Source: http://www.google.com/patents/US6066094?dq=6,406,777
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Patent US6066094 - Cardiac electromechanics - Google PatentsSearch Images Maps Play YouTube News Gmail Drive More »Sign inPatentsA method of constructing a cardiac map of a heart having a heart cycle including; bringing an invasive probe into contact with a location on a wall of the heart; determining, at at least two different phases of the heart cycle, a position of the invasive probe; and determining a local non-electrical...http://www.google.com/patents/US6066094?utm_source=gb-gplus-sharePatent US6066094 - Cardiac electromechanicsAdvanced Patent SearchPublication numberUS6066094 APublication typeGrantApplication numberUS 09/005,091Publication dateMay 23, 2000Filing dateJan 9, 1998Priority dateJul 20, 1993Fee statusPaidAlso published asUS5738096Publication number005091, 09005091, US 6066094 A, US 6066094A, US-A-6066094, US6066094 A, US6066094AInventorsShlomo Ben-HaimOriginal AssigneeBiosense, Inc.Export CitationBiBTeX, EndNote, RefManPatent Citations (61), Non-Patent Citations (58), Referenced by (144), Classifications (76), Legal Events (3) External Links: USPTO, USPTO Assignment, EspacenetCardiac electromechanics
US 6066094 AAbstract
A method of constructing a cardiac map of a heart having a heart cycle including; bringing an invasive probe into contact with a location on a wall of the heart; determining, at at least two different phases of the heart cycle, a position of the invasive probe; and determining a local non-electrical physiological value at the location. The method is repeated for a plurality of locations in the heart. The positions are combined to form a time-dependent map of at least a portion of the heart and local relationships between changes in positions of the invasive probe and determined local non-electrical physiological values are determined. Preferably, local electrical activity at the plurality of locations is also acquired.
1. A method of cardiac shaping comprising:generating a map of a heart; analyzing the map to determine a portion of the heart having a certain level of a physiological value thereat; and determining a pacing regime for changing the level of the physiological value. 2. A method according to claim 1, comprising pacing the heart using the determined pacing regime.
3. A method according to claim 1, comprising:determining an effect of the pacing regime on the level of the physiological value; and repeating the analyzing, determining and pacing until a desired level of the value is reached. 4. A method according to claim 1, wherein the physiological value is changed by changing an activation time of the portion.
5. A method according to claim 1, wherein the physiological value comprises a thickness of local muscle tissue.
6. A method according to claim 1, wherein the physiological value comprises a measure of local stress.
7. A method according to claim 1, wherein the physiological value comprises a measure of local intra-cardiac pressure.
8. A method according to claim 1, wherein changing the level of the physiological value comprises maintaining the physiological value within a given range.
9. A method according to claim 8, wherein the range comprises a phase-dependent range, including a different preferred range of levels of the value for each phase of a cardiac cycle.
10. Apparatus for determining a preferred pacing regime of a heart, comprising:a sensor for generating a map of the heart and for determining a physiological value at a plurality of locations from said map of the heart; and a processor which receives the physiological values from the sensor and determines a pacing regime which changes a distribution of the physiological value in a desired manner. 11. Apparatus according to claim 10, wherein the distribution comprises a temporal distribution.
12. Apparatus according to claim 10, wherein the distribution comprises a spatial distribution.
13. Apparatus according to claim 10, and comprising a pacemaker which paces the heart according to the determined pacing regime.
14. Apparatus according to claim 10, wherein the computer compares the physiological values determined under different pacing regimes to determine the effect of the pacing.
15. Apparatus according to claim 10, wherein the physiological value comprises a measure of a thickness of tissue at the location.
16. Apparatus according to claim 10, wherein the physiological value comprises a measure of perfusion.
17. Apparatus according to claim 10, wherein the physiological value comprises a plateau duration.
This application is a continuation of U.S. patent application Ser. No. 08/595,365, filed Feb. 1, 1996, now U.S. Pat. No. 5.738,096 which claims the benefit of (1) then co-pending U.S. provisional application Ser. No. 60/009,769, filed Jan. 11, 1996, and is a continuation-in-part of (2) then co-pending PCT patent patent application No. PCT/US95/01103, filed Jan. 24, 1995, which entered the national phase as U.S. patent application Ser. No. 08/793,371 filed May 19, 1997 and of (3) U.S. patent application Ser. No. 08/293,859, filed Aug. 19, 1994, now abandoned, and (4) U.S. patent application Ser. No. 08/311,593, filed Sep. 23, 1994, now U.S. Pat. No. 5,546,951, which in turn is a divisional of U.S. patent application Ser. No. 08/094,539, filed Jul. 20, 1993, now U.S. Pat. No. 5,391,199.
Cardiovascular diseases accounted for approximately 43 percent of the mortality in the United States of America in 1991 (923,000 persons). However, many of these deaths are not directly caused by an acute myocardial infraction (AMI). Rather, many patients suffer a general decline in their cardiac output known as heart failure. Once the overt signs of heart failure appear, half the patients die within five years. It is estimated that between two and three million Americans suffer from heart failure and an estimated 200,000 new cases appear every year. In many cases heart failure is caused by damage accumulated in the patient's heart, such as damage caused by disease, chronic and acute ischemia and especially (.sup.˜ 75%) as a result of hypertension.
It should be noted that even though the left and the right sides of heart 20 operate in synchronization with each other, their phases do not overlap. In general, right atrial systole starts slightly before left atrial systole and left ventricular systole starts slightly before right ventricular systole. Moreover, the injection of blood from left ventricle 26 into aorta 38 usually begins slightly after the start of injection of blood from right ventricle 24 towards the lungs and ends slightly before end of injection of blood from right ventricle 24. This is caused by pressures differences between the pulmonary and body circulatory systems.
When heart 20 contracts (during systole), the ventricle does not contract in a linear fashion, such as shortening of one dimension or in a radial fashion. Rather, the change in the shape of the ventricle is progressive along its length and involves a twisting effect which tends to squeeze out more blood. It should be appreciated that blood which remains in one place without moving, even in the heart, can clot, so it is very important to eject as much blood as possible out of the heart. FIG. 2 shows an arrangement of a plurality of muscle fibers 44 around left ventricle 28 which enables this type of contraction. When muscle fibers 44 are arranged in a spiral manner as shown in FIG. 2 and the activation of muscle fibers 44 is started from an apex 46 of left ventricle 28, left ventricle 28 is progressively reduced in volume from the bottom up. The spiral arrangement of muscle fibers 44 is important because muscle fibers typically contract no more than 50% in length. A spiral arrangement results in a greater change of left ventricular volume than is possible with, for example, a flat arrangement in which the fibers are arranged in bands around the heart. An additional benefit of the spiral arrangement is a leverage effect. In a flat arrangement, a contraction of 10% of a muscle fiber translates into a reduction of 10% of the ventricular radius. In a spiral arrangement with, for example, a spiral angle 48 of 45�, a 10% contraction translates into a 7.07% contraction in ventricular radius and a 7.07% reduction in ventricular length. Since the ventricular radius is typically smaller than the ventricular length, the net result is that, depending on spiral angle 48, a tradeoff is effected between a given amount of contraction and the amount of force exerted by that contraction.
As described above, activation of the heart muscle is from the apex up. Thus, the muscle on the top of the ventricle could theoretically exert more force than the muscle at apex 46, which would cause a distention at apex 46. The varying spiral angle is one mechanism to avoid distention. Another mechanism is that the muscle near apex 46, which is activated first, is slightly more developed than the muscle at the top of the ventricle, which is activated last. As a result of the above described mechanisms, the force exerted by the ventricular wall is more evenly distributed over time and space.
FIG. 3 shows the main conduction pathways in heart 20. An SA node 50, located in right atrium 22, generates an activation signal for initiating contraction of muscle fibers 44. The activation signal is transmitted along a conduction pathway 54 to left atria 26 where the activation signal is locally disseminated via Bachman bundles and Crista terminals. The activation signal for contracting the left and right ventricles is conducted from SA node 50 to an AV node 52, where the activation signal is delayed. The ventricles are normally electrically insulated from the atria by non-conducting fibrous tissue, so the activation signal must travel through special conduction pathways. A left ventricle activation signal travels along a left pathway 58 to activate left ventricle 28 and a right ventricle activation signal travels along a right pathway 56 to activate right ventricle 24. The activation signal is locally disseminated in the left and right ventricles via Purkinje fibers 60. Generally, the conduction pathways convey the activation signal to apex 46 where they are locally disseminated via Purkinje fibers 60 and propagation over the rest of the heart is achieved by conduction in muscle fibers 44. In general, the activation of the heart is from the inner surface towards the outer surface. It should be noted that electrical conduction in muscle fibers 44 is generally faster along the direction of the muscle fibers. Thus, the conduction velocity of the activation signals in heart 20 is generally anisotropic.
An important factor which may affect the length of the plateau is the existence of ionic currents which propagate from the most recently activated portions of the heart towards the earlier activated portions of the heart. As can be appreciated, the ionic current starts at the last activated portion of the heart and progresses back along the path of the activation. Thus, it is the later activated portions of the heart which are first affected by the ionic current. As a result, the repolarization of these cells is relatively faster than the repolarization of the first activated muscle fibers, and their contraction time is relatively shorter. As can be appreciated, in a healthy heart, where the propagation time of the activation signal is relatively short, the ionic currents are significantly smaller than in a diseased or externally paced heart.
One of the main results of the contraction of the ventricles is increased intra-ventricular pressure. In general, when the intra-cardiac pressure is higher, the outflow from the heart into the circulatory system is stronger and the efficiency of the heart is higher. A mathematical relationship termed Laplace's law can be used to model the relationship between the pressure in the ventricle and the tension in the wall of the ventricle. Laplace's law was formulated for generally spherical or cylindrical chambers with a distentible wall, however, the law can be applied to the ventricles since they are generally elongated spherical in shape. FIGS. 5A-C show three formulations for determining the tension in a portion of the ventricle wall, all of which are based of the law of Laplace. In FIG. 5A, the tension across a cross-section of the wall is shown wherein T, the tension in the wall, is equal to the product of P, the transmural pressure across the wall, r (squared), the radius of the ventricle, and r. FIGS. 5B and C show formulas for calculating the tension per unit in portions of the ventricular wall, for example in FIG. 5C, for a unit cross-sectional area of muscle in a wall of thickness δ.
Unfortunately, not all people have healthy hearts and vascular systems. Some types of heart problems are caused by disease. HCM (hypertrophic cardiomyopathy) is a disease in which the left ventricle and, in particular, the ventricular septum hypertrophy, sometimes to an extent which blocks the aortic exit from the left ventricle. Other diseases, such as atrophy causing diseases reduce the amount of muscle fibers in portions of the heart.
Lameh Fananapazir, et al., in "Long-Term Results Of Dual-Chamber (DDD) Pacing In Obstructive Hypertrophic Cardiomyopathy", Circulation, Vol. 90, No. 60, pp 2731-2742, December 1994, describes the effects of pacing a HCM-diseased heart using DDD pacing at the apex of the right ventricle. One effect is that the muscle mass near the pacing location is reduced, i.e., the ventricular septum is atrophied. The atrophy is hypothesized to be caused by the changes in workload at the paced location which are due to the late activation time of ventricular segments far from the pacing location.
Margarete Hochleitner, et al., in "Long-Term Efficiency Of Physiologic Dual-Chamber Pacing In The Treatment Of End-Stage Idiopathic Dilated Cardiomyopathy", American Journal of Cardialogy, volume 70, pp 1320-1325, 1992, describes the effect of DDD pacing on hearts which are dilated as a result of idiopathic dilated cardiomyopathy. DDD pacing resulted in an improvement of cardiac function and in a reduction in hypertrophy in several patients. In addition, it is suggested that positioning the ventricular electrode of the DDD pacemaker in near the apex of the right ventricle reduced the stress at the apex of the left ventricle, by its early activation.
Xavier Jeanrenaud, et al., in "Effects Of Dual Chamber Pacing In Hypertrophic Obstructive Cardiomypathy", The Lancet, Vol. 339, pp 1318-1322, May 30, 1992, teaches that to ensure success of DDD pacing in HCM diseased hearts, an optimum AV interval (between atrial activation and ventricular activation) is required.
Several methods may be used to treat heart failure. One method is to connect assist pumps to the patient's circulatory system, which assist the heart by circulating the blood. To date, no satisfactory long-term assist pump has been developed. In some cases, a diseased heart is removed and replaced by another human heart. However, this is an expensive, complicated and dangerous operation and not many donor hearts are available. Artificial hearts suffer from the same limitations as assist pumps and, like them, are not yet practical.
When used herein, the terms "physiological variable" and "cardiac parameter" do not include electrical activity, rate, arrhythmia or sequencing of the heart. The term "local physiological value" does not include electrical activity, per se, rather it refers to a local physiological state, such as contraction of local heart muscle, perfusion or thickness. The term "location" refers to a location on or in an object, such as the heart muscle. For example, a valve or an apex of the heart. "Position" refers to a position in space, usually relative to a known portion of the heart, for example, 1.5 inches perpendicular from the apex of the heart.
Preferably, the catheter is in contact with the heart wall through the entire cardiac cycle. It should be appreciated that contact with the heart wall can be achieved either from the inside or from the outside of the heart, such as outside contact being achieved by inserting the catheter into the coronary arteries and/or veins. Alternatively, the catheter is directly inserted into the body (not through the vascular system), such as through a lacoroscope or during surgery.
Although the above maps are described as being time based or cardiac-phase based, in a preferred embodiment of the invention, measurements are binned based on geometrical characteristics of the heart or on ECG or electrogram characteristics. Preferably, the ECG characteristics comprise pulse rate and/or ECG morphology.
A preferred embodiment of the invention provides for changing the distribution of muscle-mass in the heart from an existing muscle-mass distribution to a desired muscle-mass distribution. This is achieved by adjusting the pacing of the heart to achieve an activation profile which affects such change. Preferably, portions of the heart which are relatively atrophied are activated so that relatively more effort is required of them than previously. Alternatively or additionally, portions of the heart which are hypertrophied are activated so that less effort is required of them than previously. Preferably, the decision how to change the activation profile of the heart is based on a map of the heart, further preferably, using a map which shows the local energy expenditure and/or the local work performed by each portion of the heart. Alternatively or additionally, a map which shows the ratio between local perfusion and local energy expenditure is used. Preferably, the activation profile of the heart is changed when the heart approaches the desired muscle mass distribution. Typically, the heart is paced using an implanted pacemaker. Preferably, a map is used to determine the optimal location for the pacing electrode(s). Additionally or alternatively, pharmaceuticals are used to affect the pacing.
Although the description of the present invention focuses on the heart, apparatus and methods described herein are also useful for mapping and affecting other organs, such as the stomach and other muscles. For example, in treating atrophied muscles using stimulation, an electromechanical map of the muscle is preferably acquired during a test stimulation to help in determining and optimal stimulation regime.
There is thus provided, in accordance with a preferred embodiment of the present invention, a method of constructing a map of a heart having a heart cycle comprising:
(a) bringing an probe into contact with a location on a wall of the heart;
(b) determining a position of the probe at the location;
(c) repeating (a)and(b) for a multiplicity of locations of the heart; and
(d) combining the positions to form a map of at least a portion of the heart.
In a preferred embodiment of the present invention, the method includes determining local pathologies in the heart based on the map.
In a preferred embodiment of the present invention, the method includes determining at least a second position of the probe at a phase of the cycle different from the phase at the position determination of (b) and wherein the map is a phase dependent geometric map. Preferably, the second position determination is performed at the location. Preferably, the method includes analyzing the map to determine underutilized portions of the heart. Additionally or alternatively, the method includes analyzing the map to determine procedures for improving the operation of the heart.
In a preferred embodiment of the present invention, the method includes determining local information at the location and wherein combining the positions comprises associating positions with locations and combining the locations and the local information to form a map of local information. Preferably, the method includes analyzing the map to determine overstressed portions of the heart. Preferably, the local information is determined using a sensor not mounted on the probe. According to one preferred embodiment, the local information is determined using a sensor external to the body. According to another preferred embodiment, the local information is determined using a sensor on the probe.
According to one preferred embodiment of the present invention, the local information and the position of the probe are determined at substantially the same time. In another preferred embodiment of the present invention, the local information and the position of the probe are determined at substantially different times.
In a preferred embodiment of the present invention, the method includes determining a relationship between changes in positions of the probe and determined local information at at least one location. Preferably, the method further includes determining local pathologies in the heart based on the at least one local relationship.
In a preferred embodiment of the present invention, the method includes determining local information at at least two phases of the heart cycle and wherein combining the positions comprises combining the positions and the local information to form a phase dependent map of local information. Preferably, the method further includes analyzing changes in the determined local information. Preferably, the method further includes determining local pathologies in the heart based on the changes in the local information. Preferably, the changes are a function of the heart cycle and further comprising determining the phase of the heart cycle at which the local information is determined.
In a preferred embodiment of the present invention, the method includes determining local electrical activity at the location and wherein the changes are related to local electrical activity at the location.
In a preferred embodiment of the present invention, the method includes analyzing the map to determine underutilized portions of the heart. Additionally or alternatively, the method includes analyzing the map to determine procedures for improving the operation of the heart.
In a preferred embodiment of the present invention, the local information comprises a chemical concentration value. Additionally or alternatively, the local information comprises a thickness of the heart at the location. Preferably, the thickness of the heart is determined using an ultrasonic transducer mounted on the probe.
In a preferred embodiment of the present invention, the local information includes the thickness of the heart and the method further includes determining a reaction of the heart to an activation signal by analyzing changes in the thickness of the heart.
In a preferred embodiment of the present invention, the local information comprises a measure of a perfusion of the heart at the location. Additionally or alternatively, the local information comprises a measure of the work performed by the heart portion at the location. Additionally or alternatively, the local information comprises local electrical activity. Preferably, the electrical activity comprises a local electrogram. Additionally or alternatively, the electrical activity comprises a local activation time.
Additionally or alternatively, the electrical activity comprises a local plateau duration of heart tissue at the location.
In a preferred embodiment of the present invention, the method includes determining a local change in the geometry of the heart. Preferably, the method further includes determining local pathologies in the heart based on the local changes in geometry. Preferably, the local change comprises a change in a local radius of the heart wall at the location. Preferably, the method includes determining an intra-cardiac pressure of the heart.
In a preferred embodiment of the present invention, the method includes determining a relative tension of the heart at the location by applying Laplace's law to the change in the local radius.
In a preferred embodiment of the present invention, the method includes determining the activity of the heart at the location. Preferably, determining the activity comprises determining a relative motion profile of the location on the heart wall relative to neighboring locations. Preferably, the method further includes determining local pathologies in the heart based on the relative motion profile. Preferably, determining the activity comprises determining a motion profile of the heart at the location. Preferably, the method includes determining local pathologies in the heart based on the motion profile. Preferably, the method includes monitoring the stability of the contact between the probe and the heart based on the motion profile. Preferably, monitoring comprises detecting changes in the motion profile for different heart cycles. Additionally or alternatively, monitoring comprises detecting differences in positions of the probe at the same phase for different heart cycles.
In a preferred embodiment of the present invention, the method includes reconstructing a surface portion of the heart. Preferably, the method further includes determining local pathologies in the heart based on the reconstructed surface portion.
In a preferred embodiment of the present invention, the method includes binning positions according to characteristics of the heart cycle. Preferably, the method further includes separately combining the information in each bin into a map. Preferably, the method further includes determining differences between the maps. Preferably, the method further includes determining local pathologies in the heart based on the determined differences between maps.
In a preferred embodiment of the present invention, the characteristics comprise a heart rate. Additionally or alternatively, the characteristics comprise a morphology of an ECG of the heart.
In a preferred embodiment of the present invention, the method includes binning local information according to characteristics of the heart cycle. Preferably, the characteristics comprise a heart rate. Additionally or alternatively, the characteristics comprise a morphology of an ECG of the heart.
In a preferred embodiment of the present invention, the positions of the probe are positions relative to a reference location. Preferably, the reference location is a predetermined portion of the heart. Preferably, a position of the reference location is determined using a position sensor. Preferably, the method includes periodically determining a position of the reference location. Preferably, the position of the reference location is acquired at the same phase of consecutive cardiac cycles.
In one preferred embodiment of the present invention, the probe is located in a coronary vein or artery.
In another preferred embodiment of the present invention, the probe is located outside a blood vessel.
In still another preferred embodiment of the present invention, the probe is located in a coronary vein or artery.
There is also provided in accordance with a preferred embodiment of the invention, a method of diagnosis including:
constructing a first map of a heart as described above;
performing a medical procedure on the heart; and
constructing a second map of the heart.
There is provided in accordance with another preferred embodiment of the invention a method of cardiac shaping including:
(a) choosing a portion of a heart having a certain amount of muscle tissue thereat;
(b) determining a pacing regime for changing the workload of the portion; and
(c) pacing the heart using the determined pacing regime. Preferably, the workload of the portion is increased in order to increase the amount of muscle tissue therein. Alternatively, the workload of the portion is decreased in order to decrease the amount of muscle tissue thereat.
Preferably, the workload is changed by changing a plateau duration in the portion. Alternatively or additionally, the workload is changed by changing an activation time in the portion.
There is also provided in accordance with yet another preferred embodiment of the invention a method of cardiac shaping including:
(b) determining a pacing regime for changing the plateau duration of the portion; and
(c) pacing the heart using the determined pacing regime. Preferably, the plateau duration of the portion is changed in order to increase the amount of muscle tissue therein. Alternatively, the plateau duration of the portion is changed in order to decrease the amount of muscle tissue thereat.
Preferably, the plateau duration is changed by applying a local voltage in the portion. Alternatively or additionally, the plateau duration is changed by changing an activation time in the portion.
Preferably, cardiac shaping includes constructing a map of at least a part of the heart.
Preferably, cardiac shaping includes:
(d) determining after a time the effect of (c); and
(e) repeating (a)-(d) if a desired effect is not reached.
There is further provided in accordance with still another preferred embodiment of the invention a method of implanting a pacemaker electrode including:
(b) determining a cardiac parameter associated with pacing at the location;
(d) implanting the electrode at the location in which the cardiac parameter is optimal. Preferably, the cardiac parameter includes stroke volume. Alternatively or additionally, the cardiac parameter includes intra-cardiac pressure. Preferably, the cardiac parameter is determined by measuring using an invasive probe.
There is also provided in accordance with a preferred embodiment of the invention a method of pacing a heart including:
(b) determining a pacing regime which changes the temporal or spatial distribution of the physiological value; and
(c) pacing the heart using the determined pacing regime. Preferably, changing the distribution includes maintaining physiological values within a range. Preferably, the range is a locally determined range.
Preferably, (a)-(c) are performed by a pacemaker. Alternatively or additionally, the physiological values are determined substantially simultaneously. Alternatively or additionally, the physiological value includes perfusion. Alternatively or additionally, the physiological value includes stress. Alternatively or additionally, the physiological value is plateau duration.
There is provided in accordance with an additional preferred embodiment of the invention a method of adaptive pacing including:
(b) pacing the heart using the preferred pacing regime. Preferably, determining a preferred pacing regime includes generating a map of the activation profile of the heart. Preferably, determining a preferred pacing regime includes generating a map of the reaction profile of the heart. Preferably, adaptive pacing includes analyzing an activation map or a reaction map of the heart to determine portions of the heart which are under-utilized due to an existing activation profile of the heart.
Preferably, pacing is initiated by implanting at least one pacemaker electrode in the heart. Further preferably, the at least one pacemaker electrode includes a plurality of electrodes.
Preferably, pacing is initiated by changing the electrification of a plurality of previously implanted pacemaker electrodes.
Preferably, the physiological variable is a stroke volume.
There is provided in accordance with yet another preferred embodiment of the invention, a method of pacing including:
(b) changing the pacing scheme to a second pacing scheme, where the change in pacing is not directly related to arrhythmias, fibrillation or heart rate in the heart. Preferably, each of the pacing regimes optimizes the utilization of different portions of the heart. Alternatively or additionally, the changing of the pacing regimes temporally distributes workload between different portions of the heart.
There is also provided in accordance with a preferred embodiment of the invention, a pacemaker including:
a controller which changes the electrification of the electrodes in response to a plurality of measured local values of a heart to achieve an optimization of a cardiac parameter of the heart.
Preferably, the measured values include a local activation time. Alternatively or additionally, the local values include a local plateau duration. Preferably, the local values are measured using the electrodes. Alternatively or additionally, the values are measured using a sensor.
Preferably, the local values include non-electrical local physiological values.
Preferably, the cardiac parameter includes a stroke volume. Alternatively or additionally, the cardiac parameter includes an intra-cardiac pressure. Preferably, the cardiac parameter is measured by the pacemaker.
(c) repeating (a)-(b) for a plurality of locations of the heart;
(e) analyzing the map to determine structural anomalies in the heart. Preferably, the positions are acquired during systole, and analyzing includes determining a bulge in the geometry of the heart. Alternatively or additionally, analyzing the map includes analyzing the map to determine an abnormal size of the heart. Alternatively or additionally, analyzing the map includes analyzing the map to determine an abnormal size of a chamber of the heart.
Preferably, (b) is repeated at least a second time, at the same location and at a different phase of the cardiac cycle than (b).
There is provided in accordance with still another preferred embodiment of the invention a method of adding a conductive pathway in a heart between a first segment of the heart and a second segment of the heart, including:
providing a conductive device having a distal end and a proximal end;
electrically connecting the distal end of the device to the first location; and
electrically connecting the proximal end of the device to the second location.
There is also provided in accordance with still another preferred embodiment of the invention a conductive device for creating conductive pathways in the heart, including:
a first lead adapted for electrical connection to a first portion of the heart;
a second lead adapted for electrical connection to a second portion of the heart;
a capacitor for storing electrical charge generated at the first portion of the heart and for discharging the electrical charge at the second portion of the heart.
FIGS. 5A-C are partial schematic cross-sectional perspective views of a heart showing application of Laplace's law to determination of tension in the heart;
FIG. 7 is a flowchart of a preferred method of constructing the map of FIG. 6;
Referring to FIG. 6, a distal tip 74 of a mapping catheter 72 is inserted into heart 20 and brought into contact with heart 20 at a location 75. Preferably, the position of tip 74 is determined using a position sensor 76. Sensor 76 is preferably a position sensor as described in PCT application US95/01103, "Medical diagnosis, treatment and imaging systems", filed Jan. 24, 1995, in U.S. Pat. No. 5,391,199 or in U.S. Pat. No. 5,443,489, all assigned to the same assignee as the instant application and the disclosures of which are incorporated herein by reference, and which typically require an external magnetic field generator 73. Alternatively, other position sensors as known in the art are used, for example, ultrasonic, RF and rotating magnetic field sensors. Alternatively or additionally, tip 74 is marked with a marker whose position can be determined from outside of heart 20, for example, a radio-opaque marker for use with a fluoroscope. Preferably, at least one reference catheter 78 is inserted into heart 20 and placed in a fixed position relative to heart 20. By comparing the positions of catheter 72 and catheter 78 the position of tip 74 relative to the heart can be accurately determined even if heart 20 exhibits overall motion within the chest. Preferably the positions are compared at least once every cardiac cycle, more preferably, during diastole. Alternatively, position sensor 76 determines the position of tip 74 relative to catheter 78, for example, using ultrasound, so no external sensor or generator 73 is required. Alternatively, catheter 78 is outside the heart, such as outside the body or in the esophagus.
In an alternative preferred embodiment of the invention, position values are acquired also while tip 74 is not in contact with heart 20. These position values can be used to help generation of an image of the inner surface of heart 20.
It is also known that initiation of contact between tip 74 and heart 20 causes artifacts in a locally measured electrogram. Thus, in a preferred embodiment of the invention, tip 74 includes an electrode 79 which measures the local electrical activity. Artifacts in the measured activity indicate that tip 74 is not in stable contact with location 75. Preferably, the local electrical activity and in particular the local activation time and local plateau length are stored in association with each location in heart 20.
Local geometric changes in the heart are also clinically interesting. FIG. 9A shows a local movement of a segment 90 of heart 20. Movement of segment 90 relative to the cardiac cycle and/or movement of other segments of heart 20 indicates forces acting at segment 90. These forces may be as a result of local contraction at segment 90 or as a result of contraction of other portions of heart 20. Movement of segment 90 before an activation signal reaches segment 90 may indicate that segment 90 is not activated at an optimal time and, thus, that it does not contribute a maximum amount to the output of heart 20. Movement without an activation signal usually indicates non-muscular tissue, such as scar tissue. The activation time is preferably measured using electrode 79 (FIG. 6).
FIG. 9B shows another way of determining the reaction of muscle tissue to an activation signal. A first location 92 is located a distance D1 from a second location 94 and a distance D2 from a third location 96. In a normal heart D1 and D2 can be expected to contract at substantially the same time by a substantially equal amount. However, if the tissue between location 92 and location 94 is non-reactive, D1 might even grow when D2 contracts (Laplace's law). In addition a time lag between the contraction of D1 and of D2 is probably due to block in the conduction of the activation signal.
Alternatively or additionally, a perfusion meter is mounted on tip 74 to determine the amount of perfusion. Examples of perfusion meters include: a Doppler ultrasound perfusion meter or a Doppler laser perfusion meter, such as disclosed in "Design for an ultrasound-based instrument for measurement of tissue blood flow", by Burns, S. M. and Reid, M. H., in "Biomaterials, Artificial Cells and Artificial Organs", Volume 17, Issue 1 page 61-68, 1989, the disclosure of which is incorporated herein by reference. Such a perfusion meter preferably indicates the flow volume and/or the flow velocity.
Mapping is typically performed when heart 20 is externally paced, such as using another catheter, either to set a constant heart rate or to generate certain arrhythmias. Electrode 79 is useful in identifying and analyzing arrhythmias. In addition electrode 79 can be used as a pacemaker to determine the effect of pacing from a certain location, such as initiating VT.
Several types of maps are generally acquired. One type maps local physiological values as a function of location on the heart, for example conductance. In this type of map, the position of tip 74 is typically determined at the same phase of the cardiac cycle for each new location and is unrelated to the acquisition of the local value. The local value may be time dependent. For example, a map of the instant local thickness of the heart wall as a function of the phase of the cardiac cycle. Another example, is local electrogram as a function of time. The value may be continuously acquired over the entire cardiac cycle, only over a portion thereof or at a single instant synchronized to the position determination and/or the cardiac cycle. A geometric map includes information about the geometry of the heart, for example shape and volume, and/or changes in the geometry of the heart as a function of time, for example, thickness, local curvature and shape. An electromechanical map includes information about the coupling between electrical signals and mechanical changes in the heart, for example, thickening as a function of activation time. Other types of maps include chemical-mechanical maps, which correlate mechanical and chemical action of the heart, energy expenditure maps which show local expenditures of energy, perfusion maps which show local perfusion of cardiac muscle and a map of the ratio between energy expenditure and local perfusion.
Aneurysms are readily detectable on a geometric map, as bulges during systole. Furthermore, potential aneurysms can be detected soon after an AMI (acute myocardial infraction) from local reactions to an activation signal and local reactions to changes in intra-cardiac pressure.
It should be noted that increasing the plateau duration of a muscle segment can cause both atrophy and hypertrophy of the muscle segment. In general, increasing the plateau duration increases the both the amount of work performed by the muscle segment and the force that the muscle exerts. As a result, the muscle segment may atrophy. However, if the muscle is diseased, the exerted force may not be increased. Further, changing the activation time may reduce the effectiveness of the muscle, so that it hypertrophies, even if the plateau duration was increased. Further, it may be desirable to activate a muscle portion early and/or to extend its activation duration so that better perfused muscle will take over less perfused muscle. Thus, even if the contractile force exerted by the muscle is increased by the increase in plateau duration, this increase is not sufficient to compensate for the increase in workload requirement, with the result that the muscle hypertrophies. Also, since the extent of ionic currents is usually different in healthy and diseased hearts, the effect of changing the plateau duration can be expected to be different.
FIG. 12A shows a heart 20' having a hypertrophied ventricular septum 109. The activation of the left ventricle of heart 20' typically starts from a location 108 at the apex of heart 20', with the result that the activation times of a location 110 in an external wall 111 is substantially the same as the activation time of a location 112 in septum 109. If the initial activation location is moved from location 108 to location 112, e.g. by external pacing, septum 109 will be more efficiently utilized, while wall 111 will be activated later in the systole, resulting in a shorter plateau duration of wall 111. As a result, wall 111 will hypertrophy and septum 109 will atrophy, which is a desired result. It should be appreciated, that not all pathological changes in muscle-mass distribution are reversible, especially if slippage of muscle fibers and/or formation of scar tissue are involved.
Another preferred embodiment of the invention relates to changing the activation profile of the heart in order to reduce the stress on certain portions of the heart. FIG. 12B shows a heart 20" having a partially infracted portion 114. Portion 114 has less muscle mass than other parts of wall 111 and, in addition, may be activated later in the cardiac cycle than optimal. As a result, an aneurysm can be expected to form at portion 114. Pacing at location 116, with or without pacing at location 108, both stimulates the existing muscle tissue at portion 114 and, since portion 114 is always contracted when other portions of the left ventricle are contracting, reduces the chances of stretching.
Instead of redistributing stress, other local physiological values can redistributed, for example, local oxygen requirement. As is well known, the local oxygen requirement is directly related to the local workload. In some diseased hearts, the coronary arteries perfusing a first portion of the heart are more limited in their oxygenation capability than the coronary arteries perfusing a second portion of the heart. In a patient suffering from chronic ischemia in the first portion of the heart, it may be advantageous to redistribute the workload so that the first portion has less workload and the second portion has more workload. FIG. 12C shows heart 20" having a first portion 120 suffers from chronic ischemia and a second portion 122 is well oxygenated. If the pacing of the left ventricle of heart 20" is moved from its normal location 108 to a location 124, portion 122 takes over part of the workload of portion 120.
FIG. 12D shows heart 20" having a substantially inactive muscle segment 126 which is closer to natural pacing location 108 of the left ventricle and a healthy muscle segment 130 which is further away from pacing location 108. Muscle segment 130 is not called upon to perform as much work as it can because of its late activation time, on the other hand, segment 126 cannot perform as much work as it should since it is infracted. Pacing the left ventricle from location 128 transfers the demand from segment 126 to segment 130, which is able to answer the demand. As a result, the output and efficiency of heart 20" increase. If heart 20" hypertrophied to compensate for its reduced output, the hypertrophy may be reversed. Other compensatory mechanisms, such as increased heart rate may also be reversed, resulting in less stress on heart 20".
In a preferred embodiment of the invention local plateau duration is increased by applying local voltages which counteract the effect of the ionic currents. Thus, the plateau duration can be increased also at portions which are activated later in the cardiac cycle. It should be appreciated, that the local applied voltages are not activation signals, rather they are applied after the muscle is activated, in order to maintain its activation state for a longer period of time. Alternatively, local voltages are applied to reduce the plateau duration for oxygen starved tissue.
There are several ways in which an optimal activation profile and its optimal pacing regime can be determined. In one preferred embodiment of the invention, a map of the heart is constructed and analyzed to determine an optimal activation profile. Such determination is usually performed using a model of the heart, such as a finite-element model. It should be appreciated that a relatively simple map is sufficient in many cases. For example, an activation-time map is sufficient for determining portions of the heart which are activated too late in the cardiac cycle and are, thus, under utilized. In another example, A map of thickness changes is sufficient to determine portions of the heart which are inactive and/or to detect aneurysms.
In a further preferred embodiment of the invention, an electrode is test-implanted, or simulated by pacing from a catheter, in each of a plurality of electrode locations and the heart output associated with each pacing location is measured. After determining the pacing location which yields the highest cardiac output, the electrode is implanted in that location. Preferably, the electrode is mounted on a position sensing catheter to aid in repositioning of the electrode. Further preferably, a steerable catheter is used. Preferably, the operation of the heart is re-evaluated after one or two weeks to determine the effect of the cardiac-adaptation mechanisms on the position of the optimal pacing position. If necessary, one or more electrodes are moved. Alternatively or additionally, when a multi-electrode pacemaker is used, the pacing location can be changed by activating alternative electrodes.
FIG. 13 shows an implanted pacemaker according to a preferred embodiment of the invention. A control unit 140 electrifies a plurality of electrodes 142 implanted in various locations in heart 20", in accordance with at least one of the pacing regimes described above. Various local physiological values of the heart can be determined using electrodes 142, for example, local activation time and plateau length. Alternatively or additionally, at least one implanted sensor 146 is used to determine local physiological values, such as perfusion and thickness. Alternatively or additionally, a cardiac physiological variable is measured using a sensor 144. Examples of physiological variables include, the intra-cardiac pressure which may be measured using a solid state pressure transducer and the stroke volume, which may be measured using a flow velocity sensor in the aorta. Other variables include: heart rate, diastolic interval, long and short axis shortening, ejection fraction and valvular cross-section. In addition, vascular variables may be measured in any particular vessel, for example, blood-vessel cross-section, vascular flow velocity, vascular flow volume and blood pressure. Any one of these variables can be used to asses the functionality of the heart under a new pacing regime.
It should also be appreciated that once the position of the catheter is known, external sensors can be used to provide local physiological values of heart tissue adjacent to the tip of the sensor. For example, if the tip of the catheter caries an ultra-sound marker, an ultrasound image including the marker can be used to determine the local wall thickness. Another example is a combination with SPECT (single photon emission tomography). If the catheter incorporates a radioactive marker suitable for SPECT, local functional information can be gleaned from a SPECT image. Yet another example is determining local perfusion from Doppler-ultrasound images of the coronaries, from nuclear medicine images or from X-ray or CT angiography and overlaying the perfusion map on the geometrical map.
It will be appreciated by persons skilled in the art that the present invention is not limited to what has thus far been described. Rather the scope of the present invention is limited only by the claims which follow:
Patent CitationsCited PatentFiling datePublication dateApplicantTitleUS4173228 *May 16, 1977Nov 6, 1979Applied Medical DevicesCatheter locating deviceUS4304239 *Mar 7, 1980Dec 8, 1981The Kendall CompanyEsophageal probe with balloon electrodeUS4431005 *May 7, 1981Feb 14, 1984Mccormick Laboratories, Inc.Method of and apparatus for determining very accurately the position of a device inside biological tissueUS4444195 *Nov 2, 1981Apr 24, 1984Cordis CorporationCardiac lead having multiple ring electrodesUS4499493 *Feb 22, 1983Feb 12, 1985The Board Of Trustees Of The Leland Stanford Junior UniversityMultiple measurement noise reducing system using artifact edge identification and selective signal processingUS4522212 *Nov 14, 1983Jun 11, 1985Mansfield Scientific, Inc.Endocardial electrodeUS4573473 *Apr 13, 1984Mar 4, 1986Cordis CorporationCardiac mapping probeUS4613866 *May 13, 1983Sep 23, 1986Mcdonnell Douglas CorporationThree dimensional digitizer with electromagnetic couplingUS4628937 *Aug 2, 1984Dec 16, 1986Cordis CorporationMapping electrode assemblyUS4649924 *Jul 8, 1985Mar 17, 1987Consiglio Nazionale Delle RicercheMethod for the detection of intracardiac electrical potential fieldsUS4697595 *Jan 31, 1985Oct 6, 1987Telectronics N.V.Ultrasonically marked cardiac cathetersUS4699147 *Sep 25, 1985Oct 13, 1987Cordis CorporationIntraventricular multielectrode cardial mapping probe and method for using sameUS4777955 *Nov 2, 1987Oct 18, 1988Cordis CorporationLeft ventricle mapping probeUS4821731 *Dec 8, 1987Apr 18, 1989Intra-Sonix, Inc.Acoustic image system and methodUS4899750 *Apr 19, 1988Feb 13, 1990Siemens-Pacesetter, Inc.Lead impedance scanning system for pacemakersUS4921482 *Jan 9, 1989May 1, 1990Hammerslag Julius GSteerable angioplasty deviceUS4922912 *Oct 3, 1988May 8, 1990Hideto WatanabeMAP catheterUS4940064 *Jun 30, 1987Jul 10, 1990Desai Jawahar MCatheter for mapping and ablation and method thereforUS4945305 *Apr 11, 1989Jul 31, 1990Ascension Technology CorporationDevice for quantitatively measuring the relative position and orientation of two bodies in the presence of metals utilizing direct current magnetic fieldsUS5000190 *Jun 20, 1989Mar 19, 1991The Cleveland Clinic FoundationContinuous cardiac output by impedance measurements in the heartUS5012814 *Nov 9, 1989May 7, 1991Instromedix, Inc.Implantable-defibrillator pulse detection-triggered ECG monitoring method and apparatusUS5025786 *Jul 21, 1988Jun 25, 1991Siegel Sharon BIntracardiac catheter and method for detecting and diagnosing myocardial ischemiaUS5041973 *May 1, 1989Aug 20, 1991London Health AssociationCardiac mapping system simulatorUS5042486 *Sep 12, 1990Aug 27, 1991Siemens AktiengesellschaftCatheter locatable with non-ionizing field and method for locating sameUS5054492 *Dec 17, 1990Oct 8, 1991Cardiovascular Imaging Systems, Inc.Ultrasonic imaging catheter having rotational image correlationUS5054496 *Jul 13, 1989Oct 8, 1991China-Japan Friendship HospitalMethod and apparatus for recording and analyzing body surface electrocardiographic peak mapsUS5056517 *Jul 24, 1989Oct 15, 1991Consiglio Nazionale Delle RicercheBiomagnetically localizable multipurpose catheter and method for magnetocardiographic guided intracardiac mapping, biopsy and ablation of cardiac arrhythmiasUS5081993 *Nov 10, 1988Jan 21, 1992Circulation Research LimitedMethods and apparatus for the examination and treatment of internal organsUS5104393 *Nov 2, 1990Apr 14, 1992Angelase, Inc.CatheterUS5154501 *Oct 19, 1990Oct 13, 1992Angelase, Inc.Process for identification of an active site of ventricular tachycardia and for electrode attachment of an endocardial defibrilatorUS5156151 *Feb 15, 1991Oct 20, 1992Cardiac Pathways CorporationEndocardial mapping and ablation system and catheter probeUS5158092 *Oct 27, 1988Oct 27, 1992Christian GlaceMethod and azimuthal probe for localizing the emergence point of ventricular tachycardiasUS5161536 *Mar 22, 1991Nov 10, 1992Catheter TechnologyUltrasonic position indicating apparatus and methodsUS5172699 *Oct 19, 1990Dec 22, 1992Angelase, Inc.Process of identification of a ventricular tachycardia (VT) active site and an ablation catheter systemUS5195968 *Jul 17, 1992Mar 23, 1993Ingemar LundquistCatheter steering mechanismUS5211165 *Sep 3, 1991May 18, 1993General Electric CompanyTracking system to follow the position and orientation of a device with radiofrequency field gradientsUS5220924 *Nov 6, 1991Jun 22, 1993Frazin Leon JDoppler-guided retrograde catheterization using transducer equipped guide wireUS5222501 *Jan 31, 1992Jun 29, 1993Duke UniversityMethods for the diagnosis and ablation treatment of ventricular tachycardiaUS5246016 *Nov 8, 1991Sep 21, 1993Baxter International Inc.Transport catheter and multiple probe analysis methodUS5287788 *Jan 30, 1992Feb 22, 1994Hill Jr Richard WTonal exponentUS5295484 *May 19, 1992Mar 22, 1994Arizona Board Of Regents For And On Behalf Of The University Of ArizonaApparatus and method for intra-cardiac ablation of arrhythmiasUS5297549 *Sep 23, 1992Mar 29, 1994Endocardial Therapeutics, Inc.Endocardial mapping systemUS5311873 *Aug 28, 1992May 17, 1994Ecole PolytechniqueComparative analysis of body surface potential distribution during cardiac pacingUS5335663 *Dec 11, 1992Aug 9, 1994Tetrad CorporationLaparoscopic probes and probe sheaths useful in ultrasonic imaging applicationsUS5341807 *Jun 30, 1992Aug 30, 1994American Cardiac Ablation Co., Inc.Ablation catheter positioning systemUS5368564 *Dec 23, 1992Nov 29, 1994Angeion CorporationSteerable catheterUS5368592 *Sep 23, 1993Nov 29, 1994Ep Technologies, Inc.Articulated systems for cardiac ablationUS5373849 *Jan 19, 1993Dec 20, 1994Cardiovascular Imaging Systems, Inc.Forward viewing imaging catheterUS5383923 *May 11, 1993Jan 24, 1995Webster Laboratories, Inc.Steerable catheter having puller wire with shape memoryUS5391199 *Jul 20, 1993Feb 21, 1995Biosense, Inc.Apparatus and method for treating cardiac arrhythmiasUS5403356 *Apr 28, 1993Apr 4, 1995Medtronic, Inc.Method and apparatus for prevention of atrial tachy arrhythmiasUS5404297 *Jan 21, 1994Apr 4, 1995Puritan-Bennett CorporationAircraft reading lightUS5431168 *Aug 23, 1993Jul 11, 1995Cordis-Webster, Inc.Steerable open-lumen catheterUS5433198 *Mar 11, 1993Jul 18, 1995Desai; Jawahar M.Apparatus and method for cardiac ablationUS5443489 *Sep 23, 1994Aug 22, 1995Biosense, Inc.Apparatus and method for ablationUS5487391 *Jan 28, 1994Jan 30, 1996Ep Technologies, Inc.Systems and methods for deriving and displaying the propagation velocities of electrical events in the heartUS5558091 *Oct 6, 1993Sep 24, 1996Biosense, Inc.Magnetic determination of position and orientationUS5577502 *Apr 3, 1995Nov 26, 1996General Electric CompanyImaging of interventional devices during medical proceduresUS5588432 *Jul 10, 1995Dec 31, 1996Boston Scientific CorporationCatheters for imaging, sensing electrical potentials, and ablating tissueUS5592939 *Jun 14, 1995Jan 14, 1997Martinelli; Michael A.Method and system for navigating a catheter probeEP0499491A2 *Feb 17, 1992Aug 19, 1992Cardiac Pathways CorporationEndocardial mapping and ablation system and catheter probe and method* Cited by examinerNon-Patent CitationsReference1 *Buckles et al., Computer Enhanced Mapping of Activation Sequences in the Surgical Treatment of Supraventricular Arrhythmias, PACE vol. 13, Pt. 1, pp. 1401 1407, Nov. 1990.2Buckles et al., Computer-Enhanced Mapping of Activation Sequences in the Surgical Treatment of Supraventricular Arrhythmias, PACE vol. 13, Pt. 1, pp. 1401-1407, Nov. 1990.3 *Chen et al., Radiofrequency Catheter Ablation for Treatment of Wolff Parkinson White Syndrome Short and Long Term Follow up International Journal of Cardiology , vol. 37, pp. 199 207, 1992.4Chen et al., Radiofrequency Catheter Ablation for Treatment of Wolff-Parkinson-White Syndrome--Short-and Long-Term Follow-up International Journal of Cardiology, vol. 37, pp. 199-207, 1992.5 *Chen et al., Reappraisal of Electrical Cure of Atrioventricular Nodal Reentrant Tachycardia Lesions from a Modified Catheter Ablation Technique International Journal of Cardiology , vol. 37, pp. 51 60, 1992.6Chen et al., Reappraisal of Electrical Cure of Atrioventricular Nodal Reentrant Tachycardia--Lesions from a Modified Catheter Ablation Technique International Journal of Cardiology, vol. 37, pp. 51-60, 1992.7 *Desai et al., Orthogonal Electrode Catheter for Mapping of Endocardial Focal Site of Ventricular Activation, PACE vol. 14, Pt. 1, pp. 557 574, Apr. 1991.8Desai et al., Orthogonal Electrode Catheter for Mapping of Endocardial Focal Site of Ventricular Activation, PACE vol. 14, Pt. 1, pp. 557-574, Apr. 1991.9 *Fananapazir et al., Long term Results of Dual Chamber (DDD) Pacing in Obstructive Hypertrophic Cardiomyopathy: Evidence for Progressive Symptomatic and Hemodynamic Improvement and Reduction of Left Ventricular Hypertrophy, Circulation vol. 90, No. 6, pp. 2731 2742, Dec. 1994.10Fananapazir et al., Long-term Results of Dual-Chamber (DDD) Pacing in Obstructive Hypertrophic Cardiomyopathy: Evidence for Progressive Symptomatic and Hemodynamic Improvement and Reduction of Left Ventricular Hypertrophy, Circulation vol. 90, No. 6, pp. 2731-2742, Dec. 1994.11 *Fann et al., Endocardial Activation mapping and Endocardial Pace Mapping Using a Balloon Apparatus, American Journal of Cardiology vol. 55, pp. 1076 1083, Apr. 1, 1985.12Fann et al., Endocardial Activation mapping and Endocardial Pace-Mapping Using a Balloon Apparatus, American Journal of Cardiology vol. 55, pp. 1076-1083, Apr. 1, 1985.13 *Hauer et al., Endocardial Catheter Mapping: Wire Skeleton Techniques for Representation of Computed Arrhythmogenic Sites Compared with Intraoperative Mapping, Circulation , vol. 74, No. 6, pp. 1346 1354, Dec. 1986.14Hauer et al., Endocardial Catheter Mapping: Wire Skeleton Techniques for Representation of Computed Arrhythmogenic Sites Compared with Intraoperative Mapping, Circulation, vol. 74, No. 6, pp. 1346-1354, Dec. 1986.15 *Holt et al., Ventricular Arrhythmias A Guide to Their Localization, British Heart Journal , vol. 53, pp. 417, 430, 1985.16Holt et al., Ventricular Arrhythmias--A Guide to Their Localization, British Heart Journal, vol. 53, pp. 417, 430, 1985.17 *Huang et al., Radiofrequency Catheter Ablation of the Left and Right Ventricles: Anatomic and Electrophysiologic Observations, PACE vol. 11, pp. 449 459, Apr. 1988.18Huang et al., Radiofrequency Catheter Ablation of the Left and Right Ventricles: Anatomic and Electrophysiologic Observations, PACE vol. 11, pp. 449-459, Apr. 1988.19 *Jackman et al., New Catheter Technique for Recording Left Free Wall Accessory Atrioventricular Pathway Activation, Circulation vol. 78, No. 3, pp. 598 611, Sep. 1988.20Jackman et al., New Catheter Technique for Recording Left Free-Wall Accessory Atrioventricular Pathway Activation, Circulation vol. 78, No. 3, pp. 598-611, Sep. 1988.21 *Jeanrenaud et al., Effects of Dual chamber pacing in Hypertrophic Obstructive Cardiomyopathy, The Lancet , vol. 339, pp. 1318 1323. May 30, 1992.22Jeanrenaud et al., Effects of Dual-chamber pacing in Hypertrophic Obstructive Cardiomyopathy, The Lancet, vol. 339, pp. 1318-1323. May 30, 1992.23 *Josephson et al., Comparison of Endocardial Catheter Mapping with Intraoperative Mapping of Ventricular Tachycardia, Circulation , vol. 61, No. 2, pp. 395 404, 1980.24Josephson et al., Comparison of Endocardial Catheter Mapping with Intraoperative Mapping of Ventricular Tachycardia, Circulation, vol. 61, No. 2, pp. 395-404, 1980.25 *Josephson et al., Role of Catheter Mapping in the Preoperative Evaluation of Ventricular Tachcardia, The American Journal of Cardiology , vol. 40, pp. 207 220, Jan. 1982.26Josephson et al., Role of Catheter Mapping in the Preoperative Evaluation of Ventricular Tachcardia, The American Journal of Cardiology, vol. 40, pp. 207-220, Jan. 1982.27 *Josephson et al., Ventricular Activation During Ventricular Endocardial Pacing II: Role of Pace Mapping to Localize Origin of Ventricular Tachycardia The American Journal of Cardiology , vol. 30, 50, pp. 11 22, Jul. 1982.28Josephson et al., Ventricular Activation During Ventricular Endocardial Pacing--II: Role of Pace-Mapping to Localize Origin of Ventricular Tachycardia The American Journal of Cardiology, vol. 30, 50, pp. 11-22, Jul. 1982.29 *Josephson, Clinical Cardiac Electrophysiology: Techniques and Interpretations, 2nd Ed. pp. 566 580, 608 615, 770 783, Lea & Febiger, Malvern Pa., 1993.30Josephson, Clinical Cardiac Electrophysiology: Techniques and Interpretations, 2nd Ed. pp. 566-580, 608-615, 770-783, Lea & Febiger, Malvern Pa., 1993.31 *Kaltenbrunner et al., Epicardial and Endocardial Mapping of Ventricular Tachycardia in Patients with Myocardial Infarction, Circulation vol. 83, No. 3, pp. 1058 1071, Sep. 1991.32Kaltenbrunner et al., Epicardial and Endocardial Mapping of Ventricular Tachycardia in Patients with Myocardial Infarction, Circulation vol. 83, No. 3, pp. 1058-1071, Sep. 1991.33 *Kuchar et al., Electrocardiographic Localization of the Site of Ventricular Tachycardia in Patients with Prior Myocardial Infarction, JACC , vol. 13, No. 4, pp. 893 900, 1989.34Kuchar et al., Electrocardiographic Localization of the Site of Ventricular Tachycardia in Patients with Prior Myocardial Infarction, JACC, vol. 13, No. 4, pp. 893-900, 1989.35Langberg, J.J. et al. "The Echo Transponder Electrode Catheter: A New Method for Mapping the Left Ventricle," JACC vol. 12 No. 1, Jul. 1988: 218-223.36 *Langberg, J.J. et al. The Echo Transponder Electrode Catheter: A New Method for Mapping the Left Ventricle, JACC vol. 12 No. 1, Jul. 1988: 218 223.37 *Mass e et al., A Three Dimensional Display for Cardiac Activation Mapping, PACE , vol. 14, Pt. 1, pp. 538 545, Apr. 1991.38Masse et al., A Three-Dimensional Display for Cardiac Activation Mapping, PACE, vol. 14, Pt. 1, pp. 538-545, Apr. 1991.39 *Pag e , Surgical Treatment of Ventricular Tachycardia: Regional Cryoablation Guided by Computerized Epicardial and Endocardial Mapping, Circulation vol. 80, (Supplement I), No. 3, pp. I 124 I 134, Sep. 1989.40Page, Surgical Treatment of Ventricular Tachycardia: Regional Cryoablation Guided by Computerized Epicardial and Endocardial Mapping, Circulation vol. 80, (Supplement I), No. 3, pp. I-124 -I-134, Sep. 1989.41 *Pogwizd et al., Reentrant and Nonreentrant mechanisms Contribute to Arrhythmogenesis During Early Myocardial Ischemia: Results using Three Dimensional Mapping, Circulation Research , vol. 61, No. 3, pp. 352 371, Sep. 1987.42Pogwizd et al., Reentrant and Nonreentrant mechanisms Contribute to Arrhythmogenesis During Early Myocardial Ischemia: Results using Three-Dimensional Mapping, Circulation Research, vol. 61, No. 3, pp. 352-371, Sep. 1987.43 *Pollak et al., Intraoperative Identification of a Radiofrequency Lesion Allowing Validation of Catheter Mapping of Ventricular Tachycardia with a Computerized Balloon Mapping System, PACE vol. 15, pp. 854 858, Jun. 1992.44Pollak et al., Intraoperative Identification of a Radiofrequency Lesion Allowing Validation of Catheter Mapping of Ventricular Tachycardia with a Computerized Balloon Mapping System, PACE vol. 15, pp. 854-858, Jun. 1992.45 *Scheinman et al., Current Role of Catheter Ablative Procedures in Patients with Cardiac Arrhythmias, Circulation vol. 83, No. 6, pp. 2146 2153, Jun. 1991.46Scheinman et al., Current Role of Catheter Ablative Procedures in Patients with Cardiac Arrhythmias, Circulation vol. 83, No. 6, pp. 2146-2153, Jun. 1991.47 *Scheinman, North American Society of Pacing and Electrophysiology (NASPE) Survey of Radiofrequency Catheter Ablation: Implications For Clinicians, Third Party Insurers, and Government Regulatory Agencies, PACE vol. 15, pp. 2228 2231, Dec. 1992.48Scheinman, North American Society of Pacing and Electrophysiology (NASPE) Survey of Radiofrequency Catheter Ablation: Implications For Clinicians, Third Party Insurers, and Government Regulatory Agencies, PACE vol. 15, pp. 2228-2231, Dec. 1992.49 *Shenasa et al., Cardiac Mapping. Part I: Wolff Parkinson White Syndrome PACE , vol. 13, pp. 223 230, Feb. 1990.50Shenasa et al., Cardiac Mapping. Part I: Wolff-Parkinson-White Syndrome PACE, vol. 13, pp. 223-230, Feb. 1990.51 *Silka et al., Phase Image Analysis of Anomalous Ventricular Activation in Pediatric Patients with Preexcitation Syndromes or Ventricular Tachycardia, American Heart Journal vol. 125, No. 2, Pt. 1, pp. 372 380, Feb. 1993.52Silka et al., Phase Image Analysis of Anomalous Ventricular Activation in Pediatric Patients with Preexcitation Syndromes or Ventricular Tachycardia, American Heart Journal vol. 125, No. 2, Pt. 1, pp. 372-380, Feb. 1993.53 *Tanigawa et al., Prolonged and Fractionated Right Atrial Electrograms During Sinus Rhythm in Patients with Paroxysmal Atrial Fibrillation and Sick Sinus Node Syndrome, Journal of American College of Cardiologists vol. 17, No. 2, pp. 403 408, Feb. 1991.54Tanigawa et al., Prolonged and Fractionated Right Atrial Electrograms During Sinus Rhythm in Patients with Paroxysmal Atrial Fibrillation and Sick Sinus Node Syndrome, Journal of American College of Cardiologists vol. 17, No. 2, pp. 403-408, Feb. 1991.55 *Tweddel et al., Potential Mapping in Septal Tachycardia: Evaluation of a New Intraoperative Mapping Technique, Circulation vol. 80, (Supplement I), No. 3, pp. I 97 I 108, Sep. 1989.56Tweddel et al., Potential Mapping in Septal Tachycardia: Evaluation of a New Intraoperative Mapping Technique, Circulation vol. 80, (Supplement I), No. 3, pp. I-97 -I-108, Sep. 1989.57 *Witnowski et al., An Automated Simultaneous Transmural Cardiac Mapping System, American Journal of Physiology vol. 247, pp. H661 H668, 1984.58Witnowski et al., An Automated Simultaneous Transmural Cardiac Mapping System, American Journal of Physiology vol. 247, pp. H661-H668, 1984.* Cited by examinerReferenced byCiting PatentFiling datePublication dateApplicantTitleUS6368285Aug 18, 2000Apr 9, 2002Biosense, Inc.Method and apparatus for mapping a chamber of a heartUS6385476Sep 21, 1999May 7, 2002Biosense, Inc.Method and apparatus for intracardially surveying a condition of a chamber of a heartUS6522913 *Apr 28, 1999Feb 18, 2003Ep Technologies, Inc.Systems and methods for visualizing tissue during diagnostic or therapeutic proceduresUS6546271Oct 1, 1999Apr 8, 2003Bioscience, Inc.Vascular reconstructionUS6633773Sep 29, 2000Oct 14, 2003Biosene, Inc.Area of interest reconstruction for surface of an organ using location dataUS6650927Aug 18, 2000Nov 18, 2003Biosense, Inc.Rendering of diagnostic imaging data on a three-dimensional mapUS6915160Feb 8, 2002Jul 5, 2005Cardiac Pacemakers, Inc.Dynamically optimized multisite cardiac resynchronization deviceUS6957101Aug 20, 2003Oct 18, 2005Joshua PorathTransient event mapping in the heartUS6965797 *Sep 13, 2002Nov 15, 2005Cardiac Pacemakers, Inc.Method and apparatus for assessing and treating myocardial wall stressUS6973349 *Dec 5, 2001Dec 6, 2005Cardiac Pacemakers, Inc.Method and apparatus for minimizing post-infarct ventricular remodelingUS7003348Jul 1, 2003Feb 21, 2006Pacesetter, Inc.Monitoring cardiac geometry for diagnostics and therapyUS7103410Aug 27, 2003Sep 5, 2006Cardiac Pacemakers, Inc.Apparatus and method for reversal of myocardial remodeling with electrical stimulationUS7215997Dec 22, 2003May 8, 2007Cardiac Pacemakers, Inc.Dynamic device therapy control for treating post myocardial infarction patientsUS7366567Mar 23, 2005Apr 29, 2008Cardiac Pacemakers, Inc.Method for treating myocardial infarctionUS7499749Dec 29, 2004Mar 3, 2009Cardiac Pacemakers, Inc.Method and apparatus for minimizing post-infarct ventricular remodelingUS7548782Sep 1, 2006Jun 16, 2009Cardiac Pacemakers, Inc.Method for reversal of myocardial remodeling with electrical stimulationUS7567841Aug 20, 2004Jul 28, 2009Cardiac Pacemakers, Inc.Method and apparatus for delivering combined electrical and drug therapiesUS7613513Jul 1, 2003Nov 3, 2009Pacesetter, Inc.System and method for determining cardiac geometryUS7676259Mar 9, 2010Cardiac Pacemakers, Inc.Dynamically optimized multisite cardiac resynchronization deviceUS7715907 *Aug 1, 2007May 11, 2010Siemens Medical Solutions Usa, Inc.Method and system for atrial fibrillation analysis, characterization, and mappingUS7729761Jul 14, 2004Jun 1, 2010Cardiac Pacemakers, Inc.Method and apparatus for controlled gene or protein deliveryUS7751882Jul 6, 2010Pacesetter, Inc.Method and system for determining lead position for optimized cardiac resynchronization therapy hemodynamicsUS7764995 *Jul 27, 2010Cardiac Pacemakers, Inc.Method and apparatus to modulate cellular regeneration post myocardial infarctUS7774051Aug 10, 2010St. Jude Medical, Atrial Fibrillation Division, Inc.System and method for mapping electrophysiology information onto complex geometryUS7774057Aug 10, 2010Cardiac Pacemakers, Inc.Method and apparatus for device controlled gene expression for cardiac protectionUS7828711Nov 9, 2010Cardiac Pacemakers, Inc.Method and apparatus for modulating cellular growth and regeneration using ventricular assist deviceUS7840263Feb 27, 2004Nov 23, 2010Cardiac Pacemakers, Inc.Method and apparatus for device controlled gene expressionUS7844330Mar 22, 2007Nov 30, 2010Cardiac Pacemakers, Inc.Dynamic device therapy control for treating post myocardial infarction patientsUS7899532Mar 2, 2009Mar 1, 2011Cardiac Pacemakers, Inc.Method and apparatus for minimizing post-infarct ventricular remodelingUS7966058Jun 21, 2011General Electric CompanySystem and method for registering an image with a representation of a probeUS7976518Jul 12, 2011Corpak Medsystems, Inc.Tubing assembly and signal generator placement control device and method for use with catheter guidance systemsUS7981065Jul 19, 2011Cardiac Pacemakers, Inc.Lead electrode incorporating extracellular matrixUS8016783Sep 13, 2011Cardiac Pacemakers, Inc.Method and apparatus for modulating cellular metabolism during post-ischemia or heart failureUS8046049Feb 23, 2004Oct 25, 2011Biosense Webster, Inc.Robotically guided catheterUS8046066Jun 15, 2009Oct 25, 2011Cardiac Pacemakers, Inc.Apparatus for reversal of myocardial remodeling with pre-excitationUS8050761Apr 25, 2008Nov 1, 2011Cardiac Pacemakers, Inc.Method for treating myocardial infarctionUS8060219Nov 15, 2011Cardiac Pacemakers, Inc.Epicardial patch including isolated extracellular matrix with pacing electrodesUS8090442Jan 3, 2012Cardiac Pacemakers, Inc.Apparatus and method for spatially and temporally distributing cardiac electrical stimulationUS8116849 *Dec 18, 2007Feb 14, 2012Siemens Medical Solutions Usa, Inc.Non-invasive temperature scanning and analysis for cardiac ischemia characterizationUS8165666 *Aug 24, 2011Apr 24, 2012Topera, Inc.System and method for reconstructing cardiac activation informationUS8180428Apr 9, 2009May 15, 2012Medtronic, Inc.Methods and systems for use in selecting cardiac pacing sitesUS8197494Jun 12, 2012Corpak Medsystems, Inc.Medical device position guidance system with wireless connectivity between a noninvasive device and an invasive deviceUS8214019Sep 1, 2011Jul 3, 2012Biosense Webster, Inc.Robotically guided catheterUS8265732Dec 23, 2009Sep 11, 2012Corpak Medsystems, Inc.Catheter locator apparatus and method of useUS8346356Mar 25, 2010Jan 1, 2013Cardiac Pacemakers, Inc.Method for preparing an implantable controlled gene or protein delivery deviceUS8364253Jun 24, 2010Jan 29, 2013St. Jude Medical, Atrial Fibrillation Division, Inc.System and method for mapping electrophysiology information onto complex geometryUS8369948Feb 5, 2013Cardiac Pacemakers, Inc.Apparatus for reversal of myocardial remodeling with pre-excitationUS8388541Nov 25, 2008Mar 5, 2013C. R. Bard, Inc.Integrated system for intravascular placement of a catheterUS8388546Mar 5, 2013Bard Access Systems, Inc.Method of locating the tip of a central venous catheterUS8406878Mar 26, 2013Cardiac Pacemakers, Inc.Method for treating myocardial infarctionUS8437833Oct 7, 2009May 7, 2013Bard Access Systems, Inc.Percutaneous magnetic gastrostomyUS8478382Feb 11, 2009Jul 2, 2013C. R. Bard, Inc.Systems and methods for positioning a catheterUS8504155Nov 9, 2010Aug 6, 2013Cardiac Pacemakers, Inc.Dynamic device therapy control for treating post myocardial infarction patientsUS8512256Sep 9, 2010Aug 20, 2013Bard Access Systems, Inc.Method of locating the tip of a central venous catheterUS8538520Jul 6, 2010Sep 17, 2013Cardiac Pacemakers, Inc.Method and apparatus for device controlled gene expression for cardiac protectionUS8560067Oct 31, 2007Oct 15, 2013Cardiac Pacemakers, Inc.Apparatus for spatially and temporally distributing cardiac electrical stimulationUS8594777 *Apr 3, 2012Nov 26, 2013The Reagents Of The University Of CaliforniaSystem and method for reconstructing cardiac activation informationUS8606347Aug 9, 2012Dec 10, 2013Corpak Medsystems, Inc.Catheter locator apparatus and method of useUS8612001Feb 24, 2011Dec 17, 2013Cardiac Pacemakers, Inc.Method and apparatus for minimizing post-infarct ventricular remodelingUS8615288Jun 12, 2012Dec 24, 2013Biosense Webster, Inc.Robotically guided catheterUS8634913Feb 4, 2013Jan 21, 2014Cardiac Pacemakers, Inc.Apparatus for reversal of myocardial remodeling with pre-excitationUS8715199Mar 15, 2013May 6, 2014Topera, Inc.System and method to define a rotational source associated with a biological rhythm disorderUS8774907Jan 9, 2013Jul 8, 2014Bard Access Systems, Inc.Method of locating the tip of a central venous catheterUS8781555Mar 2, 2010Jul 15, 2014C. R. Bard, Inc.System for placement of a catheter including a signal-generating styletUS8784336Aug 23, 2006Jul 22, 2014C. R. Bard, Inc.Stylet apparatuses and methods of manufactureUS8801693Oct 27, 2011Aug 12, 2014C. R. Bard, Inc.Bioimpedance-assisted placement of a medical deviceUS8805492Jun 25, 2009Aug 12, 2014Cardiac Pacemakers, Inc.Method and apparatus for delivering combined electrical and drug therapiesUS8838222Oct 24, 2013Sep 16, 2014The Regents Of The University Of CaliforniaMethod for treating complex rhythm disordersUS8838223Oct 24, 2013Sep 16, 2014The Regents Of The University Of CaliforniaMethod for analysis of complex rhythm disordersUS8849382Sep 10, 2009Sep 30, 2014C. R. Bard, Inc.Apparatus and display methods relating to intravascular placement of a catheterUS8858455Aug 16, 2013Oct 14, 2014Bard Access Systems, Inc.Method of locating the tip of a central venous catheterUS8868169Dec 20, 2013Oct 21, 2014The Regents Of The University Of CaliforniaMethod and system for detection of biological rhythm disordersUS8934960Dec 9, 2013Jan 13, 2015Corpak Medsystems, Inc.Catheter locator apparatus and method of useUS8971994Apr 8, 2013Mar 3, 2015C. R. Bard, Inc.Systems and methods for positioning a catheterUS9028441Sep 7, 2012May 12, 2015Corpak Medsystems, Inc.Apparatus and method used with guidance system for feeding and suctioningUS9050006Mar 15, 2013Jun 9, 2015The Regents Of The University Of CaliforniaSystem and method for reconstructing cardiac activation informationUS9055876Nov 7, 2013Jun 16, 2015The Regents Of The University Of CaliforniaSystem and method for reconstructing cardiac activation informationUS9055877Nov 12, 2013Jun 16, 2015The Regents Of The University Of CaliforniaSystem and method for reconstructing cardiac activation informationUS9055878Aug 29, 2014Jun 16, 2015The Regents Of The University Of CaliforniaSystem and method for reconstructing cardiac activation informationUS9089269Mar 31, 2014Jul 28, 2015The Regents Of The University Of CaliforniaSystem and method for reconstructing cardiac signals associated with a complex rhythm disorderUS9107600Aug 29, 2014Aug 18, 2015The Regents Of The University Of CaliforniaSystem and method for reconstructing cardiac activation informationUS9125578Feb 2, 2011Sep 8, 2015Bard Access Systems, Inc.Apparatus and method for catheter navigation and tip locationUS9131956Jun 2, 2011Sep 15, 2015Corpak Medsystems, Inc.Tubing assembly and signal generator placement control device and method for use with catheter guidance systemsUS9211107Nov 7, 2012Dec 15, 2015C. R. Bard, Inc.Ruggedized ultrasound hydrogel insertUS9220427Mar 26, 2015Dec 29, 2015The Regents Of The University Of CaliforniaSystem and method for reconstructing cardiac activation informationUS9241667Jun 12, 2015Jan 26, 2016The Regents Of The University Of CaliforniaSystem and method for reconstructing cardiac signals associated with a complex rhythm disorderUS9265443May 5, 2014Feb 23, 2016Bard Access Systems, Inc.Method of locating the tip of a central venous catheterUS9282910May 2, 2012Mar 15, 2016The Regents Of The University Of CaliforniaSystem and method for targeting heart rhythm disorders using shaped ablationUS9289145Dec 5, 2013Mar 22, 2016Medtronic, Inc.Identification of abnormal cardiac substrate during left-ventricular pacingUS9332915Mar 15, 2013May 10, 2016The Regents Of The University Of CaliforniaSystem and method to identify sources associated with biological rhythm disordersUS9339206Jun 14, 2010May 17, 2016Bard Access Systems, Inc.Adaptor for endovascular electrocardiographyUS9345422Oct 3, 2014May 24, 2016Bard Acess Systems, Inc.Method of locating the tip of a central venous catheterUS9375156Apr 21, 2014Jun 28, 2016The Regents Of The University Of CaliforniaSystem for analysis of complex rhythm disordersUS9380950Aug 12, 2013Jul 5, 2016The Regents Of The University Of CaliforniaMethods for detecting biological rhythm disordersUS20030105493 *Dec 5, 2001Jun 5, 2003Salo Rodney W.Method and apparatus for minimizing post-infarct ventricular remodelingUS20030153952 *Feb 8, 2002Aug 14, 2003Angelo AuricchioDynamically optimized multisite cardiac resynchronization deviceUS20040049236 *Aug 27, 2003Mar 11, 2004Cardiac Pacemakers, Inc.Apparatus and method for reversal of myocardial remodeling with electrical stimulationUS20040054381 *Sep 13, 2002Mar 18, 2004Pastore Joseph M.Method and apparatus for assessing and treating myocardial wall stressUS20040087877 *Aug 23, 2001May 6, 2004Besz William JohnCatheter locator apparatus and method of useUS20050137631 *Dec 22, 2003Jun 23, 2005Yinghong YuDynamic device therapy control for treating post myocardial infarction patientsUS20050154279 *Dec 31, 2003Jul 14, 2005Wenguang LiSystem and method for registering an image with a representation of a probeUS20050154281 *Dec 31, 2003Jul 14, 2005Xue Joel Q.System and method for registering an image with a representation of a probeUS20050154282 *Dec 31, 2003Jul 14, 2005Wenguang LiSystem and method for registering an image with a representation of a probeUS20050154285 *Jan 2, 2004Jul 14, 2005Neason Curtis G.System and method for receiving and displaying information pertaining to a patientUS20050154286 *Jan 2, 2004Jul 14, 2005Neason Curtis G.System and method for receiving and displaying information pertaining to a patientUS20050177195 *Dec 29, 2004Aug 11, 2005Cardiac Pacemakers, Inc.Method and apparatus for minimizing post-infarct ventricular remodelingUS20050203382 *Feb 23, 2004Sep 15, 2005Assaf GovariRobotically guided catheterUS20050209524 *Mar 10, 2004Sep 22, 2005General Electric CompanySystem and method for receiving and storing information pertaining to a patientUS20050216066 *May 23, 2005Sep 29, 2005Cardiac Pacemakers, Inc.Dynamically optimized multisite cardiac resynchronization deviceUS20050222509 *Apr 2, 2004Oct 6, 2005General Electric CompanyElectrophysiology system and methodUS20050228251 *Mar 30, 2004Oct 13, 2005General Electric CompanySystem and method for displaying a three-dimensional image of an organ or structure inside the bodyUS20050228252 *Apr 2, 2004Oct 13, 2005General Electric CompanyElectrophysiology system and methodUS20050288721 *Jun 7, 2004Dec 29, 2005Cardiac Pacemakers, Inc.Method and apparatus to modulate cellular regeneration post myocardial infarctUS20060041276 *Aug 20, 2004Feb 23, 2006Cardiac Pacemakers, Inc.Method and apparatus for delivering combined electrical and drug therapiesUS20060211948 *Mar 18, 2005Sep 21, 2006International Business Machines CorporationDynamic technique for fitting heart pacers to individualsUS20060217773 *Mar 23, 2005Sep 28, 2006Qingsheng ZhuMethod for treating myocardial infarctionUS20060293716 *Sep 1, 2006Dec 28, 2006Cardiac Pacemakers, Inc.Apparatus and method for reversal of myocardial remodeling with electrical stimulationUS20070162081 *Mar 22, 2007Jul 12, 2007Cardiac Pacemakers, Inc.Dynamic device therapy control for treating post myocardial infarction patientsUS20080009758 *Dec 29, 2006Jan 10, 2008Voth Eric JSystem and method for mapping electrophysiology information onto complex geometryUS20080097475 *Sep 8, 2006Apr 24, 2008Viasys Holdings, Inc.Medical device position guidance system with wireless connectivity between a noninvasive device and an invasive deviceUS20080097538 *Oct 31, 2007Apr 24, 2008Cardiac Pacemakers, Inc.Apparatus and method for spatially and temporally distributing cardiac electrical stimulationUS20080097541 *Oct 31, 2007Apr 24, 2008Cardiac Pacemakers, Inc.Apparatus and method for spatially and temporally distributing cardiac electrical stimulationUS20080161705 *Dec 29, 2006Jul 3, 2008Podmore Jonathan LDevices and methods for ablating near AV grooveUS20080208274 *Apr 25, 2008Aug 28, 2008Cardiac Pacemakers, Inc..Method for treating myocardial infarctionUS20080208275 *May 6, 2008Aug 28, 2008International Business Machines CorporationDynamic technique for fitting heart pacers to individualsUS20080214945 *Aug 1, 2007Sep 4, 2008Siemens Medical Solutions Usa, Inc.Method and System for Atrial Fibrillation Analysis, Characterization, and MappingUS20080221425 *Mar 9, 2007Sep 11, 2008Olson Eric SSystem and method for local deformable registration of a catheter navigation system to image data or a modelUS20080221643 *Mar 9, 2007Sep 11, 2008Olson Eric SSystem and method for correction of inhomogeneous fieldsUS20090043223 *Dec 18, 2007Feb 12, 2009Siemens Medical Solutions Usa, Inc.Non-Invasive Temperature Scanning and Analysis for Cardiac Ischemia CharacterizationUS20090171407 *Mar 2, 2009Jul 2, 2009Salo Rodney WMethod and apparatus for minimizing post-infarct ventricular remodelingUS20090198298 *Apr 9, 2009Aug 6, 2009Kaiser Daniel RMethods and systems for use in selecting cardiac pacing sitesUS20090254141 *Jun 15, 2009Oct 8, 2009Kramer Andrew PApparatus and method for reversal of myocardial remodeling with electrical stimulationUS20090259268 *Jun 25, 2009Oct 15, 2009Gregory Waimong ChanMethod and apparatus for delivering combined electrical and drug therapiesUS20100179609 *Jul 15, 2010Girouard Steven DMethod for preparing an implantable controlled gene or protein delivery deviceUS20110054557 *Nov 9, 2010Mar 3, 2011Yinghong YuDynamic device therapy control for treating post myocardial infarction patientsUS20120283579 *Apr 3, 2012Nov 8, 2012The Regents Of The University Of CaliforniaSystem and method for reconstructing cardiac activation informationUSD699359Aug 1, 2012Feb 11, 2014C. R. Bard, Inc.Ultrasound probe headUSD724745Aug 1, 2012Mar 17, 2015C. R. Bard, Inc.Cap for an ultrasound probeUSD754357Jan 24, 2014Apr 19, 2016C. R. Bard, Inc.Ultrasound probe headEP1415608A2Oct 20, 2003May 6, 2004Biosense, Inc.Real-time monitoring and mapping of ablation lesion formation in the heartEP1566150A2Feb 22, 2005Aug 24, 2005Biosense Webster, Inc.Robotically guided catheterEP1915968A2Feb 22, 2005Apr 30, 2008Biosense Webster, Inc.Robotically guided catheterEP2626033A2Feb 22, 2005Aug 14, 2013Biosense Webster, Inc.Robotically guided catheterWO2001034026A1Nov 3, 2000May 17, 2001Zynergy Cardiovascular (Zvc) Inc.Cardiac mapping systems* Cited by examinerClassifications U.S. Classification600/437International ClassificationA61B18/20, A61B5/00, A61M25/01, A61N1/32, A61B18/24, A61B8/08, A61N1/362, A61B19/00, A61B18/02, A61B18/00, A61B5/029, A61B5/06, A61N1/368, A61B5/0215, A61B18/14, A61B5/0456, A61N1/40, A61B17/00, A61B5/042, A61B18/18, A61N1/365, A61N1/06Cooperative ClassificationA61B5/06, A61B2017/00247, A61B5/0422, A61B18/24, A61B18/14, A61N1/3621, A61B18/02, A61B18/00, A61B2017/00044, A61B5/145, A61B2090/3958, A61B34/20, A61B5/0456, A61B5/6859, A61B2018/00392, A61B5/6843, A61N1/32, A61N1/36564, A61B18/1492, A61B2017/00061, A61B2034/2051, A61B18/18, A61B5/6885, A61M25/0133, A61B8/0833, A61N1/368, A61N1/06, A61N1/3627, A61N1/403, A61B5/029, A61B2017/00243, A61B18/20, A61B2018/00869, A61B2034/105, A61B5/0215European ClassificationA61B5/145, A61B5/68D5, A61B19/52H12, A61B5/68B5, A61B5/68D1H6, A61N1/40T, A61B5/029, A61B5/042D, A61M25/01C10, A61N1/06, A61N1/365B9, A61B5/0215, A61N1/362C, A61B5/06, A61B8/08H, A61B18/20, A61B18/14V, A61N1/32Legal EventsDateCodeEventDescriptionOct 24, 2003FPAYFee paymentYear of fee payment: 4Oct 24, 2007FPAYFee paymentYear of fee payment: 8Sep 21, 2011FPAYFee paymentYear of fee payment: 12RotateOriginal ImageGoogle Home - Sitemap - USPTO Bulk Downloads - Privacy Policy - Terms of Service - About Google Patents - Send FeedbackData provided by IFI CLAIMS Patent Services