Patent Description:
A wide range of medical procedures involve placing probes, such as catheters, within a patient's body. Location sensing systems have been developed for tracking such probes. Magnetic location sensing is one of the methods known in the art. In magnetic location sensing, magnetic field generators are typically placed at known locations external to the patient. A magnetic field sensor within the distal end of the probe generates electrical signals in response to these magnetic fields, which are processed to determine the coordinate locations of the distal end of the probe. These methods and systems are described in <CIT>,<CIT>,<CIT>, <CIT>, <CIT> and <CIT>, in <CIT>, and in <CIT> and <CIT> and <CIT>. Locations may also be tracked using impedance or current based systems.

One medical procedure in which these types of probes or catheters have proved extremely useful is in the treatment of cardiac arrhythmias. Cardiac arrhythmias and atrial fibrillation in particular, persist as common and dangerous medical ailments, especially in the aging population.

Diagnosis and treatment of cardiac arrhythmias include mapping the electrical properties of heart tissue, especially the endocardium, and selectively ablating cardiac tissue by application of energy. Such ablation can cease or modify the propagation of unwanted electrical signals from one portion of the heart to another. The ablation process destroys the unwanted electrical pathways by formation of non-conducting lesions. Various energy delivery modalities have been disclosed for forming lesions, and include use of microwave, laser and more commonly, radiofrequency energies to create conduction blocks along the cardiac tissue wall. In a two-step procedure, mapping followed by ablation, electrical activity at points within the heart is typically sensed and measured by advancing a catheter containing one or more electrical sensors into the heart, and acquiring data at a multiplicity of points. These data are then utilized to select the endocardial target areas at which the ablation is to be performed.

Electrode catheters have been in common use in medical practice for many years. They are used to stimulate and map electrical activity in the heart and to ablate sites of aberrant electrical activity. In use, the electrode catheter is inserted into a major vein or artery, e.g., femoral vein, and then guided into the chamber of the heart of concern. A typical ablation procedure involves the insertion of a catheter having a one or more electrodes at its distal end into a heart chamber. A reference electrode may be provided, generally taped to the skin of the patient or by means of a second catheter that is positioned in or near the heart. RF (radio frequency) current is applied through the tip electrode(s) of the ablating catheter, and current flows through the media that surrounds it, i.e., blood and tissue, between the tip electrode(s) and an indifferent electrode. The distribution of current depends on the amount of electrode surface in contact with the tissue as compared to blood, which has a higher conductivity than the tissue. Heating of the tissue occurs due to its electrical resistance. The tissue is heated sufficiently to cause cellular destruction in the cardiac tissue resulting in formation of a lesion within the cardiac tissue which is electrically non-conductive.

Therefore, when placing an ablation or other catheter within the body, particularly near the endocardial tissue, it is desirable to have the distal tip of the catheter in direct contact with the tissue. The contact can be verified, for example, by measuring the contact between the distal tip and the body tissue. <CIT>, <CIT> and <CIT>, describe methods of sensing contact pressure between the distal tip of a catheter and tissue in a body cavity using a force sensor embedded in the catheter.

A number of references have reported methods to determine electrode-tissue contact, including <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; and <CIT>. A number of these references, e.g., <CIT>,<CIT>, and <CIT> determine electrode-tissue contact by measuring the impedance between the tip electrode and a return electrode. As disclosed in the '<NUM> patent, it is generally known than impedance through blood is generally lower that impedance through tissue. Accordingly, tissue contact has been detected by comparing the impedance values across a set of electrodes to premeasured impedance values when an electrode is known to be in contact with tissue and when it is known to be in contact only with blood. <CIT> discloses systems and methods for virtual reality or augmented reality (VR/AR) visualization of 3D medical images using a VR/AR visualization system.

There is provided in accordance with still another embodiment of the present disclosure, a medical system including a catheter configured to be inserted into a body part of a living subject, a display configured to provide a view of at least part of a hand of a user, and a processor configured to track a position of the catheter in the body part, render to the display a three-dimensional view of an interior of an anatomical map of the body part and a representation of the catheter inside the anatomical map responsively to the tracked position, while the display is providing the view of the at least part of the hand of the user, recognize a gesture of the at least part of the hand of the user selecting a portion of the catheter, and perform an action responsively to recognizing selection by the user of the portion of the catheter.

Further in accordance with an embodiment of the present disclosure, the system includes a camera configured to capture an image of the at least part of the hand of the user, wherein the processor is configured to recognize the gesture of the at least part of the hand of the user selecting the portion of the catheter responsively to the tracked position of the catheter and the captured image.

Still further in accordance with an embodiment of the present disclosure, the system includes a head-mounted apparatus configured to be worn by the user, and including the display, which is configured to concurrently render to the display the three-dimensional view of the interior of the anatomical map of the body part, the representation of the catheter inside the anatomical map responsively to the tracked position, and the image of the at least part of the hand of the user captured by the camera.

Additionally in accordance with an embodiment of the present disclosure, the system includes a head-mounted apparatus configured to be worn by the user, and including the display, which includes an optical see-through display configured to provide the view of the at least part of the hand of the user visible through the display while augmenting the display with virtual objects including the three-dimensional view of the interior of the anatomical map of the body part, and the representation of the catheter inside the anatomical map responsively to the tracked position.

Moreover, in accordance with an embodiment of the present disclosure the catheter includes a plurality of electrodes, the processor is configured to track a position of the electrodes, and the processor is configured to recognize the gesture of the at least part of the hand of the user selecting one electrode of the electrodes of the catheter.

Further in accordance with an embodiment of the present disclosure the one electrode is configured to sense electrical activity from tissue of the body part, and the processor is configured to render to the display an intracardiac electrogram responsively to the sensed electrical activity and recognizing the gesture selecting the one electrode.

Still further in accordance with an embodiment of the present disclosure the one of the electrodes is configured to sense electrical activity from tissue of the body part, and the processor is configured to generate an electro-anatomical map responsively to the sensed electrical activity and recognizing the gesture selecting the one electrode.

Additionally, in accordance with an embodiment of the present disclosure the gesture includes any one or more of the following a pinching gesture, a pointing gesture, or a touching gesture.

Moreover in accordance with an embodiment of the present disclosure, the system includes a head-mounted apparatus configured to be worn by the user, and including the display, and wherein the processor is configured to receive user input maneuvering a virtual camera responsively to movement of the head-mounted apparatus, and render to the display the three-dimensional view of the interior of the anatomical map of the body part and the representation of the catheter inside the anatomical map as viewed from the virtual camera, while the display is providing the view of the at least part of the hand of the user.

Further in accordance with an embodiment of the present disclosure the catheter includes an expandable distal end assembly, and a plurality of electrodes disposed on the expandable distal end assembly, and the processor is configured to render to the display the three-dimensional view of the interior of the anatomical map of the body part and the representation of the catheter inside the anatomical map as viewed from a virtual camera disposed inside the expandable distal end assembly, while the display is providing the view of the at least part of the hand of the user.

There is also provided in accordance with another embodiment of the present disclosure, a medical method including providing a view of at least part of a hand of a user on a display, tracking a position of a catheter in a body part of a living subject, rendering to the display a three-dimensional view of an interior of an anatomical map of the body part and a representation of the catheter inside the anatomical map responsively to the tracked position, while the display is providing the view of the at least part of the hand of the user, recognizing a gesture of the at least part of the hand of the user selecting a portion of the catheter, and performing an action responsively to recognizing selection by the user of the portion of the catheter.

Still further in accordance with an embodiment of the present disclosure, the method includes capturing an image of the at least part of the hand of the user, wherein the recognizing includes recognizing the gesture of the at least part of the hand of the user selecting the portion of the catheter responsively to the tracked position of the catheter and the captured image.

Additionally, in accordance with an embodiment of the present disclosure the display is included in a head-mounted apparatus to be worn by the user, and the rendering includes rendering to the display the three-dimensional view of the interior of the anatomical map of the body part, the representation of the catheter inside the anatomical map responsively to the tracked position, and the captured image of the at least part of the hand of the user.

Moreover, in accordance with an embodiment of the present disclosure the providing includes providing the view of the at least part of the hand of the user visible through an optical see-through display included in a head-mounted apparatus to be worn by the user, while augmenting the display with virtual objects including the three-dimensional view of the interior of the anatomical map of the body part, and the representation of the catheter inside the anatomical map responsively to the tracked position.

Further in accordance with an embodiment of the present disclosure, the method includes tracking a position of electrodes of the catheter, and wherein the recognizing includes recognizing the gesture of the at least part of the hand of the user selecting one electrode of the electrodes of the catheter.

Still further in accordance with an embodiment of the present disclosure, the method includes sensing electrical activity from tissue of the body part by the one electrode, and wherein the rendering includes rendering to the display an intracardiac electrogram responsively to the sensed electrical activity and the recognizing the gesture selecting the one electrode.

Additionally, in accordance with an embodiment of the present disclosure, the method includes sensing electrical activity from tissue of the body part by the one electrode, and generating an electro-anatomical map responsively to the sensed electrical activity and the recognizing the gesture selecting the one electrode.

Moreover, in accordance with an embodiment of the present disclosure the gesture includes any one or more of the following a pinching gesture, a pointing gesture, or a touching gesture.

Further in accordance with an embodiment of the present disclosure, the method includes receiving user input maneuvering a virtual camera responsively to movement of a head-mounted apparatus worn by the user, and wherein the rendering includes rendering to the display the three-dimensional view of the interior of the anatomical map of the body part and the representation of the catheter inside the anatomical map as viewed from the virtual camera, while the display is providing the view of the at least part of the hand of the user.

Still further in accordance with an embodiment of the present disclosure the rendering includes rendering to the display the three-dimensional view of the interior of the anatomical map of the body part and the representation of the catheter inside the anatomical map as viewed from a virtual camera disposed inside an expandable distal end assembly of the catheter, while the display is providing the view of the at least part of the hand of the user.

There is also provided in accordance with still another embodiment of the present disclosure, a software product, including a non-transient computer-readable medium in which program instructions are stored, which instructions, when read by a central processing unit (CPU), cause the CPU to track a position of a catheter in a body part of a living subject, render to a display a three-dimensional view of an interior of an anatomical map of the body part, and a representation of the catheter inside the anatomical map responsively to the tracked position, while the display is providing a view of at least part of a hand of a user, recognize a gesture of the at least part of the hand of the user selecting a portion of the catheter, and perform an action responsively to recognizing selection by the user of the portion of the catheter.

As mentioned previously, in a two-step procedure, mapping followed by ablation, electrical activity at points within the heart is typically sensed and measured by advancing a catheter containing one or more electrodes into the heart, and acquiring data at a multiplicity of points. These data are then utilized to select the target areas at which the ablation is to be performed.

In particular, the electrical activity may be displayed as intracardial electrogram (IEGM) traces for analysis by a physician in order to find sources of arrhythmia. A catheter electrode, which is not in contact with tissue in the heart, generally measures some electrical signal from the heart tissue and a far field signal. When the catheter electrode is in contact with the heart tissue, the amplitude of the signal is mainly based on tissue conductivity, while the far field is minor. Therefore, the physician is generally interested in analyzing the IEGM traces of electrodes in contact with the tissue.

For focal catheters with one or two electrodes, a single IEGM trace is typically displayed for a physician to analyze. A physician can quickly determine based on the form of the signal whether the catheter electrode providing the signal is in contact with the tissue. However, multi-electrode catheters simultaneously capturing electrical activity from different tissue locations may provide data for a plurality of IEGM traces to be displayed at the same time on a single display. In some cases, the number of IEGM traces may be too numerous for the physician to easily determine which of the IEGM traces are provided by electrodes in contact with the tissue, and which are not.

An example of a multielectrode catheter is the Octaray® catheter, with in excess of <NUM> electrodes, produced by Biosense Webster Inc. , of Irvine, CA, USA. The Octaray includes eight deflectable arms disposed at the distal end of a shaft, with each of the deflectable arms including six electrodes. Some catheters such as basket catheters may include more electrodes, for example, but not limited to, <NUM> electrodes.

In addition of the need to determine electrode contact during mapping discussed above, the physician performing an ablation procedure monitors the contact of electrodes with tissue, as effective ablation generally requires sufficient contact between the ablation electrode(s) and the tissue. For small numbers of electrodes, monitoring the contact may be performed by presenting a measure of the contact, such as the impedance seen by an electrode or the force on the electrode, numerically or even graphically. However, as the number of active electrodes used in an ablation procedure increases, it becomes increasingly difficult for the physician to monitor any parameter for the individual electrodes. In the case of electrode contact, this problem is exacerbated by the fact that in most cases as the contact varies, so the parameter measuring the contact also varies.

Embodiments of the present invention solve the above problems during a medical procedure such as a mapping or ablation procedure, by providing a user interface in which the user views a three-dimension (3D) representation of a catheter and its electrodes inside an anatomical map of a body part such as a cardiac chamber. The anatomical map may include anatomical features and/or tags identifying previous ablation points or information such as electrical activation information. The user can then easily see the catheter with respect to the body part (and its features), for example, which electrodes are in sufficient contact with tissue of the body part. A hand or hands (or part thereof) of the user are shown on the screen (for example, by using a see-through display of a head-mounted display (HMD), or via capturing images of the hand(s) with a camera mounted in the room or on an HMD, described in more detail below) along with the catheter representation and anatomical map so that the user can make hand gestures (which are recognized by software) to select portions of the catheter, such as one or more of the electrodes. An action associated with the selection may then be performed, for example, displaying an IEGM sensed by the selected electrode, or capturing electrical activity from the selected electrode into an electro-anatomical map. Different gesture types may be used to perform different actions. For example, the user may point to an electrode to view the IEGM associated with that electrode or pinch an electrode to select the electrode for mapping purposes.

In some embodiments, the user wears an HMD including an eye-level video display screen and a forward-facing camera. The camera captures images of the user's hand(s) (or part thereof) and displays the images of the hand(s) (or part thereof) along with the 3D catheter representation and interior 3D view of the anatomical map on the eye-level video display screen. The image of the hands and/or the catheter representation are scaled accordingly so that a finger or fingers of the user may easily select a single electrode, while the finger(s) can move around easily to select any electrode on the catheter. In some embodiments, the catheter representation and the interior of the anatomical map may be viewed from the point of view of a virtual camera which may be maneuvered by the user moving the (HMD) for example, in a different orientation and/or location. In some embodiments, the virtual camera may be disposed inside an expandable distal end assembly (e.g., basket) of the catheter.

In some embodiments, the HMD includes an optical see-through display which provides a view of the hand(s) (or part thereof) as seen through the display, while augmenting the display with virtual objects including the 3D representation of the catheter and the 3D view of the interior of the anatomical map of the body part responsively to a tracked position of the catheter.

In some embodiments, the view of the hands, representation of the catheter, and the interior of the anatomical map may be displayed on a display monitor, tablet or any suitable display device.

Reference is now made to <FIG>, which is a schematic view of a medical system <NUM> constructed and operative in accordance with an embodiment of the present invention. The system <NUM> includes a catheter <NUM> configured to be inserted into a body part of a living subject (e.g., a patient <NUM>). A physician <NUM> navigates the catheter <NUM> (for example, a basket catheter produced Biosense Webster, Inc. of Irvine, CA, USA), to a target location in a heart <NUM> of the patient <NUM>, by manipulating an elongated deflectable element <NUM> of the catheter <NUM>, using a manipulator <NUM> near a proximal end of the catheter <NUM>, and/or deflection from a sheath <NUM>. In the pictured embodiment, physician <NUM> uses catheter <NUM> to perform electro-anatomical mapping of a cardiac chamber and ablation of cardiac tissue.

Catheter <NUM> includes an expandable distal end assembly <NUM> (e.g., a basket assembly), which is inserted in a folded configuration, through sheath <NUM>, and only after the catheter <NUM> exits sheath <NUM> does the distal end assembly <NUM> regain its intended functional shape. By containing distal end assembly <NUM> in a folded configuration, sheath <NUM> also serves to minimize vascular trauma on its way to the target location.

Catheter <NUM> includes a plurality of electrodes <NUM> disposed on the expandable distal end assembly <NUM> for sensing electrical activity and/or applying ablation power to ablate tissue of the body part. The catheter <NUM> may also include a proximal electrode <NUM> disposed on the deflectable element <NUM> proximal to the expandable distal end assembly <NUM>. Catheter <NUM> may incorporate a magnetic position sensor (not shown) at the distal edge of deflectable element <NUM> (i.e., at the proximal edge of the distal end assembly <NUM>). Typically, although not necessarily, the magnetic sensor is a Single-Axis Sensor (SAS). A second magnetic sensor (not shown) may be included at any suitable position on the assembly <NUM>. The second magnetic sensor may be a Triple-Axis Sensor (TAS) or a Dual-Axis Sensor (DAS), or a SAS by way of example only, based for example on sizing considerations. The magnetic sensors, the proximal electrode <NUM>, and electrodes <NUM> disposed on the assembly <NUM> are connected by wires running through deflectable element <NUM> to various driver circuitries in a console <NUM>.

In some embodiments, system <NUM> comprises a magnetic-sensing sub-system to estimate an ellipticity of the basket assembly <NUM> of catheter <NUM>, as well as its elongation/retraction state, inside a cardiac chamber of heart <NUM> by estimating the elongation of the basket assembly <NUM> from the distance between the magnetic sensors. Patient <NUM> is placed in a magnetic field generated by a pad containing one or more magnetic field generator coils <NUM>, which are driven by a unit <NUM>. The magnetic fields generated by coil(s) <NUM> transmit alternating magnetic fields into a region where the body-part is located. The transmitted alternating magnetic fields generate signals in the magnetic sensors, which are indicative of position and/or direction. The generated signals are transmitted to console <NUM> and become corresponding electrical inputs to a processor <NUM>.

The method of position and/or direction sensing using external magnetic fields and magnetic sensors, is implemented in various medical applications, for example, in the CARTO® system, produced by Biosense-Webster, and is described in detail in <CIT>,<CIT>, <CIT>, <CIT>,<CIT> and <CIT>, in <CIT>, and in <CIT>, <CIT> and <CIT>.

Processor <NUM>, typically part of a general-purpose computer, is further connected via a suitable front end and interface circuits <NUM>, to receive signals from body surface-electrodes <NUM>. Processor <NUM> is connected to body surface-electrodes <NUM> by wires running through a cable <NUM> to the chest of patient <NUM>.

Processor <NUM> renders to a display <NUM>, a representation <NUM> of at least a part of the catheter <NUM> and a mapped body-part (e.g., anatomical or electro-anatomical map), responsively to computed position coordinates of the catheter <NUM>.

Processor <NUM> is typically programmed in software to carry out the functions described herein. The software may be downloaded to the computer in electronic form, over a network, for example, or it may, alternatively or additionally, be provided and/or stored on non-transitory tangible media, such as magnetic, optical, or electronic memory.

The medical system <NUM> may also include an ablation power generator <NUM> (such as an RF signal generator) configured to be connected to the catheter <NUM>, and apply an electrical signal between one or more of the electrodes <NUM> and the proximal electrode <NUM>. The medical system <NUM> may also include an irrigation reservoir <NUM> configured to store irrigation fluid, and a pump <NUM> configured to be connected to the irrigation reservoir <NUM> and the catheter <NUM>, and to pump the irrigation fluid from the irrigation reservoir <NUM> via an irrigation tube through irrigation holes of the catheter <NUM>.

The example illustration shown in <FIG> is chosen purely for the sake of conceptual clarity. <FIG> shows only elements related to the disclosed techniques for the sake of simplicity and clarity. System <NUM> typically comprises additional modules and elements that are not directly related to the disclosed techniques, and thus are intentionally omitted from <FIG> and from the corresponding description. The elements of system <NUM> and the methods described herein may be further applied, for example, to control an ablation of tissue of heart <NUM>.

The catheter <NUM> has been described herein as a basket catheter. The expandable distal end assembly <NUM> may include any suitable number of splines, any suitable number of electrodes, and any suitable number of electrodes per spline. The catheter <NUM> may be implemented as any suitable catheter-type, for example, a balloon catheter, a lasso-shape catheter, a grid-shape catheter, or a flexible spline catheter where distal ends of flexible splines are not connected together.

Reference is now made to <FIG>, which is a schematic view showing the catheter <NUM> inside a body part such as the heart <NUM> for use in the system <NUM> of <FIG>. <FIG> shows that some of the electrodes <NUM> (the ones visible in <FIG> - only some labeled for the sake of simplicity) on the expandable distal end assembly <NUM> are not in contact with tissue of the heart <NUM>, whereas other electrodes <NUM> (not visible in <FIG> but indicated using an arrow <NUM>) are in contact with the tissue of the heart <NUM>. The position (location and orientation) of the catheter <NUM> and the electrodes <NUM> may be tracked using any suitable tracking method, for example, the method described above with reference to <FIG>.

The physician <NUM> or another user of the medical system <NUM> may use a display such as the display <NUM> (<FIG>), or a head-mounted apparatus <NUM> (e.g., head-mounted display (HMD)) including a display screen <NUM>, to view the position of the catheter <NUM> and the electrodes <NUM> with respect to the body part. The catheter <NUM>, the electrodes <NUM>, and the interior of the body part may be viewed from a virtual camera <NUM>, which may be virtually placed in the body part and/or in the expandable distal end assembly <NUM> (as shown in <FIG>) and maneuvered by the physician <NUM>. The virtual camera <NUM> may be maneuvered using a user interface (such as a joystick) and/or by moving the head-mounted apparatus <NUM>. <FIG> shows dotted lines <NUM>, which indicate the field of view of the virtual camera <NUM>.

The physician <NUM> selects portions of the catheter <NUM> including one or more of the electrodes <NUM> using hand gestures. The hand(s) (or part thereof) of the physician <NUM> (or images of the hand(s)) are shown on the display <NUM> (or other suitable display) so that the physician <NUM> can view his/her hand(s) with respect to a representation of the catheter <NUM> and electrodes <NUM> on the display <NUM>, as described in more detail below with reference to <FIG>.

The hand gestures may be tracked by analyzing images captured with a camera <NUM>. The camera <NUM> may be disposed in the room where the medical procedure is being performed, or on the front of the head-mounted apparatus <NUM> or any suitable location. Alternatively, or additionally, the hand gestures may be tracked using any suitable tracking technique, for example, a glove-based technology using virtual-reality gloves with sensors in the gloves to track hand and finger movement of the physician <NUM> who is wearing the gloves. The sensors may include any one or more of the following sensors: mechanical; piezoresistive; or fiber-optic to measure bending of fingers. Other sensors include: a gyroscope, accelerometer(s), and/or magnetometer(s) to track movement of the hands. The signals from the gloves are sent to the processor <NUM> to be processed by software to identify hand movements and/or gestures.

The head-mounted apparatus <NUM> is configured to be worn by the physician <NUM> (or any suitable user). It should be noted that when the physician <NUM> is described herein as performing a task, the task may also be performed by any suitable user. In some embodiments, the display <NUM> comprises an optical see-through display in which the physician <NUM> can see his/her hands (or part thereof) through the display <NUM> when his/her hands are placed out in front of him/her. In other embodiments, the display <NUM> is an eye-level video display, in which images (e.g., a video) of the hand(s) (or part thereof) captured by the camera <NUM> are shown on the display <NUM>, as described in more detail with reference to <FIG>.

Reference is now made to <FIG>, which is a schematic view of the display <NUM> providing a view <NUM> of a hand performing a gesture, and a rendering of an interior of an anatomical map <NUM> of a body part and a rendering of a representation <NUM> of the catheter <NUM> of <FIG> inside the anatomical map <NUM>. Reference is also made to <FIG>.

<FIG> shows the inside of the expandable distal end assembly <NUM> with the electrodes <NUM> of the expandable distal end assembly <NUM> hidden from view as electrodes <NUM> are facing the tissue of the body part (i.e., into the page of the drawing of <FIG>). In order to allow the physician <NUM> to view and select the "hidden" electrodes <NUM>, the positions of the electrodes <NUM> are shown on the representation <NUM> as representations <NUM> (only some labeled for the sake of simplicity). <FIG> shows the hand (view <NUM>) performing a pinching action on one of the representations <NUM>. The corresponding electrode <NUM> is then selected. In the example of <FIG>, the pinching action causes the display of an IEGM <NUM> sensed by the selected electrode <NUM>. In some embodiments, the representation <NUM> may show the catheter <NUM> using a semi-transparent rendering in order to see the positions of the "hidden" electrodes <NUM>.

In embodiments where the display <NUM> of the head-mounted apparatus <NUM> comprises an optical see-through display, the view <NUM> seen on the display <NUM> is the actual hand(s) of the physician <NUM> placed in front of him/her. The anatomical map <NUM> and the representation <NUM> (including the representations <NUM>) are then augmented onto the display <NUM> so that the hand(s) is seen with the anatomical map <NUM> and the representation <NUM> of the catheter <NUM>. The movement of the hands may be registered with the coordinate frame used to track the catheter <NUM> based on images captured by the camera <NUM> or using tracking gloves worn by the physician <NUM> or any suitable method. The size of the representation <NUM> and the anatomical map <NUM> is scaled according to the size of the hands viewed on the display <NUM> (either based on actual captured images of the hands or based on an assumed size of the hands) so that a gesture such as pointing with a finger or pinching with two fingers may be used to easily select a single electrode.

In embodiments where the display <NUM> of the head mounted apparatus <NUM> is an eye-level video display, the view <NUM> includes images (e.g., a video) of the hand(s) (or part thereof) captured by the camera <NUM>. The view <NUM>, anatomical map <NUM>, and the representation <NUM> (including the representations <NUM>) are rendered to the display <NUM> by the processor <NUM>. The movement of the hands may be registered with the coordinate frame used to track the catheter <NUM> based on images captured by the camera <NUM> or using tracking gloves worn by the physician <NUM> or any suitable method. The size of the view <NUM> of the hands, and/or the representation <NUM> and the anatomical map <NUM>, may be scaled so that a gesture such as pointing with a finger or pinching with two fingers may be used to easily select a single electrode.

Reference is now made to <FIG>, which is a flowchart <NUM> including steps in a method of operation of the system <NUM> of <FIG>. Reference is also made to <FIG>. The steps described below with reference to the flowchart <NUM> may be performed in any suitable order and some of the steps may be performed concurrently, unless the steps require a given processing order.

The catheter <NUM> is configured to be inserted into a body part (e.g., a chamber of the heart <NUM>) of a living subject. The electrodes <NUM> of the catheter <NUM> and the electrodes <NUM> of the catheter <NUM> are configured to sense electrical activity from tissue of the body part. The processor <NUM> (<FIG>) is configured to track (block <NUM>) a position (e.g., location, orientation, and roll) of the catheter <NUM> in the body part. The processor is configured to track a position of the electrodes <NUM> of the catheter <NUM>. Any suitable tracking method may be used, for example, the tracking method described above with reference to <FIG>.

In embodiments including the camera <NUM>, the camera <NUM> is configured to capture (block <NUM>) at least one image (e.g., a video) of the hand(s) (or part thereof) of the physician <NUM>.

The display <NUM> is configured to provide (block <NUM>) the view <NUM> (<FIG>) of the hand(s) (or part thereof) of the physician <NUM>. In embodiments where the display <NUM> of the head-mounted apparatus <NUM> comprises an optical see-through display, the view <NUM> seen on the display <NUM> is the actual hand(s) of the physician <NUM> placed in front of him/her. In embodiments where the display <NUM> of the head mounted apparatus <NUM> is an eye-level video display, the view <NUM> includes images (e.g., a video) of the hand(s) (or part thereof) captured by the camera <NUM> and the processor <NUM> is configured to render the images of the hand(s) (or part thereof) to the display <NUM>.

The processor <NUM> is configured to render (block <NUM>) to the display <NUM> the three-dimensional view of the interior of the anatomical map <NUM> of the body part and the representation <NUM> of the catheter <NUM> (and the representations <NUM> of the electrodes <NUM>) inside the anatomical map <NUM> responsively to the tracked position of the catheter <NUM>, while the display <NUM> is providing the view <NUM> of the hand(s) (or part thereof) of the physician <NUM>. In some embodiments, the processor <NUM> is configured to render to the display <NUM> the three-dimensional view of the interior of the anatomical map <NUM> of the body part and the representation <NUM> of the catheter <NUM> (and the representations <NUM> of the electrodes <NUM>) inside the anatomical map <NUM> as viewed from the virtual camera <NUM>, while the display <NUM> is providing the view of the hand(s) (or part thereof) of the physician <NUM>. The virtual camera <NUM> is optionally disposed inside the expandable distal end assembly <NUM> of the catheter <NUM>.

In some embodiments, where the display <NUM> is a video display comprised in the head mounted apparatus <NUM>, the display <NUM> is configured to concurrently render (block <NUM>) to the display <NUM>: the three-dimensional view of the interior of the anatomical map <NUM> of the body part; the representation <NUM> of the catheter <NUM> (and the representations <NUM> of the electrodes <NUM>) inside the anatomical map <NUM> responsively to the tracked position of the catheter <NUM>; and the view <NUM> of the hand(s) (or a part thereof) of the physician <NUM> included in the images (e.g., video) captured by the camera <NUM>. In some embodiments, the processor <NUM> may be configured to generate the view <NUM> based on virtual-reality gloves worn by the physician <NUM>.

In some embodiments, where the display <NUM> is comprised in the head-mounted apparatus <NUM>, and includes an optical see-through display, the optical see-through display is configured to provide (block <NUM>) the view of the hand(s) (or part thereof) of the physician <NUM> visible through the display <NUM> while augmenting the display <NUM> with virtual objects including the three-dimensional view of the interior of the anatomical map <NUM> of the body part, and the representation <NUM> of the catheter <NUM> (and the representations <NUM> of the electrodes <NUM>) inside the anatomical map <NUM> responsively to the tracked position of the catheter <NUM>.

In some embodiments, the processor <NUM> is configured to receive (block <NUM>) user input maneuvering the virtual camera <NUM> responsively to movement of the head-mounted apparatus <NUM> or any suitable user interface (such as a joystick). In response to movement of the virtual camera <NUM>, the view of the representation <NUM> and the anatomical map <NUM> shown in the display <NUM> changes.

The processor <NUM> is configured to recognize (block <NUM>) a gesture of the hand(s) (or part thereof) of the physician <NUM> selecting a portion of the catheter <NUM> and/or one of the electrodes <NUM> of the catheter <NUM>. The processor <NUM> may recognize the gesture based on: analysis of the images captured by the camera <NUM>; and/or analysis of the images displayed on the display <NUM>; and/or other gesture tracking methods, for example, tracking glove movement. The proximity of the hand or finger(s) to the portion of the catheter <NUM> or one of the electrodes <NUM> may be determined from: analysis of the images displayed on the display <NUM>; and/or the tracked position of the catheter <NUM> and/or the electrodes <NUM> with respect to a tracked position of the hand(s) or finger(s). The gesture may include any one or more of the following, by way of example: a pinching gesture; a pointing gesture; or a touching gesture.

The processor <NUM> is configured to perform (block <NUM>) an action responsively to recognizing selection by the physician <NUM> of the portion of the catheter <NUM> (or of one of the electrodes <NUM>). Example action now follow. In some embodiments, the processor <NUM> is configured to render to the display <NUM> the IEGM <NUM> responsively to the sensed electrical activity of the selected electrode <NUM> and recognizing the gesture of selecting that electrode <NUM>. In some embodiments, the processor <NUM> is configured to generate an electro-anatomical map responsively to the sensed electrical activity of the selected electrode <NUM> and recognizing the gesture of selecting that electrode <NUM>.

More specifically, "about" or "approximately" may refer to the range of values ±<NUM>% of the recited value, e.g., "about <NUM>%" may refer to the range of values from <NUM>% to <NUM>%.

Various features of the invention which are, for clarity, described in the contexts of separate embodiments may also be provided in combination in a single embodiment. Conversely, various features of the invention which are, for brevity, described in the context of a single embodiment may also be provided separately or in any suitable sub-combination.

Claim 1:
A medical system comprising:
a catheter (<NUM>) configured to be inserted into a body part of a living subject, wherein the catheter includes a plurality of electrodes (<NUM>);
a display (<NUM>) configured to provide a view of at least part of a hand of a user; and
a processor (<NUM>) configured to:
track a position of the catheter (<NUM>) in the body part;
track a position of the electrodes (<NUM>);
render to the display (<NUM>) a three-dimensional view of an interior of an anatomical map of the body part and a representation of the catheter inside the anatomical map responsively to the tracked position, while the display (<NUM>) is providing the view of the at least part of the hand of the user; characterised in that the processor is further configured to:
recognize a gesture of the at least part of the hand of the user selecting one electrode of the electrodes (<NUM>) of the catheter (<NUM>);
and
perform an action responsively to recognizing selection by the user of the one electrode of the electrodes (<NUM>).