Patent Publication Number: US-11389078-B2

Title: Reducing capacitance effects in active current location (ACL)

Description:
FIELD OF THE INVENTION 
     The present invention relates generally to tracking a probe location within a living body, and specifically to electrical catheter-based position measurements. 
     BACKGROUND OF THE INVENTION 
     Spatial mapping of an intrabody cavity is required in many medical procedures. For example, U.S. Patent Application Publication 2011/0306867 describes methods and systems for determining information about a vascular bodily lumen. An exemplary method includes generating an electrical signal, delivering the electrical signal to a plurality of excitation elements in the vicinity of the vascular bodily lumen, measuring a responsive electrical signal from a plurality of sensing elements in response to the delivered electrical signal, and determining a lumen dimension. Specific embodiments include generating a multiple frequency electrical signal. Another embodiment includes measuring a plurality of responsive signals at a plurality of frequencies. Still other embodiments include using spatial diversity of the excitation elements. Yet other embodiments use method for calibration and de-embedding of such measurements to determine the lumen dimensions. Diagnostic devices incorporating the method are also disclosed, including guide wires, catheters and implants. 
     U.S. Patent Application Publication 2006/0085049 describes systems and methods for discriminating and locating tissues within a body, which involve applying a waveform signal to tissue between two electrodes and measuring the electrical characteristics of the signal transmitted through the tissue. At least one of the electrodes is constrained in area so that localized electrical characteristics of the tissue are measured. Such localized electrical characteristics are determined over a portion of a body of the subject by using an array of electrodes or electrodes that can be moved over the body. A controller may implement the process and perform calculations on the measured data to identify tissue types and locations within the measured area, and to present results in graphical form. Results may be combined with other tissue imaging technologies and with image-guided systems. 
     SUMMARY OF THE INVENTION 
     An embodiment of the present invention provides a method for location tracking including measuring one or more first impedance-magnitudes, between a probe located at a location in an organ of a patient and one or more body-surface electrodes, at a first electrical frequency. One or more second impedance-magnitudes, between the probe located at the location and the one or more body-surface electrodes, are measured at a second electrical frequency. Based on the measured first and second impedance-magnitudes, one or more probe zero-frequency impedance-magnitudes between the probe and the one or more body-surface electrodes are estimated. The location of the probe in the organ is estimated based on the one or more probe zero-frequency impedance-magnitudes. 
     In some embodiments, the method further includes, prior to inserting the probe, acquiring using a calibration tool a set of calibration impedance-magnitudes at the first and second electrical frequencies, between the calibration tool located at calibration locations and the one or more body-surface electrodes, and acquiring corresponding calibration locations. Based on the acquired calibration impedance-magnitudes, one or more calibration zero-frequency impedance-magnitudes between the calibration tool and the one or more body-surface electrodes are estimated. Estimating the location of the probe includes comparing the probe zero-frequency impedance-magnitudes to the calibration zero-frequency impedance-magnitudes. 
     In some embodiments, the method includes interpolating the calibration zero-frequency impedance-magnitudes, so as to produce one or more interpolated zero-frequency calibration impedance-magnitudes that best match the one or more probe zero-frequency impedance-magnitudes. 
     In an embodiment, the method includes reducing a capacitive distortion in the first and second impedance-magnitudes that were measured at the first and second electrical frequencies. 
     In another embodiment, the capacitive distortion is caused by at least another probe located in the organ. 
     There is additionally provided, in accordance with an embodiment of the present invention, a location tracking system, including a memory and a a processor. The memory is configured to store (i) one or more first impedance-magnitudes, measured at a first electrical frequency between a probe located at a location in an organ of a patient and one or more body-surface electrodes, and (ii) one or more second impedance-magnitudes, measured at a second electrical frequency between the probe located at the location and the one or more body-surface electrodes. The processor is configured to, based on the measured first and second impedance-magnitudes, estimate one or more probe zero-frequency impedance-magnitudes between the probe and the one or more body-surface electrodes, estimate the location of the probe in the organ based on the one or more probe zero-frequency impedance-magnitudes. 
     The present invention will be more fully understood from the following detailed description of the embodiments thereof, taken together with the drawings in which: 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a schematic, pictorial illustration of a zero-frequency impedance-based Active Current Location (ACL) tracking system, in accordance with an embodiment of the present invention; 
         FIGS. 2A and 2B  are schematic, pictorial illustrations of a zero-frequency ACL method, in accordance with an embodiment of the present invention; and 
         FIG. 3  is a flow chart schematically illustrating the zero-frequency ACL method for estimating a location of a probe, in accordance with an embodiment of the present invention. 
     
    
    
     DETAILED DESCRIPTION OF EMBODIMENTS 
     Overview 
     Embodiments of the present invention that are described hereinafter provide an impedance-based catheter location-tracking system, and a method capable of tracking a location of a probe in an organ despite deviations in impedance-magnitude values. Deviating impedance-magnitude values may occur, for example, when several probes are present in an organ in parallel, which adds a capacitive impedance in parallel. The measured impedance-magnitude values then deviate relative to location-calibrated impedance-magnitude values, as described below. 
     The disclosed system is capable of retracing the deviating impedance-magnitudes to location-calibrated impedance-magnitudes, so as to accurately determine locations of one or more probes. To achieve this goal, the system initially measures the impedance-magnitudes at two or more different electrical frequencies at each probe location, rather than at a single electrical frequency, as further described below. 
     An example of an impedance-based catheter location-tracking system is the Carto® 3 system (made by Biosense-Webster, Irvine, Calif.), which applies an Active Current Location (ACL) impedance-based position-tracking method. With the ACL method, a processor receives position-indicative impedance-magnitudes that are measured between an electrode fitted at a distal end of a catheter and surface electrodes attached to the patient&#39;s skin. Based both on the measured impedance-magnitudes and on a stored location-calibrated impedance-magnitudes, the processor of the Carto® 3 system estimates a location of the catheter inside an organ of a patient. 
     The location-calibration of impedance-magnitudes is performed using another, more accurate, location tracking method, such as one based on magnetic signals or on imaging. During such calibration, the location-tracking system (a) measures a set of coordinates of intrabody locations; (b) measures respective impedance-magnitudes at the respective locations using a calibration tool; (c) calibrates the measured impedance-magnitudes by deriving a relation that connects each measured coordinate with a corresponding measured impedance-magnitude (i.e., correlates the measured impedance-magnitude with the respective coordinate), and; (d) saves the calibration impedance-magnitudes and the respective location coordinates (also termed hereinafter “calibration location”) in a memory. In some embodiments the location-tracking system applies the calibration tool to perform step (a), using for example a magnetic position sensor that is fitted at a distal end of the calibration tool. 
     Subsequently, e.g., during an investigative session, a processor tracks the location of a probe by correlating impedance-magnitudes measured by the probe (named hereinafter “probe impedance-magnitudes”) with the stored calibration impedance-magnitudes (i.e., using the ACL method) and estimates the corresponding coordinates of the unknown location based on the stored set of coordinates. 
     In some cases, however, the legacy ACL method may encounter difficulties, such as when several probes are inserted into the heart in parallel. The simultaneous presence of several probes changes the electrical conditions that each probe experiences relative to those experienced by the calibration tool. Specifically, the insertion of several probes may add capacitive impedance in parallel. As a result, impedance-magnitudes measured by any of the probes will generally deviate to lower values than those measured by the calibration tool during calibration. In such a case, the correct location of any of the probes can no longer be estimated by comparing the (deviating) impedance-magnitudes with the calibrated impedance-magnitudes. 
     To track a location using deviating impedance-magnitudes, embodiments of the present invention estimate and utilize the Ohmic component of the impedance (also named “DC impedance” or “zero-frequency impedance”). The zero-frequency impedance is unaffected by the presence of parallel capacitive impedances since any parallel capacitive component of an impedance will diminish (i.e., becomes an open-circuit) at zero-frequency. Therefore, in embodiments of the present invention, a processor correlates a zero-frequency probe-impedance Z PT (0) with stored zero-frequency calibration-impedances Z Cal (0) to correctly estimate a location of a probe. The disclosed method is named hereinafter “zero-frequency ACL.” 
     As noted above, in order to derive the zero-frequency impedance, two different calibration impedance-magnitudes are measured during the calibration phase: one at a first electrical frequency and another at a second electrical frequency. Using the dual frequency measurements, a processor derives a location-calibrated zero-frequency impedance, Z Cal (0), e.g., by extrapolating the frequency-dependence of the impedance-magnitude to DC. Subsequently, during a probe tracking phase, probe impedance-magnitudes are also measured at the first electrical frequency and at the second electrical frequency. Using these measurements, the processor derives the probe zero-frequency impedance, Z PT (0), as further described below. 
     In an embodiment, the processor interpolates over zero-frequency calibration-impedances to find interpolated values that best match the zero-frequency probe-impedances. Next, based on interpolating over respective measured locations, the processor estimates a respective interpolated location of the probe. In an optional embodiment, the calibrated impedance-magnitudes and the probe impedance-magnitudes are measured at one or more additional frequencies (e.g., at a third frequency), so as to derive respective zero-frequency impedances with, for example, improved accuracy. 
     Using the disclosed zero-frequency ACL impedance-based location-tracking method and system, a processor is capable of correctly estimating the location of a probe in an organ, despite the presence of capacitive effects that distort the measurement. This technique is useful, for example, in procedures in which multiple probes are present in the patient organ simultaneously. As another example, the technique is useful in mitigating group coupling between cable patches (e.g., between cables carrying high voltages and cables carrying low voltages). The disclosed technique enables tracking of multiple probes without requiring additional location tracking techniques. This advantage may simplify multi-probe-based investigative and therapeutic systems and procedures, such as those used in cardiac catheterization. 
     System Description 
       FIG. 1  is a schematic, pictorial illustration of a zero-frequency impedance-based Active Current Location (ACL) location sensing system  36 , in accordance with an embodiment of the present invention. ACL system  36  is used in determining the location of a probe distal end  30 , which is fitted at the distal end of a shaft  22 , as seen in inset  25 . Distal end  30  is inserted by a physician  56  into an organ, such as a heart  38  of a patient  39 . 
     Typically, distal end  30  of the probe is configured to perform diagnostics, such as mapping electrical potentials in the heart to identify locations where an arrhythmia may originate, or through which it may propagate. For such purposes, distal end  30  comprises multiple distal-electrodes  32 . Distal-electrodes  32  are connected by wires through shaft  22  to driver circuitry  44  connected to a processor  46  that is included in a console  24 , whereas driver circuitry  44  drives distal-electrodes  32  as commanded by processor  46 . 
     As seen in inset  25 , an additional probe  29  is present in heart  38 , which causes impedance-magnitudes measured using electrodes  32  to deviate, e.g., to be lower than those measured at a same location during calibration phase. As noted above, the lower impedance-magnitudes (sensed using electrodes  32 ) will indicate wrong locations for electrodes  32  if not retraced to zero-frequency impedances by the disclosed zero-frequency ACL method. 
     Six body-surface electrodes, for receiving signals, are attached to the skin of the patient, which are named hereinafter ACL patches  60 ,  62 ,  64 ,  66 ,  68 , and  70 , or collectively named hereinafter “ACL patches  60 P”. As seen, ACL patches  60 P are placed at the chest and back around heart  38  of patient  39 . The signals for deriving impedance-magnitudes are passed to a driver circuitry  44 , which is connected to ACL patches  60 P by wires through cable  39 . In some embodiments, driver circuitry  44  is configured to generate signals (i.e., currents and/or voltages) at two or more different electrical frequencies. Distal-electrodes  32  are configured to be driven by these signals, at the two or more different electrical frequencies. ACL patches  60 P are configured to receive the resulting signals. The signals at the two or more frequencies may be applied and measured simultaneously or separately, using multiplexing and demultiplexing techniques known in the art. 
     In an embodiment, each of the six ACL patches  60 P is used for measuring impedance-magnitudes to distal-electrodes  32 . The measured impedance-magnitudes are indicative of locations of the one or more distal-electrodes  32 . In the absence of any additional probe  29 , processor  46  estimates the locations of each of the electrodes  32  inside heart  38  based on a stored set of calibration impedance-magnitudes and the measured respective locations (namely the ACL method). Driver circuitry  44  drives a display  52 , which may show the locations of each of distal electrodes  32  inside heart  38 . 
     With the presence of additional probe  29 , the measured impedance-magnitudes deviate, and are typically lower than those calibrated. Still, using the disclosed zero-frequency ACL method for deriving zero-frequency impedances from deviating impedances, and based on a stored set of zero-frequency calibration impedance-magnitudes, processor  46  correctly estimates the locations of each of distal electrodes  32  inside heart  38 , as described below. 
     The method of electrode location sensing using ACL system  36  in conjunction with calibrated impedances is implemented in various medical applications, for example, in some CARTO™ systems produced by Biosense-Webster described in detail in U.S. Pat. Nos. 7,756,576, 7,869,865, 7,848,787, and 8,456,182 whose disclosures are all incorporated herein by reference. The number of ACL patches can be larger than six, whereas using six ACL patches is described by way of example. 
     Processor  46  is typically a general-purpose computer, with suitable front end, interface circuits for receiving signals from ACL patches  60 P and/or distal-electrodes  32 , and appropriate signal processing circuits. Processor  46  is programmed in software to carry out the functions described herein. The software may be downloaded to the computer in electronic form, over a network, for example, or it may, alternatively or additionally, be provided and/or stored on non-transitory tangible media, such as magnetic, optical, or electronic memory. 
     Typically, system  36  includes other elements, which are not shown in the figures for the sake of simplicity, and which are referred to as necessary in the following description. For example, system  36  may include an ECG monitor, coupled to receive signals from one or more body surface ECG electrodes, so as to provide an ECG synchronization signal to console  24 . As another example, system  36  may comprise one or more additional catheters, such as an ablation catheter and/or additional sensing-catheter, which, as noted, are not shown for clarity. 
     System  36  shown in  FIG. 1  is an example chosen purely for the sake of conceptual clarity. In alternative embodiments, the impedance-magnitudes can be derived by, for example, a location-tracking system that applies voltage gradients between pair of patches  60 P and measures, using electrodes  32 , voltages induced at heart  38  (e.g., by using, for example, the Carto® 4 system produced by Biosense-Webster). In general, embodiments of the present invention may apply to any catheter-based location sensing method that uses modulated electrical signals which are position-indicative. 
     Additional types of catheters or other intrabody devices may be used in parallel for other purposes, by themselves or in conjunction with treatment devices such as a radiofrequency ablating-catheter. 
     Location sensing system  36  may be used in other organs with probes similar to probe  30 . 
     Reducing Capacitance Effects in ACL 
       FIGS. 2A and 2B  are schematic, pictorial illustrations of the zero-frequency ACL method, in accordance with an embodiment of the present invention. For simplicity, the figures refer to a single zero-frequency component of a single impedance-magnitude curve. In practice, one or more first impedance-magnitudes are measured at a first electrical frequency and respectively at a second electrical frequency (e.g., for each of axes x, y, and z). The one or more impedance-magnitudes are measured between one or more distal electrodes  32  of while the probe is located at a location in an organ and one or more body-surface electrodes  60 P. Next, based on the measured first and second impedance-magnitudes, processor  46  estimates one or more zero-frequency impedances between the probe and the one or more body-surface electrodes. Finally, the processor estimates the location of the probe in the organ based on the one or more zero-frequency impedances, for example, by correlating the one or more zero-frequency impedances with a stored set of location-calibrated zero-frequency impedances, one by one. 
       FIG. 2A  shows a probe impedance-magnitude  40   a  measured using electrode  32  at distal end  30  at an unknown location in heart  38 , at an electrical frequency ω 0 , |Z PT (ω 0 )|. The measured impedance-magnitude is typically lower than one measured by a calibration tool at the same location during calibration,  50   a  (i.e., |Z Cal (ω 0 )|), due to the presence of other probes in the heart. The shown difference |ΔZ| is not known and therefore there is no way to retrace probe impedance-magnitude  40   a  to calibration impedance-magnitude  50   a  from a measurement at a single electrical frequency. 
     As seen, impedance-magnitude  40   a  (i.e., |Z PT (ω 0 )|) lays on a frequency-dependent tissue bio-impedance-magnitude curve  40  of |Z PT (ω)|. Generally, tissue impedance-magnitude curve |Z(ω)| can be presented schematically using an equivalent electrical circuit made of a resistance R 1  connected in parallel to a resistance R 2  in series with a capacitance C: 
     
       
         
           
             
               
                 
                   
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     At zero-frequency and at infinite frequency, |Z(ω)| is independent of the capacitance C and equals R 1  and R 1 R 2 /(R 1 +R 2 ), respectively. Empirically, an impedance-magnitude |Z(ω)| of a cardiac tissue decreases from approximately 300Ω at zero-frequency to approximately 100Ω at infinite frequency. A corresponding simplified representation of the bio-impedance-magnitude can therefore be given by, for example: 
                          Z   ⁡     (   ω   )            =     R   ⁢         1   +       (     ω   ⁢           ⁢   RC     )     2           1   +       (     α   ⁢           ⁢   ω   ⁢           ⁢   RC     )     2                   Eq   .           ⁢   2               
where R is the ohmic component and ωC is the capacitive component of the bio-impedance, and α may be determined empirically to be, for the above values of 300Ω and 100 Ω, α=3. According to Eq. 2, |Z(ω)| is a monotonic decreasing function of the capacitance C. Thus, for any final frequency ω&gt;0, an increase in capacitance of a bio-environment, for example by inserting more probes, lowers |Z(ω)| by certain value |ΔZ|. With regard to  FIG. 2A , as noted above, the challenge is to retrace, from the deviating probe impedance-magnitude, values that a processor can reliably correlate with location-calibrated impedance-magnitudes.
 
       FIG. 2A  shows a zero-frequency probe impedance  400  and a zero-frequency calibration impedance  500  derived for a same location r in heart  38 . As seen, the two impedances are equal despite curve  40  deviating from curve  50  over ω&gt;0. Embodiments of the present invention utilize the fact that the zero-frequency impedance, R=Z(0), described above, does not change when a parallel capacitance is introduced, for example, by the presence of several probes. Z(0) is thus a repeatable characteristic of a given unknown location r in the heart, which the tracking system derives during calibration, and subsequently, during a probe tracking session. 
       FIG. 2B  exemplifies several possible values of derived zero-frequency location-calibrated impedances  500 ,  510 , and  520 , which correspond to three different coordinates in heart  38 . Zero-frequency probe-impedance  400  derived for the unknown location may correlate, by way of example, with one of zero-frequency impedances  500 ,  510 , and  520 , as further described below. 
     Zero-frequency impedances  500 ,  510 , and  520  are derived from Eq. 2 by a processor, during a calibration phase, by substituting impedances measured at two different frequencies, ω 0  and ω 1 , seen over respective impedance curves  50 ,  51 , and  52 , and solving a set of two equations with two variables (while the global parameter a is determined empirically). 
     As noted above, the processor concludes that the coordinate of the probe location is the same as a location coordinate that corresponds to zero-frequency calibration-impedance  500 . The processor then readily identifies, and assigns to the unknown location r, a correct coordinate stored with zero-frequency calibration-impedance  500 . 
     In an optional embodiment, the calibrated impedances and the probe impedances are measured at one or more additional frequencies (e.g., at a third frequency), to solve Eq. 2 without determining an a priori value for α. Either way, a processor calculates a corresponding curve |Z(ω)| (solving Eq. 2) and afterwards derives the zero-frequency impedance value by substituting ω=0 in Eq. 2. 
     The examples shown in  FIGS. 2A and 2B  are chosen purely for the sake of conceptual clarity. Additional or alternative calculation steps may be done. For example, in an optional embodiment, the processor calculates one or more interpolated zero-frequency calibration-impedances Z Cal   + (0) that best match zero-frequency probe-impedances Z PT (0) so as to assign, to an unknown location r, a correct interpolated respective location. 
       FIG. 3  is a flow chart schematically illustrating the zero-frequency ACL method for estimating a location of a probe, in accordance with an embodiment of the present invention. The process begins with a zero-frequency ACL calibration phase  90 , after which the system is operated in a zero-frequency ACL tracking phase  92 . 
     In some embodiments, prior to inserting the probe for performing a tracking, a calibration tool is inserted and acquires a set of calibration zero-frequency impedance-magnitudes between the calibration tool, while being located at calibration locations, and the one or more body-surface electrodes  60 P at the first and second electrical frequencies, and corresponding calibration locations; 
     Processor  46  estimates, based on the acquired first and second impedance-magnitudes, one or more zero-frequency impedance-magnitudes between the calibration tool and the one or more body-surface electrodes. 
     In calibration phase  90  processor  46  correlates between a set of zero-frequency impedances {Z Cal (0)} Locations  and a respective set of locations of in heart  38  (i.e., by deriving zero-frequency calibration-impedances at respective measured locations). 
     Calibration phase  90  begins with position tracking system  36  accurately measuring a location in heart  38 , at a location measurement step  72 . In parallel, system  36  measures, at the location, respective calibration impedance-magnitudes at two frequencies, at an impedances acquisition step  74 . Based on the calibration impedance-magnitudes, processor  46  derives the multiple respective zero-frequency calibration-impedances {Z Cal (0)}, at an impedance derivation step  76 . Next, processor  46  correlates the derived multiple zero-frequency calibration-impedances with the respective location, at an impedance calibration step  78 . At a storing step  80 , processor  46  stores in a memory the multiple zero-frequency calibration-impedances with the corresponding coordinates of measured locations. The process repeats itself over the various calibrated locations, until a portion of heart  38  is location-calibrated. 
     During tracking phase  92 , several probes are present in the organ and hence lower the impedances measured by probe  30 . The lowered (i.e., deviating) impedances are again measured at two frequencies, at a probe impedance-magnitude measurement step  82 . Next, processor  46  derives, from the measured probe impedance-magnitudes, zero-frequency probe-impedances, {Z PT (0)}, at a derivation step  84 . Next, processor  46  finds in calibration results a location having the best-correlated zero-frequency impedances with those of the given unknown location, at a location retrieval step  86 . For that, processor  46  correlates the zero-frequency probe-impedances with the zero-frequency calibration-impedances that were stored in a memory at step  80 , to find zero-frequency calibration-impedances, {Z Cal *(0)}, {Z Cal *(0)}⊆{Z Cal (0)} Locations  that are best correlated with {Z PT (0)}, i.e., having Z Cal *(0)≈Z PT (0) for each component of the set {Z PT (0)}, and then retrieving the measured location that corresponds to {Z Cal *(0)}. Finally, processor  46  estimates the unknown given based on the calibration results, at a location indicating step  88 . In an embodiment, {Z Cal *(0)} is a result of interpolation between values included in the set {Z Cal (0)} Locations , and processor  46  calculates a corresponding interpolated location between the measured locations. In an optional embodiment, processor  46  indicates the location of probe  30  that was estimated at step  88  on display  52 . 
     The example flow chart shown in  FIG. 3  is chosen purely for the sake of conceptual clarity. For example, the acquisition of signals during tracking and their analysis can be performed at least partially in parallel. 
     It will be appreciated that the embodiments described above are cited by way of example, and that the present invention is not limited to what has been particularly shown and described hereinabove. Rather, the scope of the present invention includes both combinations and sub-combinations of the various features described hereinabove, as well as variations and modifications thereof which would occur to persons skilled in the art upon reading the foregoing description and which are not disclosed in the prior art. Documents incorporated by reference in the present patent application are to be considered an integral part of the application except that to the extent any terms are defined in these incorporated documents in a manner that conflicts with the definitions made explicitly or implicitly in the present specification, only the definitions in the present specification should be considered.