Enhancing visualization of electrical activity of an organ

Abstract

The invention is entitled "Augmenting visualization of organ electrical activity." The invention discloses methods, apparatuses, and systems for medical procedures, and the method includes sensing, by one or more electrodes on a catheter, a plurality of tissue potentials at an organ region of an organ, determining, from the plurality of first tissue potentials, a number of peak potentials such that the peak potentials exceed a potential threshold, determining, based on the number of peak potentials, a first visual characteristic, and displaying a rendering of the organ including the organ region such that the rendering of the first organ region includes the first visual characteristic.

Description

Technical Field

[0001] This application provides systems, apparatus, and methods for improving cardiac surgery. Background Technology

[0002] Cardiac ablation is a surgical procedure that treats abnormal heart rhythms by burning or destroying the tissue in a patient's heart that is causing the abnormal rhythm. Cardiac ablation is commonly used to treat arrhythmias such as atrial fibrillation, atrial flutter, supraventricular tachycardia, and Wolff-Parkinson-White syndrome. During cardiac ablation, an electrical measurement of the heart is performed using a catheter. Based on the measurement results, the surgeon then uses heat (radiofrequency ablation), cryoablation (cryoablation), or laser to burn or destroy the areas of the heart confirmed to be causing the electrical abnormality.

[0003] Traditional cardiac ablation procedures rely solely on the surgeon's subjective skill to determine where and how to perform ablation. This traditional approach leads to high variability in clinical outcomes between patients, between surgeons, and between hospitals. Summary of the Invention

[0004] The present invention discloses a method, apparatus, and system for medical surgery, wherein the method includes: sensing a plurality of tissue potentials at an organ region via one or more electrodes on a catheter; determining a number of peak potentials based on the plurality of first tissue potentials such that the peak potentials exceed a potential threshold; determining a first visual characteristic based on the number of peak potentials; and displaying a rendering of the organ including the organ region such that the rendering of the first organ region includes the first visual characteristic. Attached Figure Description

[0005] A more detailed understanding can be obtained by referring to the accompanying drawings and giving examples, wherein:

[0006] Figure 1 This is a schematic diagram of an exemplary system that can implement one or more features of the subject matter disclosed in this invention;

[0007] Figure 2A and Figure 2B This is an illustration of a medical system including a mapping catheter according to an embodiment of the subject matter disclosed in this invention;

[0008] Figure 3 This is an illustration of the distal end of a mapping catheter according to an embodiment of the subject matter disclosed in this invention;

[0009] Figure 4 This is a schematic diagram of a heart having a potential bar according to an embodiment of the subject matter disclosed in the present invention;

[0010] Figure 5This is a flowchart for visualizing electric potential activity according to an embodiment of the subject matter disclosed in this invention;

[0011] Figure 6 This is a schematic diagram of a heart having visual characteristics based on cardiac electrical potential, according to an embodiment of the subject matter disclosed in this invention.

[0012] Figure 7 This is a flowchart for time-based visualization of potential activity according to an embodiment of the subject matter disclosed in this invention;

[0013] Figure 8 This is a schematic diagram of a heart with visual characteristics of time-based potential activity according to an embodiment of the subject matter disclosed in the present invention;

[0014] Figure 9 It is an image of a potential signal response graph with multiple peaks and low percentage values;

[0015] Figure 10 It is an image of a potential signal response graph with multiple peaks and high percentage values;

[0016] Figure 11 It is a schematic diagram of a local potential mapping; and

[0017] Figure 12 It is an image of the heart that has visual characteristics of potential activity based on local potential mapping. Detailed Implementation

[0018] According to specific embodiments of the subject matter disclosed herein, renderings of organs such as the heart can be provided, such that the rendering includes visual characteristics based on electrical potential at different regions of the organ. By providing potential-based visual characteristics, regions of the organ with abnormal electrical potentials can be readily identified as ablation regions. Thus, as further disclosed herein, static renderings of organs having such potential-based visual characteristics are provided.

[0019] Figure 1 This is an illustration of an exemplary system 100 that can implement one or more features of this disclosure. In system 100, multiple discrete surgical networks 101A-101N are connected to a cloud platform 160 via network 150. In some cases, cloud platform 160 is implemented by a public cloud computing platform (such as Amazon Web Services or Microsoft Azure), a hybrid cloud computing platform (such as HP Enterprise OneSphere), or a private cloud computing platform.

[0020] Discrete surgical networks 101A-101N can reside in a single hospital or a single healthcare provider network. Each discrete surgical network in system 101 includes one or more surgical systems 110 connected to a local server 120. These one or more surgical systems are capable of acquiring anatomical and electrical measurements of patient organs such as the heart and performing cardiac ablation procedures. An example of a surgical system 110 that can be used in system 100 is one sold by Biosense Webster. The system. In some cases, the surgical system 110 may also associate the measurement results with a unique patient identity (ID) or other information that can be used to uniquely identify the patient.

[0021] Surgical system 110 may also, and optionally, use ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), or other medical imaging techniques known in the art to obtain anatomical measurements of the patient's heart. Surgical system 110 may use catheters, electrocardiography (EKG), or other sensors that measure the electrical properties of the heart to obtain electrical measurements. The anatomical and electrical measurements can then be stored in the local memory of surgical system 110 and transmitted to local server 120 using private network 105. In some cases, the electrical and anatomical measurements are transmitted to local server 120 immediately after acquisition.

[0022] The surgical system 110 then generates a mapping of the patient's heart by combining the electrical and anatomical measurement results. The mapping of the patient's heart can be stored in the local memory of the surgical system 110 (e.g., memory 56, such as...). Figure 2A (As shown) and transmitted to local server 120 using private network 105. In some cases, the mapping map can be transmitted to local server 120 immediately after generation.

[0023] Surgical system 110 enables surgeons to perform cardiac ablation procedures. In some cases, cardiac ablation procedures may utilize contact force techniques and flushing ablation techniques. Ablation procedures may be performed according to the techniques disclosed herein and may include identifying the ablation area based on visual characteristics of static mapping.

[0024] Private network 105 can be any network or system known in the art, such as an intranet, local area network (LAN), wide area network (WAN), metropolitan area network (MAN), direct connection or a series of connections, cellular telephone network, or any other network or medium capable of facilitating communication between surgical system 110 and local server 120. Network 105 can be wired, wireless, or a combination thereof. Wired connections can be implemented using Ethernet, Universal Serial Bus (USB), RJ-11, or any other wired connection known in the art. Wireless connections can be implemented using Wi-Fi, WiMAX and Bluetooth, infrared, cellular networks, satellite, or any other wireless connection method known in the art. Additionally, several networks can operate independently or communicate with each other to facilitate communication within network 105.

[0025] The local server 120 receives electrical and anatomical measurement results, mapping maps, and information about the ablation procedure from its local database. In some cases, the local database associates the received data with unique patient-identifiable information.

[0026] In some cases, local server 120 is implemented as a physical server. In other cases, local server 120 is implemented as a public cloud computing provider (e.g., Amazon Web Services). () virtual server.

[0027] In some cases, the local server 120 uses machine learning or other artificial intelligence techniques to analyze data stored in a local database. Such data may be correlated with potentials above a threshold or the shape of scar areas, as further disclosed herein. The local server can use machine learning to: 1) consider all previous patients with similar cardiac conditions and morphology, along with associated ablation data and best outcomes from previous patients, to recommend the optimal treatment plan for the cardiac ablation to be performed; 2) modify the treatment plan or threshold when cardiac ablation is to be performed or is being performed, taking into account the aforementioned previous patients and ablation data, and make specific recommendations to the physician during the ablation procedure; and / or 3) evaluate the performance of the surgeon performing the cardiac ablation based on the treatment plan and patient outcomes. In this way, the physician has accumulated experience from all previous patients and cardiac procedures in planning, treating, and evaluating ablation procedures to achieve optimal patient outcomes.

[0028] The collection and analysis of data related to a specific surgical procedure can include statistical information available from the relevant patient and broken down by specific individual parts of the procedure. This will help physicians and researchers measure the impact of any parameter on any other parameter. In one example, the collection and analysis of such data allows researchers to evaluate any changes introduced during cardiac catheterization, such as electrical potential thresholds, visual characteristics, etc. This will allow researchers to determine whether these changes improve patient outcomes.

[0029] Public network 150 can be any network or system known in the art, including the Internet, intranet, local area network (LAN), wide area network (WAN), metropolitan area network (MAN), direct connection or a series of connections, cellular telephone network, or any other network or medium capable of facilitating communication between discrete surgical networks 101A-101N and cloud-based platform 160. Public network 150 can be wired, wireless, or a combination thereof. Wired connections can be implemented using Ethernet, Universal Serial Bus (USB), RJ-11, or any other wired connection known in the art. Wireless connections can be implemented using Wi-Fi, WiMAX and Bluetooth, infrared, cellular networks, satellite, or any other wireless connection method known in the art. Additionally, several networks can operate independently or communicate with each other to facilitate communication within network 150.

[0030] The cloud-based platform 160 can receive data from each local server 120 of the discrete surgical networks 101A-101N and store the received information in a database. In many cases, the cloud-based platform 160 also provides an entry point for third parties 140 to query the data stored in the database via network 150. In some cases, the third party 140 can use a standard internet browser to access the entry point of the cloud-based platform 160. In other cases, the third party 140 requires a dedicated application to access the entry point of the cloud-based platform 160.

[0031] Figure 2A and Figure 2B This is an illustration of a medical system 110 including a medical probe 22 and a control console 24 according to an embodiment of the present invention. Figure 3 This illustration shows the distal end 26 of a medical probe 22 according to an embodiment of the present invention. Surgical system 110 may be part of system 100, such as... Figure 1 As shown. In the embodiments described below, the medical probe 22 may be used for diagnostic or therapeutic procedures, such as mapping the electrical potential of the heart 28 of the patient 30. In the embodiments described herein, the medical probe 22 may also be referred to as a mapping catheter and / or an ablation catheter. Alternatively, the medical probe 22 may be used for other therapeutic and / or diagnostic purposes in the heart or other body organs.

[0032] The medical probe 22 includes an insertion tube 32 and a handle 34 attached to the proximal end of the insertion tube. By manipulating the handle 34, a medical professional 36 can insert the medical probe 22 into the body cavity of a patient 30. For example, the medical professional 36 can insert the medical probe 22 through the vascular system of the patient 30, such that the distal end 26 of the medical probe 22 enters the chamber of the heart 28 and engages with myocardial tissue at one or more desired locations. For example, Figure 3 As shown, the distal end 26 of the medical probe 22 includes a flexible spline 80 formed at the end of the tubular shaft 82. During a medical procedure, a medical professional 36 can deploy the spline 80 by extending the tubular shaft from the insertion tube 32.

[0033] The console 24 is connected via cable 38 to a surface electrode, which typically includes an adhesive skin patch 40 attached to the patient 30. The console 24 includes a processor 42, which, in conjunction with a current tracking module 44, determines the position coordinates of the distal end 26 of the probe 22 within the heart 28 based on impedance measured between the adhesive skin patch 40 and the electrode 84 attached to the spline 80. Figure 3 As shown. In the embodiments described herein, electrode 84 may also be configured to apply a signal to tissue in heart 28 and / or measure a physiological characteristic (e.g., local surface potential) at a location in the heart. Electrode 84 is connected to console 24 via a wire (not shown) extending through medical probe 22.

[0034] While the embodiments described herein illustrate a medical probe 22 comprising a variety of intracardiac catheters, the use of other multi-electrode intracardiac catheters or single-electrode catheters is considered within the scope of this disclosure.

[0035] Processor 42 may include real-time noise reduction circuitry 46, typically configured as a field-programmable gate array (FPGA), followed by an analog-to-digital (A / D) ECG (electrocardiogram) or EMG (electromyography) signal conversion integrated circuit 48. The processor may pass signals from the A / D ECG or EMG circuitry 48 to another processor and / or may be programmed to execute one or more algorithms disclosed herein, each of which includes the steps described below. The processor uses the noise reduction circuitry 46 and the signal conversion integrated circuit 48, along with the features of the modules detailed below, to execute one or more algorithms.

[0036] Figure 1 and Figure 2A and Figure 2B The surgical system shown can use impedance-based sensing to measure the position of the distal end 26 of the probe 22; however, other position tracking techniques can be used (e.g., techniques using magnetic sensors).

[0037] The console 24 also includes an input / output (I / O) communication interface 50 that enables the console to transmit signals from and / or to the electrode 84 and the adhesive skin patch 40. Based on the signals received from the electrode 84 and / or the adhesive skin patch 40, the processor 42 can generate a potential-based mapping 52. Figure 2A (), which demonstrates the potential-based visual characteristics, as disclosed herein.

[0038] During the procedure, the processor 42 can present a potential-based mapping 52 to a medical professional 36 on a display 54 and store data representing the potential-based mapping 52 in a memory 56, as described below. Figure 2A As described in the description. Memory 56 may include any suitable volatile and / or non-volatile memory, such as random access memory or a hard disk drive. In some embodiments, the medical professional 36 may manipulate the mapping map 52 using one or more input devices 78. In an alternative embodiment, the display 54 may include a touchscreen that can be configured to accept input from the medical professional 36 in addition to displaying the potential-based mapping map 52.

[0039] The console 24 may also include an electromyography (EMG) module 58, which can be configured to generate EMG charts 60 based on signals received from electrodes 84. In some embodiments, the processor 42 presents one or more EMG charts 60 (i.e., together with LAT mappings 52) on a display 54 and stores data representing the EMG chart mappings in a memory 56.

[0040] like Figure 2B As shown, the memory 56 stores the processor 42, which can be used to generate and present the electroanatomical mapping data 62 of the electroanatomical mapping 52, and the storage processor can also be used to generate and present the EGM chart dataset 64 of the EGM chart 60. The electroanatomical mapping data includes a plurality of mapping point records 66, each of which includes a set of location coordinates 68 (i.e., within the patient 30) and a potential 70. In the embodiments herein, the location coordinates 68 may also be referred to as location 68.

[0041] Each EGM signal dataset 64 includes multiple EGM chart point records 72, each of which includes a measurement time 74 and a potential measurement result 76. In the embodiments described herein, each given electrode 84 has a one-to-one correspondence with a given EGM chart dataset 64. In other words, each given EGM chart dataset 64 stores multiple EGM chart point records, which in turn store the potential measurement result 76 and measurement time 74 received by the processor 42 from its corresponding electrode 84.

[0042] Figure 4 It shows that it can be similar to Figure 2A Rendering of the heart 28 organs 401. Surgical systems (such as...) can be used. Figure 1 and Figure 2A and Figure 2B The surgical system 110) maps organ 401 using a medical probe 22. The medical probe 22 can traverse different areas of the organ and can determine the shape and boundaries of organ 401 using contact, tissue proximity and / or electrical potential or ultrasound signals.

[0043] A medical probe 22, including one or more electrodes, can be used to sense tissue potential at different regions of an organ. Tissue potential can be sensed when the medical probe 22 is in contact with tissue in the organ region, or when the medical probe 22 is close to tissue in the organ region. The one or more electrodes on the medical probe 22 can sense the potential of the organ region based on changes in electron flow / voltage at the organ region. The organ region can be a physical point where the medical probe 22 senses the potential. Therefore, an organ can have as many unique organ regions as there are points where the medical probe 22 senses the potential. The one or more electrodes on the medical probe 22 can be transmitted, for example, via discrete surgical networks 101A-101N, network 150, and / or cloud platform 160 to… Figure 1 One or more components of the system 100 provide the sensed signals.

[0044] Figure 4 Visual indications (represented by raised bars) of potential activity on the surface of organ 401, including potential 410, are shown. As shown, potential 410 corresponds to organ region 411, such that potential 410 is the potential sensed by the probe when medical probe 22 comes into contact with or approaches organ region 411.

[0045] The visual indication of the potential 410 in organ region 411 Figure 4 The values ​​are shown in absolute form. Figure 4 An exemplary number of electrical potentials, such as potential 410, are shown at a given time or within a time range. Potentials, including potential 410, can be generated by one or more conduits, such as... Figure 3The medical probe 22 senses the potential. Potential 410 is a visual indication (represented by bars) of the magnitude of the potential at organ region 411. Figure 4 Other potentials shown are similarly visual indicators (represented by bars) of potential amplitude at different organ regions. Alternatively, visual indicators such as potential 410 may correspond to the potential that reaches a threshold potential at a given region (e.g., organ region 411). See reference... Figure 5 Furthermore, it is disclosed that multiple potentials can be collected within a given time period, and visual characteristics determined based on the number of potentials exceeding a given threshold in the organ region can be used to render the organ region, such as... Figure 4 Organ region 411. (See reference...) Figure 7 Furthermore, it is disclosed that multiple potentials can be collected within a given time period, and the organ region can be rendered using visual characteristics based on the amount of time the potential in the organ region exceeds a threshold potential, such as... Figure 4 Organ region 411.

[0046] Figure 5 This illustrates methods for visualizing potential activity (such as...) Figure 4 The flowchart 500 shows the potential activity. At step 510, multiple tissue potentials in each of the multiple organ regions are sensed. Medical probes such as... Figure 2A The medical probe 22 is used to sense the multiple potentials at each organ region. When the medical probe traverses an organ (such as...) Figure 4 When different organ regions of organ 401 are examined, the multiple potentials can be sensed by one or more electrodes of the medical probe.

[0047] The number of potentials sensed by the medical probe for each organ region can be predetermined. Depending on the implementation, the number of potentials for each organ region can be in the range of 2000 to 3000 potentials, for example, 2500 potentials per organ region. According to an exemplary implementation, the medical probe can begin sensing the predetermined number of potentials for each organ region when it comes into contact with or approaches the tissue of the organ region. Alternatively, the medical probe can sense the predetermined number of potentials for each organ region after a certain amount of time (such as an amount of time allocated for the medical probe to stabilize).

[0048] According to another exemplary embodiment, the medical probe can sense multiple potentials for each organ region within a given amount of time. The medical probe can be configured to sense potentials at a predetermined or provided frequency. For example, the medical probe can sense potentials at a rate of approximately 1 potential / millisecond. Therefore, the medical probe can sense the potentials of organ regions within a predetermined or provided amount of time, such that the number of potentials sensed and / or stored for each organ region is approximately the same. It should be understood that... Figure 5In subsequent steps 520 of the process shown, a subset of the total potential of the organ region is stored and / or applied, as further described herein.

[0049] For example, Figure 2A The medical probe 22 can be used with Figure 4 The medical probe 22 contacts organ region 411. It can sense the potential at organ region 411 at a frequency of 1 potential / millisecond for a total duration of 2.5 seconds. Therefore, the medical probe 22 can sense a total of 2500 potentials at organ region 411.

[0050] exist Figure 5 At step 520 of the method shown, the number of peak potentials exceeding a potential threshold can be determined based on the sensed potential. Depending on the implementation, the potential threshold can be a minimum potential value, such that when determining the number of peak potentials, potentials below the minimum potential sensed by the medical probe may not be included. For example, the potential threshold can be 0.05 mV, such that when determining the number of peak potentials, any sensed potentials that do not meet or do not exceed 0.05 mV may not be included. It should be understood that a peak potential can be any positive or negative potential exceeding the potential threshold. According to one implementation, the absolute value of the potential can be used when determining the peak potential.

[0051] In one specific implementation, the potential threshold can be a predetermined potential value. This predetermined potential can be stored in a memory such as... Figure 2A In memory 56, and / or available to the processor such as Figure 2A The processor 42 can determine the number of peak potentials exceeding a potential threshold based on the sensed potential.

[0052] According to another exemplary embodiment, the potential threshold may be determined based on an analysis of the potential sensed for an organ, and may vary from organ to organ and / or from individual to individual. According to this embodiment, processor 42 may analyze the potential from different organ regions, and based on this analysis, may determine the potential threshold. Processor 42 may determine the potential threshold based on factors including, but not limited to, average potential, standard deviation, or other distributions.

[0053] As Figure 5 Example of step 520 in the process shown. Figure 2A The medical probe 22 can be used with Figure 4 The organ region 411 is contacted and can collect 2500 potentials within 2.5 seconds. The potential threshold can be set to 0.05mV, and... Figure 5 At step 520, it can be determined that 1500 of the 2500 sensed potentials reach or exceed the potential threshold of 0.05mV. Therefore, the number of peak potentials in organ region 411 will be 1500.

[0054] exist Figure 5 At step 530 of the method shown, visual characteristics of the organ region can be determined based on the number of peak potentials in the organ region determined at step 520. Visual characteristics can be color, texture, pattern, gradient, indicator, graphic, etc. As further disclosed herein, visual characteristics can correspond to the manner in which the organ region is rendered and / or displayed.

[0055] Visual characteristics can be determined based on the number of peak potentials in an organ region, allowing selection from multiple visual characteristics that correspond to the determined number of peak potentials. A variety of different visual characteristics are available, enabling the determination of a specific visual characteristic applicable to a particular organ region based on the number of peak potentials in that organ region. Depending on the specific implementation, each or a subset of available visual characteristics (e.g., color) may correspond to a range of peak potential numbers. For example, red may correspond to an organ region with fewer than 50 peak potentials; yellow to an organ region with 50 to 100 peak potentials; green to an organ region with 100 to 150 peak potentials; blue to an organ region with 150 to 200 peak potentials; and purple to an organ region with 200 or more potentials. It should be understood that the colors described herein may differ or be opposite based on a given specific implementation.

[0056] According to an exemplary embodiment, different categories of visual characteristics may correspond to different organ regions. For example, a first organ region may correspond to color-based visual characteristics, while a second organ region may correspond to pattern-based visual characteristics.

[0057] exist Figure 5 At step 540 of the process shown, rendering of an organ comprising one or more organ regions can be displayed, such that each organ region uses its corresponding visual characteristics (e.g., in...). Figure 5 The visual characteristics determined at step 530 of the process shown are used for rendering. Therefore, organ regions with the same or similar number of peak potentials exceeding the potential threshold can be rendered with the same or similar visual characteristics (e.g., the same color). Furthermore, it is also possible that different organ regions that are close to each other can have a similar number of peak potentials exceeding the potential threshold, and thus can be rendered similarly. For example, 30 different organ regions that are close to each other can have fewer than 50 peak potentials exceeding the potential threshold. Therefore, this number of organ regions can all be rendered red.

[0058] Rendering an organ with one or more organ regions using corresponding visual characteristics provides a static mapping of the organ's electrical potential activity. For each organ region, the static mapping visually provides an overview of the electrical activity at that region based on the number of potentials exceeding a potential threshold. This overview of electrical activity can help identify regions of high and low electrical activity.

[0059] As disclosed herein, the organ region of an organ is the point where a medical probe senses the potential. Therefore, the organ region can be considered as a discrete point of the organ. It should be noted that the visual characteristics of the organ region can be applied to a surface area larger than the organ region itself. The surface area used to apply the visual characteristics includes the organ region and can be further extended based on the proximity of a given organ region to its neighboring organ regions. For example, if the organ region is located in an area densely surrounded by other organ regions, the surface area used to apply the visual characteristics to the given organ region can be smaller; and if the organ region is not surrounded by other organ regions, the surface area can be larger. For example, a first organ region with red visual characteristics can be 5 mm away from a second organ region with purple visual characteristics. According to a simplified example, the organ can be rendered such that a surface area 2.5 mm from the first organ region toward the second organ region is red, and a surface area 2.5 mm from the second organ region toward the first organ region is purple. Similarly, for example, a first organ region with red visual characteristics can be 1 mm away from a second organ region with purple visual characteristics. Based on the simplified example, an organ can be rendered such that the surface area 0.5 mm from the first organ region toward the second organ region is red, and the surface area 0.5 mm from the second organ region toward the first organ region is purple. It should be understood that although only two organ regions are illustrated for simplicity, multiple adjacent or close organ regions can help determine the surface area of ​​a given organ region that is suitable for visual characteristics.

[0060] See now Figure 6 ,according to Figure 5 Step 540 of the process shown involves rendering a patterned visual characteristic of a heart 601 having a number of peak potentials based on multiple organ regions. The organ regions facing the top of the heart 601, as shown in... Figure 6 Visually oriented, the heart 601 has a peak potential between 0 and 100. This region is designated as region 610. Therefore, region 610 of the heart 601 is rendered using a diagonal line pattern corresponding to the peak potential between 0 and 100. It should be noted that region 610 may include one or more organ regions exhibiting a potential in the range of 0 to 100 as disclosed herein. Organ regions facing the bottom of the heart 601, such as those in... Figure 6Visually oriented, the heart 601 has a peak potential between 101 and 200. This region is designated as region 620. Therefore, region 620 of the heart 601 is rendered using a horizontal line pattern corresponding to the peak potential between 101 and 200. It should be noted that region 620 may include one or more organ regions exhibiting a potential in the range of 101 and 200 as disclosed herein. Organ regions toward the center of the heart 601, such as those in… Figure 6 Visually oriented, the heart 601 exhibits more than 200 peak potentials. This region is designated as region 630. Therefore, region 630 of the heart 601 is rendered using a horizontal line pattern corresponding to more than 200 peak potentials. It should be noted that region 630 may include one or more organ regions exhibiting more than 200 potentials as disclosed herein. It should be understood that while the disclosure provided herein describes specifying visual characteristics based on range, visual characteristics may also be specified or determined based on gradients, absolute numbers, or other iterations that are not necessarily divided by range.

[0061] While this document discloses the number of peak potentials exceeding a potential threshold for a given organ region, it should be understood that the number of one or more peak potentials exceeding the potential threshold can be normalized if the total number of potentials collected for each organ region is not the same. For example, if 100 total potentials for the first organ region and 200 total potentials for the second organ region are sensed at step 510, the two sets of numbers can be normalized. For example, each potential for the first organ region can be applied twice, such that the total number of potentials for both the first and second organ regions is 200.

[0062] according to Figure 5 Step 540 of the process shown illustrates that rendering of an organ, including its visual characteristics, can provide identification of regions of abnormal electrical potential within the organ. Regions of abnormal electrical potential within an organ can be areas of one or more organ regions associated with an abnormal, specific visual characteristic (e.g., purple), and thus exhibit a given abnormal number of peak potentials. For example, an outer region of an organ could be a purple region, corresponding to an organ region with more than 200 peak potentials. Such abnormal regions can be identified as potential sources of unwanted electrical activity, such as electrical activity leading to unwanted medical conditions including atrial fibrillation, tachycardia, etc. Figure 5 At step 550 of the method shown, an ablation procedure can be performed such that a medical probe is used to ablate along an ablation region at least partially defined by a boundary of a visual feature or an area occupied by a visual feature. For example, by Figure 6 The boundary defined by region 630 can be ablated at ablation point 640, so that no electrical activity is generated from region 630, because the tissue at the boundary defined by region 630 can be destroyed by ablation point 640.

[0063] As disclosed, Figure 5 This paper outlines a method for displaying organ regions using visual characteristics determined by the number of peak potentials exceeding a potential threshold for a given organ region. Figure 7 The process of displaying organ regions using visual characteristics determined by the amount of time in which the organ region exhibits a potential greater than a potential threshold is outlined 700.

[0064] exist Figure 7 In step 710 of the method shown, multiple tissue potentials in the organ region are sensed over a period of time. Medical probes such as... Figure 2A The medical probe 22 is used to sense these multiple potentials. When the medical probe traverses an organ (such as...) Figure 4 When different organ regions of organ 401 are examined, the multiple potentials can be sensed by one or more electrodes of the medical probe.

[0065] A medical probe can sense the potential of each organ region for a specified duration. The duration for sensing the potential of each organ region can be predetermined. According to an exemplary embodiment, the duration can be in the range of 2 to 3 seconds, for example, 2.5 seconds per organ region. According to an embodiment, the medical probe can sense the potential of each organ region for a predetermined amount of time starting when the medical probe comes into contact with or approaches the tissue of the organ region. Alternatively, after a stabilization period (such as an amount of time allocated for the medical probe to stabilize), the medical probe can sense the potential of each organ region for a predetermined amount of time.

[0066] For example, Figure 2A The medical probe 22 can be used with Figure 4 The medical probe 22 can sense the potential at organ region 411 for a total duration of 2.5 seconds, and then move to different organ regions.

[0067] exist Figure 7 At step 720 of the method shown, the potential time for each organ region can be determined. The potential time can be the amount of time during which the sensed potential in a given organ region exceeds a potential threshold. It is important to note that the potential time will not be longer than the duration of sensing the potential in the organ region. The potential threshold can be determined or provided according to the techniques disclosed herein.

[0068] As Figure 7 Example of step 720 in the process shown. Figure 2A The medical probe 22 can be used with Figure 4 The organ region 411 is contacted for 2500 milliseconds. The potential threshold can be set to 0.05 mV. Figure 7At step 720, it can be determined that the potential at organ region 411 exceeds the potential threshold of 0.5 mV for 1500 milliseconds out of a total of 2500 milliseconds. Therefore, the potential duration of organ region 411 will be 1500 milliseconds.

[0069] exist Figure 7 At step 730 of the method shown, the visual characteristics of the organ region can be determined based on the potential time of the organ region determined in step 720. According to one embodiment, the visual characteristics can be determined based on the potential time divided by the total duration of sensing the potential of the organ region. Visual characteristics can be color, texture, pattern, gradient, indicator, graphic, etc. Visual characteristics can be determined, rendered, or otherwise combined for display according to the techniques and embodiments disclosed herein.

[0070] exist Figure 7 At step 740 of the process shown, rendering of an organ comprising one or more organ regions can be displayed, such that each organ region uses its corresponding visual characteristics (e.g., in...). Figure 7 The visual characteristics determined at step 730 of the process shown are used for rendering. Therefore, organ regions with the same or similar potential times can be rendered with the same or similar visual characteristics (e.g., the same color). Furthermore, it is also possible that different organ regions close to each other can have similar potential times and therefore can be rendered similarly. For example, multiple organ regions close to each other can have potential times of less than 500 milliseconds. Therefore, this number of organ regions can all be rendered red. It should be understood that although potential time is described herein, visual characteristics and / or rendering can be based on percentages derived from potential time, such as by dividing the potential time by the duration of potential collection at the organ region.

[0071] Figure 8 According to Figure 7 The method shown in step 740 renders a heart 801 with patterned visual characteristics based on the potential time of multiple organ regions. The organ regions facing the top of the heart 801, as shown in... Figure 8 Visually oriented, the heart 801 has a potential time between 0 and 1000 milliseconds. This region is designated as region 810. Therefore, region 810 of the heart 801 is rendered using a diagonal line pattern corresponding to potential times between 0 and 1000 milliseconds. It should be noted that region 810 may include one or more organ regions exhibiting potential times in the range of 0 to 1000 milliseconds as disclosed herein. Organ regions facing the bottom of the heart 801, as shown in... Figure 8Visually oriented, the heart 801 has a potential time between 1001 ms and 2000 ms. This region is designated as region 820. Therefore, region 820 of the heart 801 is rendered using a horizontal line pattern corresponding to a potential time between 1001 ms and 2000 ms. It should be noted that region 820 may include one or more organ regions exhibiting a potential time between 1001 ms and 2000 ms as disclosed herein. Organ regions oriented towards the center of the heart 801, such as those in… Figure 8 Visually oriented, the heart 801 has a potential time exceeding 2000 milliseconds. This region is designated as region 830. Therefore, region 830 of the heart 801 is rendered using a horizontal line pattern corresponding to a potential time exceeding 2000 milliseconds. It should be noted that region 830 may include one or more organ regions exhibiting a potential time exceeding 2000 milliseconds as disclosed herein. It should be understood that although this document includes... Figure 8 The millisecond range is disclosed, but renderings, legends, or other visual representations can also be provided based on the percentage of time a given organ region exhibits potential from the duration of potential collection.

[0072] according to Figure 7 Step 740 of the process shown illustrates that rendering of an organ, including its visual characteristics, can provide the identification of regions of abnormal electrical potential within the organ. Regions of abnormal electrical potential within an organ can be areas of one or more organ regions that have an abnormal, specific visual characteristic (e.g., purple), and thus exhibit a given abnormal number of potential times. For example, an outer region of an organ could be a purple region, corresponding to an organ region with a potential time exceeding 2000 milliseconds. Such abnormal regions can be identified as potential sources of unwanted electrical activity, such as electrical activity leading to unwanted medical conditions including atrial fibrillation, tachycardia, etc. Figure 7 At step 750 of the method shown, an ablation procedure can be performed such that a medical probe is used to form ablation points 840 along the ablation region, which is at least partially defined by the boundary of a visual feature or by an area occupied by a visual feature. For example, by Figure 8 The boundary defined by region 830 can be ablated so that no electrical activity is generated within region 830, because the tissue at the boundary defined by region 830 can be destroyed based on the ablation point 840 formed by the ablation conduit.

[0073] According to an exemplary embodiment of the subject matter disclosed in this invention, an instruction can be received, and based on that instruction, a display can be made based on the number of peak potentials, such as... Figure 5 The rendering or potential-time based method, as mentioned above Figure 7The rendering is described above. This instruction can be determined based on stored preferences, the patient, or another criterion, or it can be provided by the user. For example, a surgeon can switch between two views by providing input via an electronic input device such as via console 24.

[0074] Figure 9 An image showing the response graph of the potential signal collected from a specific electrode is displayed. Figure 9 It shows that it includes corresponding to Figure 5 The 11 peaks of the process described in the text and corresponding to Figure 7 The signal is a lower percentage value of the process described herein. Figure 10 Another image showing the potential signal response graph collected from a specific electrode is also shown. Figure 10 It shows that it includes corresponding to Figure 5 The 108 peaks of the process described in the text and corresponding to Figure 7 The signal is a higher percentage value of the process described herein.

[0075] According to specific embodiments of the subject matter disclosed in this invention, scar areas can be identified based on electrical potential sensed by a medical probe. For example... Figure 5 Step 510 and / or of the method shown Figure 7 Step 710 of the method shown is used to sense the potential.

[0076] Scar regions can be identified based on the number of potentials sensed above a potential threshold at the organ region, where, as disclosed herein, this number is below the scar threshold. For example, the scar threshold could be 500 potentials above the threshold. Potentials at the organ region can be sensed, resulting in 2500 potential readings. Only 400 of these 2500 potential readings can be determined to be above the 0.05 mV potential threshold. Given that only 400 potentials are above the 0.05 mV potential threshold, the organ region can be determined to be part of a scar region, because 400 potentials above the threshold are lower than the scar threshold of 500 potentials above the threshold.

[0077] According to another specific embodiment, a scar region can be identified based on the amount of time during which a sensed potential at an organ region is below a potential threshold, as disclosed herein, where the time threshold is below a scar time threshold. For example, the scar time threshold could be 500 milliseconds. The potential at the organ region can be sensed over 2500 milliseconds. It can be determined that the sensed potential is above a potential threshold of 0.05 mV for only 400 milliseconds within that 2500 milliseconds. Assuming that the sensed potential is above the 0.05 mV potential threshold for only 400 milliseconds, the organ region can be determined to be part of a scar region because 400 milliseconds is lower than the scar time threshold of 500 milliseconds.

[0078] Visual characteristics of a scar region can be determined for an organ region or group of organ regions that are identified as part of a scar region. The visual characteristics may differ from those determined for organ regions that are not identified as scar regions (e.g., the visual characteristics of a scar region may be gray).

[0079] According to a specific implementation, scar tissue can be further identified based at least in part on the shape of a surface region formed by an organ region identified as part of a scar area. According to this implementation, the shape of the surface region formed by an organ region identified as part of a potential scar area can be analyzed and compared with predetermined criteria, such that a surface region matching one or more predetermined criteria is designated as a scar area.

[0080] According to specific embodiments of the subject matter disclosed in this invention, regions of complex fragmented atrial electrocardiograms (CFAEs) can be identified based on electrical potentials sensed by a medical probe. For example... Figure 5 Step 510 and / or of the method shown Figure 7 Step 710 of the method shown is used to sense the potential. The CFAE region can indicate fragmentation and can be an ideal ablation region.

[0081] According to exemplary embodiments of the subject matter disclosed in this invention, a visual indication of potential (e.g., raised bars) is dynamically displayed, such as... Figure 4 As shown, this can be provided through the rendering of organs, such as Figure 6 and Figure 8 The rendering shown (visual indication not in) Figure 6 and Figure 8 (As shown in the image). Visual indications can be provided during the potential collection activity or can be stored and provided at a later time. For example, medical probe 22 can be used to collect potentials at different organ regions. These potentials can be stored in a memory such as... Figure 2A The potential can then be displayed at a later time by accessing the information stored in memory 56. Furthermore, according to specific embodiments of the subject matter disclosed in the invention, such visual indicators may not be provided via a display. When collecting the potential, the potential can be obtained from... Figure 2A The processor 42 can use the stored potential, or the memory 56 can provide the stored potential to the processor 42. It should be noted that each organ region may have multiple corresponding sensed potentials (e.g., 2500 sensed samples), as described herein. Therefore, to view the potential of an organ region, a dynamic display can be provided, and the dynamic display can cycle through different sensed potentials for each sensed organ region.

[0082] According to an exemplary embodiment of the present invention, a given point on an organ can be rendered based on local points (e.g., shading, shading, patterning, etc.). Notably, a given point can be rendered based on the peak of the given point and / or the peaks of its neighboring points. The given point can be rendered using visual characteristics determined by calculations (e.g., average, median, pattern, normalization, etc.), the factors of which are the peaks of the neighboring points of the given point. By applying this local point-based technique, the given point can be better represented in the rendering of the organ. In addition, implementing the local point-based technique can smooth out abnormal peaks that may be anomalous and / or erroneous (e.g., due to probe movement, due to faulty electrodes, etc.).

[0083] Figure 11 An exemplary implementation of local point-based rendering as disclosed herein is shown. Figure 11 As shown, an organ such as the heart 1102 may include multiple points. When determining the rendering properties of a given point 1106, a region 1104 (e.g., area, volume, circle, sphere, etc.) that may include the given point 1106 can be identified. Additionally, region 1104 may also include one or more additional points, such as points 1108a, 1108b, and 1108c, as... Figure 11 As shown. Additional points can be points where the system can obtain electrical activity. The number and / or size of points or areas can be controlled using a graphical user interface or any other applicable controls such as voice control, haptic feedback, etc.

[0084] like Figure 11 As shown, region 1104, as a subset of organ 1102, can be determined based on size or based on the number of additional points to be included in region 1104, as further disclosed herein. A given point 1106 can be a point to be rendered according to the local point-based rendering technique disclosed herein. The number of additional points 1108a, 1108b, and 1108c can be a minimum number of points exhibiting, for example, electrical signal peaks measured by one or more electrodes. Each peak in the number of electrical signal peaks can be a peak exceeding a minimum threshold.

[0085] Visual indicators (e.g., color, shadow, pattern, etc.) can be determined based on calculations of peaks exhibited by a given point and / or its neighboring points within a region (e.g., region 1104). It is noteworthy that visual indicators can be based at least in part on neighboring points, rather than solely on peaks exhibited by a given point alone. By incorporating neighboring points into the determination of visual indicators, the system may be able to render more reliable images of organs, ensuring that anomalous or erroneous peaks are not exhibited within the rendering.

[0086] exist Figure 11In the example shown, given point 1106 may exhibit 1400 peaks within a given time window. During the same time window, additional point 1108a may exhibit 1350 peaks, additional point 1108b may exhibit 1360 peaks, and additional point 1108c may exhibit 1370 peaks. A median calculation can be performed such that the median of the peaks of all associated points (i.e., given point 1106 and additional points 1108a, 1108b, and 1108c) is calculated to be 1365 (i.e., a value between 1160 and 1170). Therefore, given point 1106 can be rendered based on the median calculated as 1365, rather than the 1400 peaks exhibited by given point 1106.

[0087] According to an exemplary embodiment of the present invention, the dimensions (e.g., volume, area, size, etc.) of region 1104 can be determined by the user, can be predetermined, or can be dynamically determined.

[0088] Users can determine the size of zone 1104 in any applicable way, such as by inputting a dimension (e.g., radius). For example, a user can use a keyboard to select one or more keys to toggle the size of zone 1104 around a given point 1106. For example, a user can select one or more keys to alternate between radii of 0.5mm, 1mm, 1.5mm, 2mm, 2.5mm, 3mm...10mm, and return to 0.5mm.

[0089] According to an exemplary embodiment of the present invention, a user can input visually guided dimensions using an applicable input device. For example, a user can use a computer mouse, mouse pad, or a custom type of device to input the dimensions of area 1104.

[0090] The predetermined size can be stored in memory, or it can be a default size pre-programmed into the system to specify the size of region 1104. Alternatively, the system can dynamically determine the size of region 1104 based on any applicable criteria, such as the distance between a given point 1106 and its neighboring points, the required normalization amount, the type of medical condition, the patient's medical history, etc.

[0091] According to an exemplary embodiment of the present invention, the area 1104 may be defined based on the number of points to be included in the area. The number of points may be provided by the user, predetermined, or dynamically determined.

[0092] Users can determine the number of points to be included in zone 1104 in any applicable manner, such as by inputting the number of points. For example, users can use a keyboard or other input device to provide the number of points to be included in zone 1104 around a given point 1106. For example, users can provide any number of points, such as 3 points, 10 points, 100 points, etc.

[0093] The predetermined number of points can be stored in memory, or it can be a default number of points pre-programmed into the system. Alternatively, the system can dynamically determine the number of points in region 1104 based on any applicable criteria (e.g., the number of peaks exhibited by a given point 1106, the required normalization, the type of medical condition, the patient's medical history, etc.).

[0094] According to exemplary embodiments of the present invention, local point-based rendering as disclosed herein can be applied to each given point (e.g., within a time window (e.g., 2.5 seconds) that satisfies a minimum number of peaks). Figure 11 Point 1106). In addition, each additional point (e.g., points 1108a, 1108b, and 1108c) can also be the minimum number of points that satisfy the peak within a time window (e.g., 2.5 seconds).

[0095] Figure 12 An image 1200 of the heart 1202 rendered using visual characteristics of potential activity based on a local potential mapping is shown. (See image 1200.) Figure 12 As shown, a visual indicator can be used to provide information on the electrical activity of the heart 1202. To determine the visual indicator for point 1206 (e.g., color in this example), region 1204 can be identified. The visual indicator can be identified in part based on the number of peaks 1208 exhibited at point 1206 within a given time period. Additionally, the number of peaks at one or more additional points adjacent to point 1206 can be identified. A calculated peak count can be generated based on the number of peaks at point 1206 and the number of peaks at adjacent points. The visual indicator can be determined based on this calculated peak count rather than the peak count of the point itself. In this example, the visual indicator can be red to indicate the calculated peak corresponding to the value indicated by the red visual indicator.

[0096] Any of the functions and methods described herein can be implemented in a general-purpose computer, processor, or processor core. By way of example, suitable processors include general-purpose processors, special-purpose processors, conventional processors, digital signal processors (DSPs), multiple microprocessors, one or more microprocessors associated with a DSP core, controllers, microcontrollers, application-specific integrated circuits (ASICs), field-programmable gate arrays (FPGAs), any other type of integrated circuit (IC), and / or state machines. Such processors can be manufactured by configuring the manufacturing process using the results of hardware description language (HDL) instructions and other intermediate data, including netlists (such instructions can be stored on a computer-readable medium). The result of this processing can be a masked work, which is subsequently used in a semiconductor manufacturing process to manufacture a processor implementing the features of this disclosure.

[0097] Any of the functions and methods described herein may be implemented in computer programs, software, or firmware incorporated into a non-transitory computer-readable storage medium for execution by a general-purpose computer or processor. Examples of non-transitory computer-readable storage media include read-only memory (ROM), random access memory (RAM), registers, cache memory, semiconductor memory devices, magnetic media (e.g., internal hard disks and removable disks), magneto-optical media, and optical media (e.g., CD-ROMs and DVDs).

[0098] It should be understood that many variations are possible based on the disclosure herein. Although features and elements have been described above in specific combinations, each feature or element may be used alone without other features and elements, or in various combinations with or without other features and elements.

Claims

1. A system for improving cardiac surgery, comprising: A catheter, the catheter including one or more electrodes and configured to sense a plurality of first tissue potentials at a first organ region of an organ, each first tissue potential being sensed at a corresponding measurement time; Processor, the processor being configured to: Receive the potential of the plurality of first tissues; The number of first peak potentials is determined based on the plurality of first organizational potentials, wherein each first peak potential exceeds a potential threshold. The first visual characteristic is determined based on a determined number of times the first potential exceeds the potential threshold. The scar region is determined by using at least the number of first peak potentials to determine the number of potentials greater than the potential threshold and less than the scar threshold. The third visual characteristics are determined based on the scar area; and A display configured to render the organ including the first organ region, such that the rendering of the first organ region includes the first visual characteristic and the third visual characteristic.

2. The system of claim 1, wherein the display is at least one of a television, a monitor, a mobile device, and a hologram.

3. The system according to claim 1, wherein the catheter is one of a single-electrode catheter and a multi-electrode catheter.

4. The system according to any of the preceding claims, wherein the first visual characteristic is selected from color, texture, pattern, gradient, indicator, and graphic.

5. The system according to any one of claims 1-3, wherein the first visual characteristic is determined based on a predetermined range.

6. The system according to any one of claims 1-3, wherein the catheter is configured to sense a plurality of second tissue potentials at a second organ region of the organ, and The processor is configured to: The number of second peak potentials is determined based on the plurality of second tissue potentials, such that the second peak potentials exceed the potential threshold. The second visual characteristic is determined based on the number of second peak potentials; and Displaying a rendering of the organ including the second organ region, such that the rendering of the second organ region includes the second visual characteristic.

7. The system of claim 6, wherein the first visual characteristic is a first color and the second visual characteristic is a second color.

8. The system of claim 6, wherein the first visual characteristic is based on the ratio between the number of the first peak potential and the number of the second peak potential.

9. The system of claim 7, wherein the first visual characteristic is based on the ratio between the number of the first peak potential and the number of the second peak potential.

10. The system according to any one of claims 1-3, wherein the processor is configured to further determine the first visual characteristic based on one or more adjacent peak potentials.

11. The system of claim 10, wherein the one or more adjacent peak potentials correspond to one or more adjacent points within a region surrounding the first organ region.

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