Source: https://patents.google.com/patent/EP2064990A1/en
Timestamp: 2020-06-06 14:29:27
Document Index: 435860054

Matched Legal Cases: ['Application No. 60', 'Application No. 11', 'art 12', 'art 12', 'art 12', 'Application No. 11']

EP2064990A1 - Determining locations of ganglia and plexi in the heart using complex fractionated atrial electrogram - Google Patents
EP2064990A1
EP2064990A1 EP08253842A EP08253842A EP2064990A1 EP 2064990 A1 EP2064990 A1 EP 2064990A1 EP 08253842 A EP08253842 A EP 08253842A EP 08253842 A EP08253842 A EP 08253842A EP 2064990 A1 EP2064990 A1 EP 2064990A1
EP08253842A
2008-11-28 Application filed by Biosense Webster Inc filed Critical Biosense Webster Inc
2009-06-03 Publication of EP2064990A1 publication Critical patent/EP2064990A1/en
2015-03-19 First worldwide family litigation filed litigation Critical https://patents.darts-ip.com/?family=40286311&utm_source=google_patent&utm_medium=platform_link&utm_campaign=public_patent_search&patent=EP2064990(A1) "Global patent litigation dataset” by Darts-ip is licensed under a Creative Commons Attribution 4.0 International License.
206010007515 Cardiac arrest Diseases 0.000 claims description 5
208000010496 Heart Arrest Diseases 0.000 claims description 5
230000000271 cardiovascular Effects 0.000 claims description 5
230000000747 cardiac Effects 0.000 abstract description 13
This Application claims the benefit of U.S. Provisional Application No. 60/990,961 , entitled "Determining Locations of Ganglia Plexus (GP) Areas in the Heart Using CFAE", filed November 29, 2007, which is herein incorporated by reference. This Application shares disclosure with copending Application No. 11/620,370 , entitled "Mapping of Complex Fractionated Atrial Electrogram", filed 05-January-2007.
The meanings of certain acronyms and abbreviations used herein are given in Table 1. Table 1 - Acronyms and Abbreviations GP Ganglionated Plexi AF Atrial Fibrillation CFAE Complex Fractionated Atrial Electrogram
Cardiac arrhythmias such as atrial fibrillation are an important cause of morbidity and death. Commonly assigned U.S. Patent No. 5,546,951 , and U.S. Patent No. 6,690,963, both issued to Ben Haim ; and PCT application WO 96/05768 , all of which are incorporated herein by reference, disclose methods for sensing an electrical property of heart tissue, for example, local activation time, as a function of the precise location within the heart. Data are acquired with one or more catheters having electrical and location sensors in their distal tips, which are advanced into the heart. Methods of creating a map of the electrical activity of the heart based on these data are disclosed in commonly assigned U.S. Patent No. 6,226,542 , and U.S. Patent No. 6,301,496, both issued to Reisfeld , which are incorporated herein by reference. As indicated in these patents, location and electrical activity is typically initially measured on about 10 to about 20 points on the interior surface of the heart. These data points are then generally sufficient to generate a preliminary reconstruction or map of the cardiac surface. The preliminary map is often combined with data taken at additional points in order to generate a more comprehensive map of the heart's electrical activity. Indeed, in clinical settings, it is not uncommon to accumulate data at 100 or more sites to generate a detailed, comprehensive map of heart chamber electrical activity. The generated detailed map may then serve as the basis for deciding on a therapeutic course of action, for example, tissue ablation, to alter the propagation of the heart's electrical activity and to restore normal heart rhythm.
Catheters containing position sensors may be used to determine the trajectory of points on the cardiac surface. These trajectories may be used to infer motion characteristics such as the contractility of the tissue. As disclosed in U.S. Patent No. 5,738,096, issued to Ben Haim , which is incorporated herein in its entirety by reference, maps depicting such motion characteristics may be constructed when the trajectory information is sampled at a sufficient number of points in the heart.
Turning now to the drawings, reference is initially made to Fig. 1, which is a pictorial illustration of a system 10 for detecting areas of abnormal electrical activity and performing ablative procedures on a heart 12 of a living subject 21 in accordance with a disclosed embodiment of the invention. The system comprises a probe, typically a catheter 14, which is percutaneously inserted by an operator 16, who is typically a physician, through the patient's vascular system into a chamber or vascular structure of the heart. The operator 16 brings the catheter's distal tip 18 into contact with the heart wall at a target site that is to be evaluated. Electrical activation maps are then prepared, according to the methods disclosed in the above-noted U.S. Patent Nos. 6,226,542 , and 6,301,496 , and in commonly assigned U.S. Patent No. 6,892,091 , whose disclosure is herein incorporated by reference.
Areas determined to be abnormal by evaluation of the electrical activation maps can be ablated application of thermal energy, e.g., by passage of radiofrequency electrical current through wires in the catheter to one or more electrodes at the distal tip 18, which apply the radiofrequency energy to the myocardium. The energy is absorbed in the tissue, heating it to a point (typically about 50°C) at which it permanently loses its electrical excitability. When successful, this procedure creates non-conducting lesions in the cardiac tissue, which disrupt the abnormal electrical pathway causing the arrhythmia. Alternatively, other known methods of applying ablative energy can be used, e.g., ultrasound energy, as disclosed in U.S. Patent Application Publication No. 2004/0102769 , whose disclosure is herein incorporated by reference. The principles of the invention are disclosed with respect to atrial complex fractionated electrograms, but can be applied to all heart chambers, to epicardial as well as endocardial approaches, and to mapping in sinus rhythm, and when many different cardiac arrhythmias are present.
The catheter 14 typically comprises a handle 20, having suitable controls on the handle to enable the operator 16 to steer, position and orient the distal end of the catheter as desired to the ablation. To aid the operator 16, the distal portion of the catheter 14 contains position sensors (not shown) that provide signals to a positioning processor 22, located in a console 24. The catheter 14 may be adapted, mutatis mutandis, from the ablation catheter described in commonly assigned U.S. Patent No. 6,669,692 , whose disclosure is herein incorporated by reference. The console 24 typically contains an ablation power generator 43.
The positioning processor 22 is an element of a positioning subsystem 26 that measures location and orientation coordinates of the catheter 14. Throughout this patent application, the term "location" refers to the spatial coordinates of the catheter, and the term "orientation" refers to its angular coordinates. The term "position" refers to the full positional information of the catheter, comprising both location and orientation coordinates.
Referring again to Fig. 1, the system 10 can be realized as the CARTO XP EP Navigation and Ablation System, available from Biosense Webster, Inc., 3333 Diamond Canyon Road, Diamond Bar, CA 91765, and suitably modified to execute the procedures described herein.
Using the system 10 (Fig. 1), an electrical activation map of a chamber of the heart 12 can be generated using the methods described in the above-noted U.S. Patent No. 6,892,091 . A summary of one of these methods, modified according to the aspects of the present invention, will facilitate an understanding of the invention. Reference is now made to Fig. 3, which depicts the distal end of the catheter 14 in contact with an endocardial surface 50 of the right atrium 52 of the heart 12, in accordance with a disclosed embodiment of the invention. The electrode 32 is maintained in contact with the endocardial surface 50 at a current contact point 54 throughout at least an entire cardiac cycle. During this time, location information is continuously measured by the position sensor 40 (Fig. 2), while electrical information, preferably, voltage (as a function of time), is measured by the electrode 32 and each of the non-contact electrodes 38 in the array 36 (Fig. 2).
The location of the contact electrodes at each of the contact points may be used to define the geometric map of the cardiac chamber. While not actually contacting the cardiac surface, the totality of the non-contact electrode locations defines a "cloud" of space, which represents a minimum chamber volume. These non-contact locations may be used, alternatively, or together with the location of the electrode 32 at each of the contact points, to define the chamber geometry.
A preferred method for generating the electrical map of the heart from the acquired location and electrical information is described in the above noted U.S. Patent No. 6,226,542 . Briefly, an initial, generally arbitrary, closed 3-dimensional curved surface (also referred to herein for brevity as a curve) is defined in a reconstruction space in the volume of the sampled points. The closed curve is roughly adjusted to a shape, which resembles a reconstruction of the sampled points. Thereafter, a flexible matching stage is preferably repeatedly performed one or more times in order to bring the closed curve to accurately resemble the shape of the actual volume being reconstructed. The 3-dimensional surface may be rendered to a video display or other screen for viewing by a physician or other user of the map.
Automatic detection of CFAE's is described in detail in the above-noted copending Application No. 11/620,370. However, a brief discussion here will facilitate understanding of some aspects of the present invention. CFAE's are nominally defined as areas that exhibit one of the following characteristics. In practice, a user or operator may vary these characteristics according to his experience and judgment with respect to a particular patient:
A method for mapping abnormal electrical activity in a heart of a living subject, comprising the steps of:
The method according to claim 1, wherein identifying one or more of the locations comprises determining that a number of the complex fractionated electrograms at the one or more of the locations complies with a predefined criterion.
The method according to claim 2, wherein compliance with the predefined criterion comprises identifying ones of the locations wherein the complex fractionated electrograms exceed a threshold number.
The method according to claim 2, wherein compliance with the predefined criterion comprises identifying ones of the locations having locally maximal numbers of complex fractionated electrograms.
The method according to claim 1, wherein deriving an electroanatomic map comprises coding the electroanatomic map according to numbers of the complex fractionated electrograms detected in the respective locations.
A computer software product for mapping abnormal electrical activity in a heart of a living subject, comprising a computer storage medium in which computer program instructions are stored, which instructions, when executed by a computer, cause the computer to accept as input electrical signal data that are obtained from respective locations of the heart, automatically analyze the signal data to identify complex fractionated electrograms therein, identify one or more of the locations as having ganglionated plexi responsively to identified ones of the complex fractionated electrograms at the one or more of the locations, deriving an electroanatomic map of the heart from the signal data that includes a spatial distribution of the complex fractionated electrograms and the ganglionated plexi, and display the electroanatomic map.
The computer software product according to claim 7, wherein the instructions further cause the computer to identify one or more of the locations by determining that a number of the complex fractionated electrograms at the one or more of the locations complies with a predefined criterion.
The computer software product according to claim 8, wherein compliance with the predefined criterion comprises an identification of ones of the locations wherein the complex fractionated electrograms exceed a threshold number.
The computer software product according to claim 8, wherein compliance with the predefined criterion comprises an identification of ones of the locations having locally maximal numbers of complex fractionated electrograms.
The computer software product according to claim 7, wherein the instructions further cause the computer to record responsively to an electrical stimulation of selected ones of the locations a cardiovascular response comprising at least one of a reduction in sinus rate, a reduction in blood pressure, and a period of asystole; and thereafter report a confirmation of a presence of the ganglionated plexi in the selected ones of the locations.
The computer software product according to claim 7, wherein the instructions further cause the computer to code the electroanatomic map according to numbers of the complex fractionated electrograms detected in the respective locations.
An apparatus for mapping electrical activity in a heart of a living subject, comprising:
The apparatus according to claim 13, wherein the processor is operative to identify one or more of the locations by determining that a number of the complex fractionated electrograms at the one or more of the locations complies with a predefined criterion.
The apparatus according to claim 14, wherein compliance with the predefined criterion comprises an identification of ones of the locations wherein the complex fractionated electrograms exceed a threshold number.
The apparatus according to claim 14, wherein compliance with the predefined criterion comprises an identification of ones of the locations having locally maximal numbers of complex fractionated electrograms.
The apparatus according to claim 13, wherein the processor is operative to record responsively to an electrical stimulation of selected ones of the locations a cardiovascular response comprising at least one of a reduction in sinus rate, a reduction in blood pressure, and a period of asystole; and thereafter report a confirmation of a presence of the ganglionated plexi in the selected ones of the locations.
The apparatus according to claim 13, wherein the processor is operative to code the electroanatomic map according to numbers of the complex fractionated electrograms detected in the respective locations.
EP08253842A 2007-11-29 2008-11-28 Determining locations of ganglia and plexi in the heart using complex fractionated atrial electrogram Withdrawn EP2064990A1 (en)
EP2064990A1 true EP2064990A1 (en) 2009-06-03
EP08253842A Withdrawn EP2064990A1 (en) 2007-11-29 2008-11-28 Determining locations of ganglia and plexi in the heart using complex fractionated atrial electrogram
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