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Timestamp: 2014-09-02 09:23:54
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Matched Legal Cases: ['application No. 60', 'application No. 60', 'application No. 60', 'application No. 60', 'art 10', 'art 10', 'art 10', 'art 10', 'application No. 60', 'application No. 60', 'Application No. 07783793']

Patent US7774051 - System and method for mapping electrophysiology information onto complex ... - Google PatentsSearch Images Maps Play YouTube News Gmail Drive More »Sign in<nobr>Advanced Patent Search</nobr>PatentsThe instant invention relates to an electrophysiology apparatus and method used to measure electrical activity occurring in a portion of tissue of a patient and to visualize the electrical activity and/or information related to the electrical activity. In particular, the instant invention relates to...http://www.google.com/patents/US7774051?utm_source=gb-gplus-sharePatent US7774051 - System and method for mapping electrophysiology information onto complex geometryAdvanced Patent SearchPublication numberUS7774051 B2Publication typeGrantApplication numberUS 11/647,276Publication dateAug 10, 2010Filing dateDec 29, 2006Priority dateMay 17, 2006Fee statusPaidAlso published asEP2018115A2, EP2018115A4, US8364253, US20080009758, US20100274123, WO2007137045A2, WO2007137045A3Publication number11647276, 647276, US 7774051 B2, US 7774051B2, US-B2-7774051, US7774051 B2, US7774051B2InventorsEric Jon VothOriginal AssigneeSt. Jude Medical, Atrial Fibrillation Division, Inc.Export CitationBiBTeX, EndNote, RefManPatent Citations (109), Non-Patent Citations (8), Referenced by (1), Classifications (7), Legal Events (2) External Links: USPTO, USPTO Assignment, EspacenetSystem and method for mapping electrophysiology information onto complex geometryUS 7774051 B2Abstract The instant invention relates to an electrophysiology apparatus and method used to measure electrical activity occurring in a portion of tissue 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.
CROSS-REFERENCE TO RELATED APPLICATIONS This application claims the benefit of U.S. provisional patent application No. 60/800,848, filed 17 May 2006, which is incorporated by reference herein as though fully set forth below.
The following co-pending applications are incorporated by reference as though fully set forth herein: U.S. application Ser. No. 11/227,006, filed 15 Sep. 2005; Ser. No. 10/819,027, filed 6 Apr. 2004; Ser. No. 11/647,275 (filed 29 Dec. 2006, entitled �System And Method For Complex Geometry Modeling Of Anatomy Using Multiple Surface Models� (which claims the benefit of U.S. provisional application No. 60/800,858, filed 17 May 2006, entitled �System And Method For Complex Geometry Modeling Using Multiple Geometries,�); and Ser. No. 11/647,304 (filed 29 Dec. 2006, entitled �Robotic Surgical System and Method for Diagnostic Data Mapping� (which claims the benefit of U.S. provisional application No. 60/851,042, filed 12 Oct. 2006, and which is a continuation-in-part of U.S. application Ser. No. 11/139,908, filed 27 May 2005, which claims the benefit of U.S. provisional application No. 60/575,411, filed 28 May 2004).
BRIEF SUMMARY OF THE INVENTION The present invention expands the previous capabilities of cardiac electrophysiology mapping systems by providing the ability to map electrophysiology measurements directly to previously obtained three-dimensional images.
BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is a schematic diagram of a system for performing a cardiac electrophysiology examination or ablation procedure wherein the location of one or more electrodes can be determined and recorded.
DETAILED DESCRIPTION OF THE INVENTION The present invention improves a system's ability to create an improved electrophysiology mapping of an anatomy. The present invention is not limited to creating accurate models of the heart, but for illustrative purposes, reference will often be made herein to a navigation and localization system used for assessment and treatment of cardiac tissue. The methodology described herein would be equally applicable to modeling other parts of the human anatomy. For purposes of illustrating the present invention, the techniques for creating an electrophysiology map of a cardiac tissue will be described below.
Of course, the three-dimensional model may utilize a segmented approach, including for example, a segmented CT or MRI scan image. A segmented model indicates that a subregion of a three-dimensional image has been digitally separated from a larger three-dimensional image, e.g., an image of the right atrium separated from the rest of the heart. Other methodologies and techniques for creating a three-dimensional model of a portion of the patient may also be utilized in accordance with the present invention, including for example, the methodologies and techniques disclosed in U.S. Pat. No. 6,728,562 (�the '562 patent�), the content of which is hereby incorporated by reference in its entirety.
The patient 11 is depicted schematically as an oval for simplicity. Three sets of surface electrodes (e.g., patch electrodes) are shown applied to a surface of the patient 11 along an X-axis, a Y-axis, and a Z-axis. The X-axis surface electrodes 12, 14 are applied to the patient along a first axis, such as on the lateral sides of the thorax region of the patient (e.g., applied to the patient's skin underneath each arm) and may be referred to as the Left and Right electrodes. The Y-axis electrodes 18, 19 are applied to the patient along a second axis generally orthogonal to the X-axis, such as along the inner thigh and neck regions of the patient, and may be referred to as the Left Leg and Neck electrodes. The Z-axis electrodes 16, 22 are applied along a third axis generally orthogonal to the X-axis and the Y-axis, such as along the sternum and spine of the patient in the thorax region and may be referred to as the Chest and Back electrodes. The heart 10 lies between these pairs of surface electrodes. An additional surface reference electrode (e.g., a �belly patch�) 21 provides a reference and/or ground electrode for the system 8. The belly patch electrode 21 is an alternative to a fixed intra-cardiac electrode 31. It should also be appreciated that, in addition, the patient 11 will have most or all of the conventional electrocardiogram (ECG) system leads in place. This ECG information is available to the system 8 although not illustrated in the FIG. 1.
In a preferred embodiment, the localization/mapping system is the EnSite NavX� navigation and visualization system of St. Jude Medical, Atrial Fibrillation Division, Inc. Other localization systems, however, may be used in connection with the present invention, including for example, the CARTO navigational and location system of Biosense Webster, Inc. and the LOCALISA intracardiac navigation system of Medtronic, Inc. The localization and mapping systems described in the following patents (all of which are hereby incorporated by reference in their entireties) can be used with the present invention: U.S. Pat. Nos. 6,990,370; 6,978,168; 6,947,785; 6,939,309; 6,728,562; 6,640,119; 5,983,126; and 5,697,377.
For example, all of the raw electrode voltage data is measured by the A/D converter 26 and stored by the computer 20 under the direction of software. This electrode excitation process occurs rapidly and sequentially as alternate sets of surface electrodes are selected and the remaining non-driven electrodes are used to measure voltages. This collection of voltage measurements is referred to herein as the �electrode data set.� The software has access to each individual voltage measurement made at each electrode during each excitation of each pair of surface electrodes.
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 catheter (sometimes referred to as an �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 data used to determine the location of the electrode(s) within the heart is measured while the surface electrode pairs impress an electric field on the heart. A number of electrode locations may be collected by either sampling a number (e.g., sixty-two electrodes spread among up to twelve catheters) simultaneously or in sequence (e.g., multiplexed) and/or by sampling one or more electrodes (e.g., the roving electrode 17) being moved within the patient (e.g., a chamber of the heart). In one embodiment, the location data for individual electrodes are sampled simultaneously, which allows for collection of data at a single stage or phase of a heartbeat. In another embodiment, location data may be collected either synchronously with one or more phases of the heartbeat or without regard for any particular stage of the heartbeat. Where the data is collected across the phases of the heartbeat, data corresponding to locations along the wall of the heart will vary with time. In one variation, the data corresponding to the outer or inner locations may be used to determine the position of the heart wall at the maximum and minimum volumes, respectively. For example, by selecting the most exterior points it is possible to create a �shell� representing the shape of the heart at its greatest volume.
Other methodologies and techniques for creating three-dimensional models of a portion of the patient may also be utilized in accordance with the present invention. For example, a convex hull may be generated using standard algorithms such as the Qhull algorithm. 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 may then be re-sampled over a more uniform grid and may be 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. The re-sampled surface generally may have a greater number of data points. The re-sampled surface may also be processed using a smoothing algorithm, which will give the geometry a much smoother appearance. Such a three-dimensional model, for example, provides an estimated boundary of the interior of the heart region from the set of points.
FIG. 3 schematically depicts another exemplary method for creating a shell corresponding to the shape of a heart chamber. The location data identifying position data points 40 of one or more electrodes within the heart chamber over a period of time is accessed. The location data may be represented as a cloud of points within the heart chamber. The most distant position data points 40 will thus correspond to the interior wall of the heart chamber in a relaxed or diastole state corresponding to its greatest volume. A shell or surface is rendered from this location data by fitting an array of �bins� 44 around groups of the position data points 40. The bins 44 are constructed by determining a mean center point 42 within the cloud of position data points 40 and then extending borders radially outward from the center point 42. The bins 44 extend to the furthest position data point 40 within the slice encompassed by the bin 44. It should be noted that even though FIG. 3 is schematically presented in two dimensions, the bins 44 are three-dimensional volumes. The radial end faces 46 of the bins 44 thus approximate the surface of the heart chamber wall. Common graphic shading algorithms can then be employed to �smooth� the surface of the shell thus created out of the radial end faces 46 of the bins 44.
Another example of creating a three-dimensional map using a cloud of points is described in U.S. application Ser. No.������ (filed 29 Dec. 2006, entitled �System And Method For Complex Geometry Modeling Of Anatomy Using Multiple Surface Models� and assigned attorney docket 0G-041001US/82410.0147)(which claims the benefit of U.S. provisional application Ser. No. 60/800,858, filed 17 May 2006, entitled �System And Method For Complex Geometry Modeling Using Multiple Geometries�). Yet another technique for creating a three-dimensional map of a tissue surface is described in U.S. application Ser. No.������ (filed 29 Dec. 2006, entitled �Robotic Surgical System and Method for Diagnostic Data Mapping� and assigned attorney docket number 0G-040406US/82410.0137) (which claims the benefit of U.S. provisional application No. 60/851,042, filed 12 Oct. 2006, and which is a continuation-in-part of U.S. application Ser. No. 11/139,908, filed 27 May 2005, which claims the benefit of U.S. provisional application No. 60/575,411, filed 28 May 2004).
Various electrophysiology data may be measured and presented to a cardiologist through the display 23 of the system 8 shown in FIG. 1. FIG. 4 depicts an illustrative computer display that may be displayed via the computer 20. The display 23, for example, may be used to show data to a user, such as a physician, and to present certain options that allow the user to tailor the configuration of the system 8 for a particular use. It should be noted that the contents on the display can be easily modified and the specific data presented is illustrative only and not limiting of the invention. An image panel 60 shows a three-dimensional model of a heart chamber 62 identifying regions that received a depolarization waveform at the same time, i.e., �isochrones,� mapped to the model in false color or grayscale. The isochrones are, in one variation, mapped to three-dimensional coordinates (e.g., X, Y, Z) corresponding to the electrogram from which they were obtained. The isochrones are also shown in guide bar 64 as a key, identifying information associated with a particular color or grayscale mapped to the three-dimensional model. In this image, the locations of multiple electrodes on a pair of catheters are also mapped to the three-dimensional model. Other data that may be mapped to the heart surface model include, for example, the magnitude of a measured voltage and the timing relationship of a signal with respect to heartbeat events. Further, the peak-to-peak voltage measured at a particular location on the heart wall may be mapped to show areas of diminished conductivity and may reflect an infarcted region of the heart.
In the variation shown in FIG. 4, for example, the guide bar 64 is graduated in milliseconds and shows the assignment of each color or grayscale to a particular time relationship mapped to the three-dimensional model. The relationship between the color or grayscale on the three-dimensional model image 62 and the guide bar 64 can also be determined by a user with reference to the information shown in panel 66. FIG. 5 shows an enlargement of the panel 66 depicted in FIG. 4. The panel 66, in this variation, shows timing information used to generate isochrones mapped on the three-dimensional model 62 shown in FIG. 4. In general, a fiducial point is selected as the �zero� time. In FIG. 5, for example, the inflection point 70 of a voltage appearing on a reference electrode is used as the primary timing point for the creation of isochrones. This voltage may be acquired from either a virtual reference or a physical reference (e.g., the roving electrode 17 shown in FIG. 1). In this variation, the voltage tracing corresponding to the fiducial point is labeled �REF� in FIG. 5. The roving electrode signal is depicted in FIG. 5 and is labeled �ROV.� The inflection point 72 of the voltage signal ROV corresponds to the roving electrode 31. The color guide bar 65 shows the assignment of color or grayscale tone for the timing relationship seen between inflection points 70 and 72 of the reference and roving voltage signals REF and ROV, respectively.
The amplitude of the voltage signal ROV corresponding to the roving electrode 17 is also shown on panel 66 of FIG. 5. The amplitude of the time-varying signal ROV is located between two adjustable bands 74 and 76, which can be used to set selection criteria for the peak-to-peak voltage of the signal ROV. In practice, regions of the heart with low peak-to-peak voltage are the result of infarcted tissue, and the ability to convert the peak-to-peak voltage to grayscale or false color allows identification of the regions that are infarcted or ischemic. In addition, a time-varying signal �V1� is also shown and corresponds to a surface reference electrode, such as a conventional ECG surface electrode. The signal V1, for example, may orient a user, such as a physician, to the same events detected on the surface of the patient.
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. (FIG. 6 is associated with an article by NADEMANEE, Koonlawee, M.D., FACC, et. al., A new approach for catheter ablation of atrial fibrillation. Mapping of the electrophysiologic substrate, Journal of the American College of Cardiology, (2004) Vol. 43, No. 11, 2044-53.) 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.�
As shown in FIG. 8, fibrillar myocardial muscle tissue can lead to irregular wavefronts of electrical activity during depolarization of the heart. The greater the ratio of fibrillar myocardial muscle tissue to compact myocardial muscle tissue, the more likely there is a propensity for atrial fibrillation. In such areas �atrial fibrillation nests� (or �AFIB nests�) may be identified as potential sources of atrial fibrillation. Thus, by use of frequency-domain information, a physician may be able to further identify potential trouble spots that may lead to atrial fibrillation.
As described above, the electrodes of at least one EP catheter are moved over the surface of the heart and while in motion they detect the electrical activation of the heart or other EP signals on the surface of the heart. During each measurement, the real-time location of the catheter electrode is noted along with the value of the EP voltage or signal. The collection of location points and the associated measurements are referred to herein as the �EP data set.� This data is then projected onto a surface of the three-dimensional model corresponding to the location of the electrode when the sampled EP data was taken. Since this model was not created while the locating surface electrodes are energized, a projection process may be used to place the electrical information on the nearest heart surfaces represented by the geometry. In one exemplary embodiment, for example, each point on the surface of the three-dimensional model is colored or gray-shaded according to the value of the single nearest location in the EP data set. This new point is used as the �location� for the presentation of EP data in the images presented to the physician.
In another embodiment, the EP data is mapped onto the three-dimensional model using a new and improved technique. Because the EP data is measured at points that may not be the same set of physical locations used to generate the three-dimensional model, the EP data must be projected onto a surface of the three-dimensional model. In this preferred embodiment, the EP data is projected onto the three-dimensional model for display purposes. The EP data values (peak voltage, activation time, maximum frequency, or other quantities) must also be interpolated onto the points of the three-dimensional geometry. Once the EP data is projected onto the three-dimensional model, the EP data may be converted into colors and rendered according to standard computer graphics techniques. A way to relate the three-dimensional model to the EP data structure must be determined. For many surface-interpolation problems, it is desirable to generate a good triangulation of the data points�connecting them into triangles which fill the x-y plane (in 2D). Then the data value can be approximated at any point in the plane using a smoothly weighted average of the three endpoints of its triangle. This triangular based interpolation is known as barycentric interpolation, although it is contemplated that other known methods of interpolation could be used. In ordinary 2D space, a particular triangulation called the Delaunay triangulation is commonly used and is known to give optimal results. The Delaunay triangulation is closely related to the Voronoi diagram, the set of regions surrounding each data point that are closer to that data point than any other. In particular, each pair of data points whose Voronoi regions border each other is connected by an edge in the Delaunay triangulation. But it is believed that there are no known algorithms for computing a Delaunay triangulation on arbitrary and complex surfaces such as the three-dimensional models of the heart as described in connection with this invention. The method of this preferred embodiment computes a good approximation to the Delaunay triangulation as follows. Each EP data point is projected to its closest point on the three-dimensional model, and those projected points are searched to determine Voronoi neighbors. A vertex is selected in the three-dimensional model, and the EP data map is searched for the two EP data points that are closest to the vertex in the three-dimensional model. Generally, the EP data points that are neighboring the selected vertex are searched first, and then generally, the neighbors of neighbors are searched, until the two closest EP data points are found. With high likelihood, those data points have Voronoi regions that border each other, and so the two points are connected with a Delaunay edge. The process is repeated for each of the other vertices in the three-dimensional model. Then, a plurality of triangles are formed out of this set of Delaunay edges, knowing that each edge should be part of exactly two triangles. If the resulting triangulation has any �holes��cycles of four or more edges not containing any triangles�the holes may be filled by recursively adding the shortest new edge connecting two data points of the cycle. This is necessary because the two-closest-data-point algorithm may not discover every Delaunay edge, although nearly all edges it does discover turn out to be Delaunay edges. Once the EP data points have been have been collected into this triangulation, the measured data may be interpolated onto each vertex of the three-dimensional model. Most vertices will be interior to one of the Delaunay triangles, and will be interpolated using EP data measured at each of the triangle's three data points. Some vertices may be sufficiently close to a triangle edge (e.g., it lies on or very close to the triangle edge), such that the value to be assigned will be bi-linearly interpolated from the respective measurements of the two endpoints. Preferably, a threshold may be set to dictate how close the vertex must be to an edge before bilinear interpolation is applied. A few vertices may be closer to a data point than any edge or triangle, in which case, the vertices will be assigned the same EP data as the close data point. Preferably, a threshold may be set to dictate how close the vertex must be to a measurement point before the value of the measurement point will be assigned. Once EP data values have been assigned to a plurality of points in the three-dimensional model, then a robust color map may be generated, and preferably, the color map is smoothed using a smoothing algorithm to provide a clinically reasonable color rendering, one in which the points in the three-dimensional model get their color only from measurements that were taken at nearby measurement points.
In yet another embodiment, the EP data is mapped onto the three-dimensional model using a technique involving subdividing the three-dimensional model. Specifically, the three-dimensional model is subdivided using triangulation in such a way as to make all EP data points vertices in a subdivided three-dimensional model. Then, the subdivided three-dimensional model may be processed using a mesh-coarsening or decimation algorithm that allows one to specify the output vertex set�which will be specified as being exactly the set of EP data points. The decimation program may then decide the proper connectivity for the points on the three-dimensional model. It is preferred in this embodiment that each vertex in the EP data be projected onto the closest vertex or edge of the subdivided three-dimensional model using the Kirsanov-Hoppe or Fast Marching geodesic algorithm. The output of the decimation program may then be submitted to a coloring program which can color the three-dimensional model based on its voltage levels. It is also contemplated that Delaunay edges that are longer than a predetermined distance threshold be disallowed.
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See p. 25 conference brochure and entire technical paper.Referenced byCiting PatentFiling datePublication dateApplicantTitleWO2012091766A1 *Sep 14, 2011Jul 5, 2012St. Jude Medical, Atrial Fibrillation Division, Inc.Electrophysiological mapping system using external electrodes* Cited by examinerClassifications U.S. Classification600/523International ClassificationA61B5/04Cooperative ClassificationA61B5/0402, A61B5/042, A61B2019/5253European ClassificationA61B5/0402, A61B5/042Legal EventsDateCodeEventDescriptionFeb 10, 2014FPAYFee paymentYear of fee payment: 4Apr 26, 2007ASAssignmentOwner name: ST. JUDE MEDICAL, ATRIAL FIBRILLATION DIVISION, INFree format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:VOTH, ERIC J.;REEL/FRAME:019214/0359Effective date: 20070322RotateOriginal ImageGoogle Home - Sitemap - USPTO Bulk Downloads - Privacy Policy - Terms of Service - About Google Patents - Send FeedbackData provided by IFI CLAIMS Patent Services©2012 Google