Source: https://patents.google.com/patent/US20070073179A1/en
Timestamp: 2019-08-22 22:35:47
Document Index: 719961703

Matched Legal Cases: ['art 10', 'art 10', 'art 10', 'art 10', 'art 10', 'art 10', 'art 10', 'art 10', 'art 10', 'art 10']

US20070073179A1 - System and Method for Three Dimensional Mapping of Electrophysiology Information - Google Patents
System and Method for Three Dimensional Mapping of Electrophysiology Information Download PDF
US20070073179A1
US20070073179A1 US11/227,006 US22700605A US2007073179A1 US 20070073179 A1 US20070073179 A1 US 20070073179A1 US 22700605 A US22700605 A US 22700605A US 2007073179 A1 US2007073179 A1 US 2007073179A1
US11/227,006
US8038625B2 (en
Valtino Afonso
2005-09-15 Application filed by St Jude Medical Atrial Fibrillation Division Inc filed Critical St Jude Medical Atrial Fibrillation Division Inc
2005-11-04 Assigned to ST. JUDE MEDICAL, DAIG DIVISION, INC. reassignment ST. JUDE MEDICAL, DAIG DIVISION, INC. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: ALFONSO, VALTINO X., SCHWEITZER, JEFFREY A., BELHE, KEDAR RAVINDRA
2006-09-05 Assigned to ST. JUDE MEDICAL, ATRIAL FIBRILLATION DIVISION, INC. reassignment ST. JUDE MEDICAL, ATRIAL FIBRILLATION DIVISION, INC. CHANGE OF NAME (SEE DOCUMENT FOR DETAILS). Assignors: ST. JUDE MEDICAL, DAIG DIVISION, INC.
2006-12-29 Priority claimed from US11/647,301 external-priority patent/US8229545B2/en
2007-03-29 Publication of US20070073179A1 publication Critical patent/US20070073179A1/en
2011-10-18 Publication of US8038625B2 publication Critical patent/US8038625B2/en
An electrophysiology apparatus is used to measure electrical activity occurring in a heart of a patient and to visualize the electrical activity and/or information related to the electrical activity. A three-dimensional map of the electrical activity and/or the information related to the electrical activity is created. Exemplary maps include a time difference between action potentials at a roving electrode and a reference electrode, the peak-to-peak timing of action potentials at the roving electrode, the peak negative voltage of action potentials at the roving electrode, complex fractionated electrogram information, a dominant frequency of an electrogram signal, a maximum peak amplitude at the dominant frequency, a ratio of energy in one band of the frequency-domain to the energy in a second band of the frequency-domain, a low-frequency or high-frequency passband of interest, a frequency with the maximum energy in a passband, a number of peaks within a passband, an energy, power, and/or area in each peak, a ratio of energy and/or area in each peak to that in another passband, and a width of each peak in a spectrum. Colors, shades of colors, and/or grayscales are assigned to values of the parameters and colors corresponding to the parameters for the electrograms sampled by the electrodes are updated on the three-dimensional model.
The instant invention relates to an electrophysiology apparatus used to measure electrical activity occurring in a heart of a patient and to visualize the electrical activity and/or information related to the electrical activity. In particular, the instant invention relates to three-dimensional mapping of the electrical activity and/or the information related to the electrical activity.
The heart contains two specialized types of cardiac muscle cells. The majority, around ninety-nine percent, of the cardiac muscle cells is contractile cells, which are responsible for the mechanical work of pumping the heart. Autorhythmic cells comprise the second type of cardiac muscle cells, which function as part of the autonomic nervous system to initiate and conduct action potentials responsible for the contraction of the contractile cells. The cardiac muscle displays a pacemaker activity, in which membranes of cardiac muscle cells slowly depolarize between action potentials until a threshold is reached, at which time the membranes fire or produce an action potential. This contrasts with a nerve or skeletal muscle cell, which displays a membrane that remains at a constant resting potential unless stimulated. The action potentials, generated by the autorhythmic cardiac muscle cells spread throughout the heart triggering rhythmic beating without any nervous stimulation.
Normal autorhythmic cardiac function may be altered by neural activation. The medulla, located in the brainstem above the spinal cord, receives sensory input from different systemic and central receptors (e.g., baroreceptors and chemoreceptors) as well as signals from other brain regions (e.g., the hypothalamus). Autonomic outflow from the brainstem is divided principally into sympathetic and parasympathetic (vagal) branches. Efferent fibers of these autonomic nerves travel to the heart and blood vessels where they modulate the activity of these target organs. The heart is innervated by sympathetic and vagal fibers. Sympathetic efferent nerves are present throughout the atria (especially in the sinoatrial node) and ventricles, including the conduction system of the heart. The right vagus nerve primarily innervates the sinoatrial node, whereas the left vagus innervates the atrial-ventricular node; however, there can be significant overlap in the anatomical distribution. Efferent vagal nerves also innervate atrial muscle. However, efferent vagal nerves only sparsely innervate the ventricular myocardium. Sympathetic stimulation increases heart rate and conduction velocity, whereas parasympathetic (vagal) stimulation of the heart has opposite effects.
Electrophysiology studies are used to identify and treat these arrhythmias. In one exemplary system, a measurement system introduces a modulated electric field into the heart chamber. The blood volume and the moving heart wall surface modify the applied electric field. Electrode sites within the heart chamber passively monitor the modifications to the field and a dynamic representation of the location of the interior wall of the heart is developed for display to the physician. Electrophysiology signals generated by the heart itself are also measured at electrode sites within the heart and these signals are low pass filtered and displayed along with the dynamic wall representation. This composite dynamic electrophysiology map may be displayed and used to diagnose the underlying arrhythmia.
The present invention expands the previous capabilities of cardiac electrophysiology mapping systems to provide additional diagnostic data using both the time domain and frequency domain representations of electrophysiology data. A three-dimensional map of the electrical activity and/or the information related to the electrical activity is created. Exemplary maps include a time difference between action potentials at a roving electrode and a reference electrode, the peak-to-peak voltage of action potentials at the roving electrode, the peak negative voltage of action potentials at the roving electrode, complex fractionated electrogram information, a dominant frequency of an electrogram signal, a maximum peak amplitude at the dominant frequency, a ratio of energy in one band of the frequency-domain to the energy in a second band of the frequency-domain, a low-frequency or high-frequency passband of interest, a frequency with the maximum energy in a passband, a number of peaks within a passband, an energy, power, and/or area in each peak, a ratio of energy and/or area in each peak to that in another passband, and a width of each peak in a spectrum. Colors, shades of color, and/or grayscales are assigned to values of the parameters and colors, shades of colors, and/or grayscales corresponding to the parameters for the electrograms sampled by the electrodes are updated on the three-dimensional model.
System Level Overview and Basic Location Methodology
FIG. 1 shows a schematic diagram of a system 8 according to the present invention for conducting cardiac electrophysiology studies by measuring electrical activity occurring in a heart 10 of a patient 11 and three-dimensionally mapping the electrical activity and/or information related to the electrical activity. In one embodiment, for example, the system 8 can instantaneously locate up to sixty-four electrodes in and/or around a heart and the vasculature of a patient, measure electrical activity at up to sixty-two of those sixty-four electrodes, and provide a three-dimensional map of time domain and/or frequency domain information from the measured electrical activity (e.g., electrograms) for a single beat of the heart 10. The number of electrodes capable of being simultaneously monitored is limited only by the number of electrode lead inputs into the system 8 and the processing speed of the system 8. The electrodes may be stationary or may be moving. In addition, the electrodes may be in direct contact with the wall of the heart, or may be merely generally adjacent to the wall of the heart to collect the electrical activity. In another embodiment in which an array electrode is used, the system 8 can determine electrograms for up to about 3000 locations along the wall of the heart. Such an array electrode is described in detail in U.S. Pat. No. 5,662,108, which is hereby incorporated by reference herein in its entirety.
An optional fixed reference electrode 31 (e.g., attached to a wall of the heart 10) is also shown on a second catheter 29. For calibration purposes, this electrode 31 may be stationary (e.g., attached to or near the wall of the heart) or disposed in a fixed spatial relationship with the roving electrode 17. The fixed reference electrode 31 may be used in addition or alternatively to, the surface reference electrode 21 described above. In many instances, a coronary sinus electrode or other fixed electrode in the heart 10 can be used as a reference for measuring voltages and displacements.
The signal generator 25 excites a pair of electrodes, for example the Y-axis electrodes 18, 19, which generates an electric field in the body of the patient 11 and the heart 10. During the delivery of the current pulse, the remaining surface electrodes are referenced to the surface electrode 21, and the voltages induced on these remaining electrodes are filtered via a low pass filter (LPF) 27. The LPF 27 may, for example, comprise an anti-aliasing filter (e.g., a 300 Hz analog LPF). The output of the LPF 27 is then provided to an analog-to-digital (A/D) converter 26 that converts the analog signal to a digital data signal. Further low pass filtering of the digital data signal may be subsequently performed by software executed on the computer 20 to remove electronic noise and cardiac motion artifact. This filtering may, for example, comprise a user-selectable cutoff frequency used to reduce noise. In this manner, the user can customize the system to trade off signal noise against signal fidelity according to the user's individual preferences. In this fashion, the surface electrodes are divided into driven and non-driven electrode sets. While a pair of surface electrodes (e.g., the X-axis electrodes 12, 14) are driven by the current generator 25 the remaining non-driven surface electrodes and other reference electrodes, if any, (e.g., the Y-axis electrodes 18, 19, the Z-axis electrodes 16, 22, the surface reference electrode 21, and, if present, the fixed reference electrode 31) are used as references to synthesize the position of any intracardial electrodes.
Thus, any two of the surface electrodes 12, 14, 16, 18, 19, 22 may be selected as a dipole source and drain with respect to a ground reference, e.g., the belly patch 21, while the unexcited electrodes measure voltage with respect to the ground reference. The measurement electrode 17 placed in the heart 10 is exposed to the field from a current pulse and is measured with respect to ground, e.g., the belly patch 21. In practice the catheters within the heart may contain multiple electrodes and each electrode potential may be measured. As previously noted, at least one electrode may be fixed to the interior surface of the heart to form a fixed reference electrode 31, which is also measured with respect to ground. Data sets from each of the surface electrodes, the internal electrodes, and the virtual electrodes are all used to determine the location of the measurement electrode 17 or other electrodes within the heart 10.
The raw electrode data is used to determine the “base” location in three-dimensional space (X, Y, Z) of the electrodes inside the heart, such as the roving electrode 17, and any number of other electrodes located in or around the heart and/or vasculature of the patient 11. FIG. 2 shows a catheter 13, which may be a conventional electrophysiology (EP) catheter, extending into the heart 10. In FIG. 2, the catheter 13 extends into the left ventricle 50 of the heart 10. The catheter 13 comprises the distal electrode 17 discussed above with respect to FIG. 1 and has additional electrodes 52, 54, and 56. Since each of these electrodes lies within the patient (e.g., in the left ventricle of the heart), location data may be collected simultaneously for each of the electrodes. In addition, when the electrodes are disposed adjacent to the surface, although not necessarily directly on the surface of the heart, and when the current source 25 is “off” (i.e., when none of the surface electrode pairs is energized), at least one of the electrodes 17, 52, 54, and 56 can be used to measure electrical activity (e.g., voltage) on the surface of the heart 10.
The electrode data may also be used to create a respiration compensation value used to improve the raw location data for the electrode locations as described in U.S. patent application publication no. 2004/0254437, which is hereby incorporated herein by reference in its entirety. The electrode data may also be used to compensate for changes in the impedance of the body of the patient as described in co-pending U.S. patent application no. ______, filed contemporaneously with this application on 15 Sep. 2005, which is also incorporated herein by reference in its entirety.
In one variation, for example, a convex hull may be generated using standard algorithms such as Qhull. The Qhull algorithm, for example, is described in Barber, C. B., Dobkin, D. P., and Huhdanpaa, H. T., “The Quickhull algorithm for convex hulls,” ACM Trans. on Mathematical Software, 22(4):469-483, December 1996. Other algorithms used to compute a convex hull shape are known and may also be suitable for use in implementing the invention. This surface is then re-sampled over a more uniform grid and interpolated to give a reasonably smooth surface stored as a three-dimensional model for presentation to the physician during the same or a later procedure. Such a three-dimensional model, for example, provides an estimated boundary of the interior of the heart region from the set of points.
Complex fractionated electrogram (CFE) and frequency-domain information may also be mapped to the three-dimensional model. CFE information, for example, may be useful to identify and guide ablation targets for atrial fibrillation. CFE information refers to irregular electrical activation (e.g., atrial fibrillation) in which an electrogram comprises at least two discrete deflections and/or perturbation of the baseline of the electrogram with continuous deflection of a prolonged activation complex (e.g., over a 10 second period). Electrograms having very fast and successive activations are, for example, consistent with myocardium having short refractory periods and micro-reentry. FIG. 6, for example, shows a series of electrograms. The first two electrograms, RAA-prox and RAA-dist, comprise typical electrograms from the right atrium of a patient such as from a proximal roving electrode and a distal roving electrode in the right atrium of a patient, respectively. The third electrogram, LA-roof, comprises a CFE electrogram, such as from the roof of the patient's left atrium. In this third electrogram, LA-roof, the cycle lengths indicated by the numbers shown in the electrogram are substantially shorter than the cycle lengths indicated by the numbers shown in the first two electrograms, RAA-prox and RAA-dist. In another example shown in FIG. 7, a first electrogram RA-Septum comprises fast and successive activations indicated by the arrows compared to the second electrogram RA. The fast and successive activations, for example, can be consistent with myocardial tissue having short refractory periods and micro-reentry, e.g., an atrial fibrillation “nest.”
Various numerical indices can be obtained from the frequency-domain of the electrogram signal. Any of these indices can then be mapped to a three-dimensional model of a patient's heart to allow a user such as a physician to identify locations on the wall of the heart that correspond to a particular characteristic. In one exemplary variation of the present invention, a dominant frequency of an electrogram signal can be identified in the frequency-domain, which has been obtained via an FFT. As can be seen in FIG. 9A, for example, a typical normal, or compact, myocardial muscle tissue may have a single peak in the spectrum, while a fibrillar myocardial muscle tissue has more spectral peaks than that for the compact myocardial muscle tissue. The number of spectral peaks may be determined for multiple points around the wall of the heart on a three-dimensional model as described above.
an electrical field generator for generating an electrical field in the patient;
at least one position electrode adapted to receive position data via said electrical field;
a plurality of data electrodes adapted to receive electrical data simultaneously from a plurality of locations within the patient;
at least one processor adapted to determine position information representative of said position data, to determine data information representative of said electrical data, and to correlate said data information to said position information; and
a presentation device adapted to present said correlated data information and position information on a map.
2. The system of claim 1, wherein said at least one position electrode comprises a roving electrode.
3. The system of claim 1, wherein at least one of said plurality of data electrodes comprises said at least one position electrode.
5. The system of claim 1, wherein said data information comprises complex fractionated electrogram information representative of said electrical data.
6. The system of claim 1, wherein said data information comprises frequency-domain information representative of said electrical data.
10. A method of acquiring for presenting information representative of electrophysiological activity of a patient, the method comprising:
generating an electrical field in the patient;
receiving position data from at least one position electrode;
receiving electrical data simultaneously from a plurality of data electrodes located in a plurality of locations within a patient;
determining position information representative of the position data;
determining data information representative of the electrical data;
correlating the data information and the position information;
presenting the correlated data information and position information on a map.
12. The method of claim 11, wherein the data information is presented via the three-dimensional model on which the data information is mapped to the plurality of locations corresponding to the data information.
19. A method for mapping electrophysiological information on a three-dimensional model, the method comprising:
acquiring electrogram data representative of electrophysiological activity of a physiological structure, wherein the electrogram data is in a time-domain;
transforming the electrogram data from the time-domain to a frequency-domain;
acquiring a graphic image of a surface of the physiological structure corresponding to the electrogram data; and
mapping the frequency domain electrogram data to the graphic image of the surface.
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