succession or synchronized with the ECG 570 or displacement between two electrodes such as xiphoid and back. This can allow the display on the display 58 to substantially mimic the cardiac cycle and respiration cycle of the patient 26.
  • the PSU 40 allows for a determination of a three dimensional position of an electrode positioned within the patient 26, based upon the measured impedance or voltage within the patient 26. Accordingly, if two electrodes are positioned relative to one another and a flow is allowed to act on at least one (i.e. a moveable electrode) of the two electrodes, a direction of movement of the moveable electrode relative to the substantially more stationery electrode can be determined.
  • the two electrodes on the mapping catheter 100 can be selected to move relative to one another to assist in determining flow direction. Nevertheless, other devices or an augmented mapping catheter 100 can be provided.
  • the display 58 can also be used to display a plurality of flow directions in a single location over time. Accordingly, the user 22 can view a turbulent area and understand the turbulence in the single area based upon a plurality of flow direction measurements. Turbulence may be due to valvular dysfunction resulting in regurgitate flow.
  • an electrode positioned within the patient 26 can be used to sense or measure a voltage and/or determine an impedance.
  • the voltage or impedance can be used to determine a position of the electrode within the patient 26.
  • the position of the electrode within the patient 26 can be illustrated on the display 58 and a map can be generated from the position data.
  • a general algorithm for sheath detection is illustrated in the flowchart 800.
  • the method can begin in Start block 802.
  • a determination block 804 it can be determined if the electrode is sheathed, as discussed below according to various manners. If it is determined that the electrode is unsheathed, the NO path 806 can be followed and Map data can be collected and saved in block 808. As discussed above, the collected map data can be displayed on the display 58 for various procedures and purposes.
  • the method 800 can then end in block 810. [00389] If it is determined that the electrode is sheathed, according to any of the various manners discussed below, then the YES path 812 can be followed.
  • an electrode can be determined to be sheathed if two electrodes s are relatively close and on a rigid portion belonging to the same instrument, such as the lead or the mapping catheter 100, travel in very different directions.
  • the two electrodes can be the tip and ring electrodes of the mapping catheter 100.
  • the process for making the determination that two electrodes travel in significantly different directions can begin with determining the unit vector describing the direction of travel for the tip 108 and ring 1 10 electrodes.
  • the ring electrode 1 10 is proximal and closer to the sheath 104 than the tip electrode 108. Initially, if the tip electrode 108 has moved a very small amount (e.g.
  • the sheathed attribute for the ring electrode 1 10 is left unchanged by this process. If the determined movement of the tip electrode 108, however, is above the selected initial threshold then a dot- product is determined between the vectors of the tip electrode 108 and the ring electrode 1 10 to calculate the similarity in direction of travel. If the dot product is below a dot-product threshold then the ring electrode is marked as sheathed.
  • the dot-product threshold can be selected by the user or automatically selected by and programmed into the PSU 40. For example, the dot-product threshold can be 0.25. It will also be understood that the instrument, such as the mapping catheter may include more than one ring electrode and, therefore, this process is repeated for each ring electrode.
  • Determination of biompedance and measurement of voltages can be in applications external to or in addition to the PSU 40.
  • External examples of bioimedance include measuring hemodynamic performance, assuring patient electrode connection, and, other patient specific applications.
  • the patient 26 may have a pacemaker implanted. If the patient 26 has an implanted pacemaker and is simultaneously undergoing a procedure utilizing the PSU 40, interference from the pacemaker may interfere with the PSU 40.
  • a sampling system of the PSU 40 can be invoked to detect if an interfering signal interprets after a procedure with the PSU 40 begins.
  • the sampling system can perform periodic interference checks to reveal if an interfering signal has appeared and switch frequencies in a manner transparent to the user 22.
  • the sampling system of the PSU 40 can periodically cease signal generation to enable the detection circuits a period and freedom to sense an interfering signal and determine the frequency of the interfering signal.
  • the periodic interference check can be manually initiated or automatic. When an interfering signal is detected a non-interfering frequency or channel can be selected for operation of the PSU 40.
  • the PSU 40 can then be automatically or manually switched to a channel that would not be interfered with by the interfering signal. Having a wide selection of frequencies can allow concurrent operation.

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Abstract

Selon l'invention, un volume d'un patient peut être cartographié à l'aide d'un système pouvant identifier et sauvegarder une pluralité d'emplacements d'un instrument de cartographie. L'instrument de cartographie peut comprendre une ou plusieurs électrodes qui détectent une tension pouvant être corrélée à un emplacement tridimensionnel de l'électrode au moment de la détection ou de la mesure. Ainsi, la carte d'un volume peut être établie sur la base de la détection de la pluralité de points, sans recourir à d'autres dispositifs d'imagerie, ce qui permet d'explorer un dispositif médical implantable en fonction des données cartographiques.
PCT/US2009/040979 2008-04-18 2009-04-17 Procédé et appareil de cartographie d'une structure WO2009129475A1 (fr)

Priority Applications (2)

Application Number Priority Date Filing Date Title
EP09733463.5A EP2273919B1 (fr) 2008-04-18 2009-04-17 Appareil de cartographie d'une structure
CN200980118467.3A CN102036606B (zh) 2008-04-18 2009-04-17 测绘结构的方法和装置

Applications Claiming Priority (40)

Application Number Priority Date Filing Date Title
US4629808P 2008-04-18 2008-04-18
US61/046,298 2008-04-18
US12/117,537 2008-05-08
US12/117,549 US8457371B2 (en) 2008-04-18 2008-05-08 Method and apparatus for mapping a structure
US12/117,537 US8260395B2 (en) 2008-04-18 2008-05-08 Method and apparatus for mapping a structure
US12/421,332 US8532734B2 (en) 2008-04-18 2009-04-09 Method and apparatus for mapping a structure
US12/421,364 US8494608B2 (en) 2008-04-18 2009-04-09 Method and apparatus for mapping a structure
US12/421,364 2009-04-09
US12/422,708 US20090267773A1 (en) 2008-04-18 2009-04-13 Multiple Sensor for Structure Identification
US12/422,681 US8214018B2 (en) 2008-04-18 2009-04-13 Determining a flow characteristic of a material in a structure
US12/422,681 2009-04-13
US12/422,658 US8208991B2 (en) 2008-04-18 2009-04-13 Determining a material flow characteristic in a structure
US12/422,670 US20090264740A1 (en) 2008-04-18 2009-04-13 Locating an Introducer
US12/422,670 2009-04-13
US12/422,689 US8340751B2 (en) 2008-04-18 2009-04-13 Method and apparatus for determining tracking a virtual point defined relative to a tracked member
US12/422,658 2009-04-13
US12/422,689 2009-04-13
US12/422,708 2009-04-13
US12/423,466 2009-04-14
US12/423,487 US8843189B2 (en) 2008-04-18 2009-04-14 Interference blocking and frequency selection
US12/423,521 2009-04-14
US12/423,454 2009-04-14
US12/423,477 2009-04-14
US12/423,466 US9179860B2 (en) 2008-04-18 2009-04-14 Determining a location of a member
US12/423,499 US20090264744A1 (en) 2008-04-18 2009-04-14 Reference Structure for a Tracking System
US12/423,499 2009-04-14
US12/423,511 US9332928B2 (en) 2008-04-18 2009-04-14 Method and apparatus to synchronize a location determination in a structure with a characteristic of the structure
US12/423,487 2009-04-14
US12/423,521 US8831701B2 (en) 2008-04-18 2009-04-14 Uni-polar and bi-polar switchable tracking system between
US12/423,477 US8768434B2 (en) 2008-04-18 2009-04-14 Determining and illustrating a structure
US12/423,454 US8660640B2 (en) 2008-04-18 2009-04-14 Determining a size of a representation of a tracked member
US12/423,511 2009-04-14
US12/424,037 US8391965B2 (en) 2008-04-18 2009-04-15 Determining the position of an electrode relative to an insulative cover
US12/423,994 US8185192B2 (en) 2008-04-18 2009-04-15 Correcting for distortion in a tracking system
US12/424,013 US8424536B2 (en) 2008-04-18 2009-04-15 Locating a member in a structure
US12/424,007 US8364252B2 (en) 2008-04-18 2009-04-15 Identifying a structure for cannulation
US12/423,996 US8345067B2 (en) 2008-04-18 2009-04-15 Volumetrically illustrating a structure
US12/423,957 US8887736B2 (en) 2008-04-18 2009-04-15 Tracking a guide member
US12/423,966 US8106905B2 (en) 2008-04-18 2009-04-15 Illustrating a three-dimensional nature of a data set on a two-dimensional display
US12/423,973 US8442625B2 (en) 2008-04-18 2009-04-15 Determining and illustrating tracking system members

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