3D electrical activity representation

Abstract

The present disclosure is entitled “3D Electrical Activity Representation.” In one embodiment, the present disclosure relates to a medical system comprising: a catheter comprising electrodes and configured to be inserted into a chamber of a heart and maneuvered between sampling sites to sample electrical activity; a display; and processing circuitry for receiving a signal provided by the catheter and, for each sampling site, calculating a sampling position of the catheter and a corresponding electrode position of the catheter electrodes, presenting to the display a 3D representation of the chamber, the 3D representation including respective sampling site markers indicating the calculated sampling positions of the catheter at respective ones of the sampling sites, receiving user input selecting one of the sampling site markers, and updating the 3D representation to include electrode markers indicating the respective electrode positions of the respective catheter electrodes when the catheter samples electrical activity of tissue at the sampling site corresponding to the selected sampling site marker.

Description

Technical Field

[0001] The present invention relates to medical systems and particularly, but not exclusively, to catheter-based systems. Background Art

[0002] A large number of medical procedures involve placing probes such as catheters within the patient's body. Position sensing systems have been developed to track such probes. Magnetic position sensing is a method known in the art. In magnetic position sensing, a magnetic field generator is typically placed at a known position outside the patient's body. 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 position of the distal end of the probe. These methods and systems are described in U.S. Patents 5,391,199, 6,690,963, 6,484,118, 6,239,724, 6,618,612, and 6,332,089, in PCT International Patent Publication WO1996 / 005768, and in U.S. Patent Application Publication 2002 / 006455, 2003 / 0120150, and 2004 / 0068178. Systems based on impedance or current can also be used to track position.

[0003] Arrhythmia treatment surgery is a medical procedure in which these types of probes or catheters have proven extremely useful. Arrhythmias, and in particular atrial fibrillation, remain common and dangerous medical conditions, especially in the elderly.

[0004] The diagnosis and treatment of cardiac arrhythmias include mapping the electrical properties of cardiac tissue, particularly the endocardium and cardiac volume, and selectively ablating cardiac tissue by applying energy. Such ablation can stop or alter the propagation of unwanted electrical signals from one part of the heart to another. Ablation methods destroy unwanted electrical pathways by forming non-conductive lesions. Various forms of energy delivery for forming lesions have been disclosed, and include the use of microwaves, lasers, and more commonly, radiofrequency energy to form conduction blocks along the walls of cardiac tissue. In a two-step procedure (mapping followed by ablation), electrical activity at various points within the heart is typically sensed and measured by advancing a catheter containing one or more electrical sensors into the heart and collecting data at multiple points. This data is then used to select a target area of ​​the endocardium to be ablated.

[0005] Electrode catheters have been commonly used in medical practice for many years. They are used to stimulate and map electrical activity in the heart, as well as to ablate sites of abnormal electrical activity. In use, an electrode catheter is inserted into a major vein or artery, such as the femoral artery, and then guided into the heart chamber of interest. A typical ablation procedure involves inserting a catheter having one or more electrodes at its distal end into the heart chamber. A reference electrode, usually taped to the patient's skin, may be provided, or a second catheter placed in or near the heart may be used to provide the reference electrode. RF (radio frequency) current is applied to the tip electrode of the ablation catheter, and the current flows to the reference electrode through the surrounding medium (i.e., blood and tissue). The distribution of the current depends on the amount of contact between the electrode surface and the tissue compared to blood, which has a higher conductivity than tissue. Due to the electrical resistance of the tissue, heating of the tissue occurs. The tissue is heated sufficiently to cause cell destruction in the cardiac tissue, resulting in the formation of non-conductive ablation lesions within the cardiac tissue.

[0006] U.S. Patent Publication 2017 / 0202470 to Urman et al. describes a system and method for identifying a focal origin. The method may include detecting electrocardiogram (ECG) signals over time via sensors, each ECG signal detected via one of the sensors having a location in the heart and indicating electrical activity of the heart, each signal including at least an R wave and an S wave; creating an RS map comprising an R to S ratio for each of the ECG signals, the R to S ratio comprising a ratio of an absolute magnitude of the R wave to an absolute magnitude of the S wave; for each of the ECG signals, identifying a local activation time (LAT); and correlating the R to S ratio of the ECG signals on the RS map with the identified LAT, and identifying a focal origin using the correlation.

[0007] U.S. Patent Publication 2017 / 0202515 to Ben Zrihem et al. describes a method for detecting a source of atrial rotational activity pattern (RAP), the method comprising detecting electrocardiogram (ECG) signals over time via a plurality of sensors, each ECG signal being detected via one of the plurality of sensors and indicating electrical activity of the heart. The method further comprises determining one or more local activation times (LATs) for each of the plurality of ECG signals, each LAT indicating an activation time of a corresponding ECG signal. The method further comprises detecting whether one or more RAP source regions of activation in the heart are indicated based on the detected ECG signal and the one or more local LATs. Mapping information of the activated detected RAP source regions in the heart is also generated to provide one or more mapping maps.

[0008] US Patent Publication 2005 / 0228252 to Neason describes a system comprising one or more probes configured to be positioned within a patient's heart, a processor communicatively coupled to the one or more probes, a display communicatively coupled to the processor, and image processing tools used by the processor to manipulate images. The processor processes electrical information about the heart. The electrical information is sensed using the one or more probes. The display displays an image of the heart.

[0009] US Patent Publication 2016 / 0022375 to Blake et al. describes a system for determining a cardiac target. The system may include at least one processing device configured to execute instructions to receive cardiac imaging data, segment the cardiac imaging data to identify at least two types of cardiac tissue, generate a cardiac model based on the identified tissue, simulate cardiac activity based on the generated cardiac model, and identify at least one cardiac target based on the simulation. A cardiac therapy system may be used to provide feedback to a user to guide a cardiac therapy device to the cardiac target.

[0010] U.S. Patent Publication No. 2013 / 0158545 to Govari et al. describes a method and system for treating abnormal cardiac electrical activity using a probe having first and second ablation electrodes disposed on a distal portion of the probe and a sensing electrode disposed between the first and second ablation electrodes, the probe being brought into contact with cardiac tissue, energy being applied via the first and second ablation electrodes to ablate target tissue along an ablation path, cardiac electrical activity being monitored using the sensing electrode to detect the cardiac electrical activity, and energy application being terminated after observing that the cardiac electrical activity is no longer detectable by the sensing electrode.

[0011] U.S. Patent Publication 2007 / 0276226 to Tal describes the use of a specialized cardiac catheter for image acquisition in which cardiac features can be readily identified on an ultrasound image based on a previously generated electrical activation map of the heart. The electrical activation map is automatically registered with the ultrasound image using information obtained from a position sensor in the catheter. Features identifiable on the electrical activation map, represented as dots, labels, design lines, and textual identifiers, are projected into the plane of an ultrasound fan and overlaid on the ultrasound image, thereby illustrating the features visible on the ultrasound fan. Summary of the Invention

[0012] According to an embodiment of the present invention, a medical system is provided, the medical system comprising a catheter, a display, and a processing circuit, the catheter comprising a distal portion and catheter electrodes provided at corresponding positions on the distal portion, the catheter being configured to be inserted into a chamber of the heart of a living subject and maneuvered between a plurality of sampling sites to sample electrical activity of tissue of the chamber using a corresponding catheter electrode of the catheter electrodes at each of the sampling sites, the processing circuit being configured to receive a signal provided by the catheter and, in response to the signal, calculate, for each of the sampling sites, a relative position of the catheter and the corresponding catheter electrode of the catheter electrodes. The apparatus comprises: a device comprising: a first electrode marker, a second electrode marker, a third electrode marker, a fourth electrode marker, a fifth ...

[0013] Further in accordance with an embodiment of the present invention, the processing circuit is configured to calculate, for each of the sampling sites, the sampling position and the electrode position as an average position of the catheter and the catheter electrode, respectively, averaged over a sampling time.

[0014] Still further in accordance with an embodiment of the present invention, the processing circuit is configured to update the rendered 3D representation to highlight the selected sampling site marker.

[0015] Additionally, according to an embodiment of the present invention, the processing circuit is configured to identify electrical activity of the tissue sensed by corresponding ones of the catheter electrodes sampled at corresponding sampling sites, and to update the presented 3D representation in response to received user input to include the electrode markers, wherein at least one of the electrode markers has a different type of appearance than other ones of the electrode markers in response to the identified electrical activity of the tissue sensed by at least one corresponding one of the catheter electrodes.

[0016] Furthermore, according to an embodiment of the present invention, the identified electrical activity is electrical activity below a threshold activity level.

[0017] Further in accordance with an embodiment of the present invention, the identified electrical activity is focal activity.

[0018] Still further in accordance with an embodiment of the present invention, the identified electrical activity is rotational activity.

[0019] Additionally, according to embodiments of the present invention, different presentation types include using electrode markers that are larger than other electrode markers.

[0020] Furthermore, according to an embodiment of the present invention, the different presentation types include using electrode markers of a different color compared to other electrode markers.

[0021] Further in accordance with an embodiment of the present invention, the processing circuit is configured to format the at least one electrode marker with an intensity of the identified electrical activity of the tissue sensed by the at least one corresponding one of the catheter electrodes.

[0022] According to another embodiment of the present invention, a medical method is provided, the method comprising receiving a signal provided by a catheter, the catheter comprising a distal portion and catheter electrodes disposed at corresponding positions on the distal portion, the catheter being configured to be inserted into a chamber of the heart of a living subject and maneuvered between a plurality of sampling sites to sample electrical activity of tissue of the chamber using a corresponding one of the catheter electrodes at each of the sampling sites, calculating a sampling position of the catheter and a corresponding electrode position of the corresponding one of the catheter electrodes for each of the sampling sites in response to the signal, and displaying the signal to a display. presenting a three-dimensional (3D) representation of the chamber, the three-dimensional (3D) representation including respective sampling site markers indicating a calculated sampling position of the catheter at a respective one of the sampling sites, receiving user input selecting one of the sampling site markers, and updating the presented 3D representation in response to the received user input to include electrode markers indicating the respective electrode positions of the respective catheter electrodes when the catheter was sampling the electrical activity of the tissue at the respective one of the sampling sites corresponding to the selected sampling site marker.

[0023] Still further in accordance with an embodiment of the present invention, calculating includes calculating, for each of the sampling sites, the sampling position and the electrode position as average positions of the catheter and the catheter electrode, respectively, averaged over a sampling time.

[0024] Additionally, according to an embodiment of the present invention, updating includes updating the rendered 3D representation to highlight the selected sampling site marker.

[0025] Furthermore, according to an embodiment of the present invention, the method includes identifying electrical activity of the tissue sensed by corresponding ones of the catheter electrodes sampling at the corresponding sampling sites, wherein the updating includes updating the presented 3D representation in response to the received user input to include the electrode markers, wherein at least one of the electrode markers has a different type of appearance than other ones of the electrode markers in response to the identified electrical activity of the tissue sensed by at least one corresponding one of the catheter electrodes.

[0026] Additionally, according to an embodiment of the present invention, the identified electrical activity is electrical activity below a threshold activity level.

[0027] Still further in accordance with an embodiment of the present invention, the identified electrical activity is focal activity.

[0028] Additionally, according to an embodiment of the present invention, the identified electrical activity is rotational activity.

[0029] Furthermore, according to embodiments of the present invention, different presentation types include using electrode markers that are larger than other electrode markers.

[0030] Additionally, according to an embodiment of the present invention, the different presentation types include using electrode markers that are a different color compared to other electrode markers.

[0031] Still further in accordance with an embodiment of the present invention, the method includes formatting the at least one electrode marker with an intensity of the identified electrical activity of the tissue sensed by the at least one corresponding one of the catheter electrodes.

[0032] According to another embodiment of the present invention, a software product is provided, the software product including a non-transitory computer-readable medium having program instructions stored therein, the instructions, when read by a central processing unit (CPU), causing the CPU to receive a signal provided by a catheter, the catheter including a distal portion and catheter electrodes disposed at corresponding positions on the distal portion, the catheter being configured to be inserted into a chamber of the heart of a living subject and maneuvered between a plurality of sampling sites to sample electrical activity of tissue of the chamber using a corresponding catheter electrode of the catheter electrodes at each of the sampling sites, and calculating, in response to the signal, a sampling position of the catheter and a sampling position of the catheter for each of the sampling sites. The apparatus comprises: detecting a corresponding electrode position of the corresponding catheter electrode in one of the sampling sites, presenting a three-dimensional (3D) representation of the chamber to the display, the three-dimensional (3D) representation including corresponding sampling site markers indicating the calculated sampling position of the catheter at the corresponding sampling site in the sampling sites, receiving user input selecting one of the sampling site markers, and updating the presented 3D representation in response to the received user input to include electrode markers indicating the corresponding electrode position of the corresponding catheter electrode when the catheter was sampling the electrical activity of the tissue at the corresponding sampling site in the sampling sites corresponding to the selected sampling site marker. BRIEF DESCRIPTION OF THE DRAWINGS

[0033] The present invention will be understood from the following detailed description taken in conjunction with the accompanying drawings, in which:

[0034] Figure 1 is a schematic diagram of a medical protocol constructed and operated in accordance with an embodiment of the present invention;

[0035] Figure 2 For use Figure 1 A schematic diagram of a catheter in a system;

[0036] Figure 3 To include Figure 1 A schematic diagram of a three-dimensional (3D) representation of a chamber of the heart with corresponding sampling site markers rendered by the system;

[0037] Figure 4 To show the Figure 3 A schematic diagram of a 3D representation of a selection of one of the sampling site markers;

[0038] Figure 5 For illustrating an alternative embodiment Figure 3 A schematic diagram of a 3D representation of a selection of one of the sampling site markers;

[0039] Figure 6 According to an alternative embodiment, the Figure 1 A schematic diagram of a three-dimensional (3D) representation of a chamber of the heart with corresponding sampling site markers and electrode markers rendered by the system;

[0040] Figure 7 To show the Figure 6 A schematic diagram of a 3D representation of a selection of one of the electrode markers;

[0041] Figure 8 for Figure 7 A schematic diagram of the 3D representation during recalculation; and

[0042] Figure 9 To include Figure 1 A flow chart of the steps in a method of operating a system. DETAILED DESCRIPTION

[0043] Overview

[0044] Due to the geometric distribution of electrodes, the complex and diverse catheters (e.g., Biosense Webster, Inc., Irvine, CA USA) It is challenging to represent the electrical activity and sampling locations of multiple electrodes sampled on a catheter (or basket catheter) or linear catheter in a manner that is intuitive to the physician. Presentation is further complicated when continuous electrical acquisition of data over an extended period of time (e.g., up to about 30 seconds) is used, as opposed to conventional electroanatomical (EA) points that may include only 2.5 seconds of signal data. When data is collected over an extended period of time, some of the data may or may not be useful due to catheter instability during the sampling period.

[0045] Embodiments of the present invention address the aforementioned problems by providing an intuitive three-dimensional (3D) representation of a cardiac chamber including respective sampling site markers indicating various sampling positions of a catheter at respective sampling sites. Upon selection of a sampling site marker, the 3D representation is updated to display electrode markers indicating the respective electrode positions of the respective catheter electrodes when the catheter samples the electrical activity of the tissue of the chamber at the sampling site corresponding to the selected sampling site marker.

[0046] In the disclosed embodiments, a catheter comprising a distal portion and catheter electrodes disposed at corresponding locations on the distal portion is inserted into a chamber of the heart of a living subject and maneuvered between a plurality of sampling sites to sample electrical activity of tissue of the chamber using a corresponding catheter electrode at each sampling site. The distal portion of the catheter may comprise any suitable distal tip assembly, such as a basket or balloon assembly or a plurality of splines connected to the distal end of the shaft of the catheter.

[0047] The processing circuit receives the signal provided by the catheter, and in response to the signal, calculates the sampling position of the catheter and the corresponding electrode position for each sampling site. The sampling position of the catheter can be any suitable position of the catheter, such as the distal end of the shaft of the catheter, or the position of the position sensor on the shaft, or the average position of the electrode at the sampling site. The signal can be provided by the electrode of the catheter or one or more other position sensors or one or more transducers. The signal can be received by the processing circuit via a cable or wirelessly from the catheter or from a body surface patch that receives the signal emitted by the catheter. In some embodiments, the processing circuit calculates the sampling position and the electrode position as the average position of the catheter and the catheter electrode averaged over the sampling time at the sampling site for each sampling site.

[0048] The processing circuit identifies the electrical activity of the tissue sensed by the corresponding catheter electrode sampled at the corresponding sampling site based on the received signal. By way of example only, identifying electrical activity may include identifying an area of ​​interest, such as focal activity or rotational activity. Focal activity may be indicated by a repetitive activation pattern exhibiting an early continuous QS morphology. U.S. Patent Publication 2017 / 0202470 by Urman et al. describes a system and method for identifying focal origins. Any suitable method may be used to identify focal origins. Rotational activity may be indicated by a repetitive activation pattern exhibiting rotational activity. U.S. Patent Publication 2017 / 0202515 by BenZrihem et al. describes a method for detecting the source of an atrial rotational activity pattern (RAP), the method comprising detecting an electrocardiogram (ECG) signal over time via a plurality of sensors, each ECG signal being detected via one of the plurality of sensors and indicating the electrical activity of the heart. Any suitable method may be used to identify rotational activity.

[0049] The processing circuitry presents a 3D representation of the chamber to a display, the 3D representation including respective sampling site markers (eg, circles or squares or any suitable shapes or symbols) indicating the calculated sampling positions of the catheters at the respective sampling sites.

[0050] Upon receiving user input selecting one of the sampling site markers, the processing circuit updates the presented 3D representation to include an electrode marker (e.g., a circle or square or any suitable shape or symbol) that indicates the corresponding electrode position of the corresponding catheter electrode when the catheter samples electrical activity of tissue at the sampling site corresponding to the selected sampling site marker. In some embodiments, the processing circuit updates the presented 3D representation to highlight the selected sampling site marker, for example, by using a brighter marker and / or placing a ring around the marker.

[0051] In some embodiments, the presentation type (e.g., shape and / or format) of the electrode marker is updated based on the identified electrical activity of the tissue sensed by the corresponding electrode. The processing circuit updates the presented 3D representation in response to the received user input to include electrode markers, wherein at least one electrode marker has a different presentation type than the other electrode markers in response to the identified electrical activity of the tissue sensed by the corresponding catheter electrode. The identified electrical activity that triggers the different presentation types may include: electrical activity below a threshold activity level, focal activity, and / or rotational activity. By way of example, the different presentation types may include using larger electrode markers than other electrode markers, and / or electrode markers of different colors than other electrode markers, and / or different shapes, shading, patterns, and / or brightness.

[0052] In some embodiments, the processing circuit formats one or more electrode markers based on the intensity of the identified electrical activity of the tissue sensed by the one or more corresponding catheter electrodes. By way of example, the formatting can include color, shading, pattern, and / or brightness to indicate the intensity of the identified electrical activity.

[0053] System Description

[0054] Now see Figure 1 , which is a schematic diagram of a medical surgical system 20 constructed and operative in accordance with an embodiment of the present invention. Referring now to Figure 2 , which is used for Figure 1 Schematic diagram of the catheter 40 in the system 20.

[0055] The medical surgical system 20 is used to determine the position of the catheter 40, such as in Figure 1 In Figure 25 and in Figure 2 The catheter 40 includes a shaft 22, a distal portion 45, and catheter electrodes 55 disposed at corresponding locations on the distal portion 45. The distal portion 45 of the catheter 40 may include a distal end assembly, such as a basket or balloon assembly or a deflectable arm 54 (e.g., Figure 2, only some are labeled for simplicity). Catheter 40 is configured for insertion into a body part of a living subject (e.g., a chamber of heart 26). Flexible arms 54 have respective proximal ends connected to the distal end of shaft 22.

[0056] The catheter 40 includes a position sensor 53 disposed on the shaft 22 in a predefined spatial relationship relative to the proximal ends of the flexible arms 54. The position sensor 53 may include a magnetic sensor 50 and / or at least one shaft electrode 52. The magnetic sensor 50 may include at least one coil, such as, but not limited to, a two-axis or three-axis coil arrangement, to provide position and orientation (including yaw) data. The catheter 40 includes a plurality of catheter electrodes 55 (for simplicity, only some are labeled) disposed at different corresponding positions along each of the flexible arms 54. Figure 2 In general, catheter 40 can be used to map electrical activity in the heart of a living subject using electrodes 55, or can be used to perform any other suitable function in a body part of a living subject. Electrodes 55 are configured to contact tissue of the body part at corresponding locations (e.g., within a chamber of the heart).

[0057] The medical surgical system 20 can determine the position and orientation of the shaft 22 of the catheter 40 based on signals provided by the magnetic sensor 50 and / or the shaft electrodes 52 (proximal electrode 52a and distal electrode 52b) mounted on the shaft 22 and located on either side of the magnetic sensor 50. At least some of the proximal electrode 52a, distal electrode 52b, magnetic sensor 50, and electrodes 55 are connected to various driver circuits in the console 24 via wires extending through the shaft 22 via the catheter connector 35. In some embodiments, at least two of the electrodes 55 of each of the flexible arms 54, the shaft electrode 52, and the magnetic sensor 50 are connected to the driver circuit in the console 24 via the catheter connector 35. In some embodiments, the distal electrode 52b and / or the proximal electrode 52a can be omitted.

[0058] Figure 2 The illustrations shown are chosen solely for clarity of concept. Other configurations of shaft electrode 52 and electrode 55 are possible. Additional functionality may be included in position sensor 53. Elements not relevant to the disclosed embodiments of the present invention, such as irrigation ports, have been omitted for clarity.

[0059] The physician 30 navigates the catheter 40 to a target location in a body part of the patient 28 (e.g., the heart 26) by manipulating the shaft 22 and / or the deflection of the sheath 23 using the manipulator 32 near the proximal end of the catheter 40. The catheter 40 is inserted through the sheath 23 with the flexible arms 54 gathered together, and only after the catheter 40 is retracted from the sheath 23 are the flexible arms 54 able to unfold and resume their intended functional shape. By holding the flexible arms 54 together, the sheath 23 also serves to minimize vascular trauma on its way to the target location.

[0060] The console 24 includes processing circuitry 41 (typically a general purpose computer) and suitable front-end and interface circuitry 44 for generating signals in and / or receiving signals from body surface electrodes 49, which are attached to the chest and back of the patient 28, or any other suitable skin surface, by wires passing through cables 39.

[0061] Console 24 also includes a magnetic sensing subsystem. Patient 28 is placed in a magnetic field generated by a pad including at least one magnetic field radiator 42, which is driven by a unit 43 disposed in console 24. Magnetic field radiator 42 is configured to emit an alternating magnetic field into an area where a body part (e.g., heart 26) is located. The magnetic field generated by magnetic field radiator 42 generates a direction signal in magnetic sensor 50. Magnetic sensor 50 is configured to detect at least a portion of the emitted alternating magnetic field and provide the direction signal as a corresponding electrical input to processing circuit 41.

[0062] In some embodiments, processing circuit 41 uses position signals received from shaft electrode 52, magnetic sensor 50, and electrode 55 to estimate the position of catheter 40 within an organ, such as a heart chamber. In some embodiments, processing circuit 41 correlates the position signals received from electrodes 52, 55 with previously acquired magnetic position-calibrated position signals to estimate the position of catheter 40 within the heart chamber. The position coordinates of shaft electrode 52 and electrode 55 can be determined by processing circuit 41 based on (among other inputs) the ratio of the measured impedance or current distribution between electrodes 52, 55 and body surface electrodes 49. Console 24 drives display 27, which shows the distal portion of catheter 40 within heart 26.

[0063] Methods using current distribution measurements and / or position sensing of external magnetic fields are implemented in various medical applications, for example, in the Magnetic Field Imaging System manufactured by Biosense Webster Inc. (Irvine, California). The system is implemented in a CMOS process and is described in detail in U.S. Patents 5,391,199, 6,690,963, 6,484,118, 6,239,724, 6,618,612, 6,332,089, 7,756,576, 7,869,865, and 7,848,787, PCT Patent Publication WO 96 / 05768, and U.S. Patent Application Publications 2002 / 0065455A1, 2003 / 0120150A1, and 2004 / 0068178A1.

[0064] The system applies a position tracking method based on active current location (ACL) impedance. In some embodiments, processing circuit 41 is configured to use the ACL method to generate a mapping (e.g., a current-position matrix (CPM)) between an indication of electrical impedance and the position of magnetic field radiator 42 in the magnetic coordinate system. Processing circuit 41 estimates the position of shaft electrode 52 and electrode 55 by performing a lookup in the CPM.

[0065] The processing circuit 41 is typically programmed with software to perform 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 a non-transitory tangible medium such as magnetic, optical, or electronic memory.

[0066] For simplicity and clarity, Figure 1 Only the elements related to the technology disclosed in the present invention are shown. System 20 generally includes additional modules and elements that are not directly related to the technology disclosed in the present invention and thus the additional modules and elements are not directly related to the technology disclosed in the present invention. Figure 1 and the corresponding descriptions are intentionally omitted.

[0067] The catheter 40 described above includes eight flexible arms 54, each of which has six electrodes. By way of example only, any suitable catheter may be used in place of the catheter 40, for example, a catheter having a different number of flexible arms and / or electrodes on each arm, or a different probe shape such as a balloon catheter, a basket catheter, or a lasso catheter.

[0068] The medical surgical system 20 may also perform ablation of cardiac tissue using any suitable catheter, such as catheter 40 or a different catheter, and any suitable ablation method. The console 24 may include an RF signal generator 34 configured to generate RF power that is applied by one or more electrodes of a catheter connected to the console 24 and one or more of the surface electrodes 49 to ablate the myocardium of the heart 26. The console 24 may include a pump (not shown) that pumps an irrigation fluid through an irrigation channel to a distal portion of the catheter performing the ablation. The catheter performing the ablation may also include a temperature sensor (not shown) for measuring the temperature of the myocardium during ablation and adjusting the ablation power and / or the irrigation rate of the pumping of the irrigation fluid based on the measured temperature.

[0069] Now see Figure 3 , which includes Figure 1 The system 20 presents the heart 26 ( Figure 1 ) is a schematic diagram of a three-dimensional (3D) representation 60 of the chamber.

[0070] The catheter 40 ( Figure 2 ) is inserted into the heart of a living subject 26 ( Figure 1 ) chamber and maneuvered between a plurality of sampling sites to use the catheter electrode 55 ( Figure 2 ) to sample the electrical activity of the tissue in the chamber. Figures 3 to 9 The embodiments described herein are based on the use of a catheter having five splines, such as a PENTARAY catheter. Any suitable catheter having more or fewer than five splines may be used. In some embodiments, any suitable catheter may be used, such as a balloon, basket, or lasso catheter. The sampling time at each sampling site may be of any suitable duration, for example, in the range of 20-30 seconds. In other embodiments, the sampling time may be less than 20 seconds or greater than 30 seconds.

[0071] Processing circuit 41 ( Figure 1 ) receives the signal from the catheter 40 ( Figure 2 ) and, in response to the signal, calculates the sampling position of the catheter 40 and the corresponding electrode position of the corresponding catheter electrode 55 for each sampling site ( Figure 2 The sampling position of the catheter 40 may be any suitable position of the catheter 40, such as the distal end of the shaft 22 of the catheter 40 ( Figure 2 ), or a position sensor on the shaft 22 (such as a magnetic sensor 50 ( Figure 2)) or the average position of electrodes 55 at the sampling sites. The calculated positions are typically projected onto a surface 64 representing the surface of the heart chamber. The surface 64 representing the chamber may be acquired from a previous scan, such as a CT or MRI, registered with the system 20. The signals may be provided by the electrodes 55 of the catheter 40 and / or one or more other position sensors or one or more transducers. The signals may be received by the processing circuit 41 from the catheter 40 via a cable or wirelessly. Additionally or alternatively, the processing circuit 41 may receive signals from body surface electrodes 49 that sense signals emitted by the catheter 40.

[0072] In some embodiments, processing circuit 41 ( Figure 1 ) is configured to calculate the sampling position and the electrode position for each sampling site as the catheter 40 ( Figure 2 ) and the catheter electrode 55 ( Figure 2 )’s average position.

[0073] Processing circuit 41 ( Figure 1 ) identifies the catheter electrode 55 ( Figure 2 ) sensed electrical activity of tissue. By way of example only, identifying electrical activity may include identifying the intensity of the electrical activity (e.g., based on the magnitude of the signal) and / or an area of ​​interest such as focal activity or rotational activity. Focal activity may be indicated by a repetitive activation pattern exhibiting an early continuous QS morphology. U.S. Patent Publication 2017 / 0202470 to Urman et al. describes a system and method for identifying focal origins. Any suitable method may be used to identify focal origins. Rotational activity may be indicated by a repetitive activation pattern exhibiting rotational activity. U.S. Patent Publication 2017 / 0202515 to Ben Zrihem et al. describes a method for detecting a source of an atrial rotational activity pattern (RAP), the method comprising detecting electrocardiogram (ECG) signals over time via a plurality of sensors, each ECG signal being detected via one of the plurality of sensors and indicating electrical activity of the heart. Any suitable method may be used to identify rotational activity.

[0074] Processing circuit 41 ( Figure 1 ) to the display 27( Figure 1 ) presents a 3D representation 60 of the chamber including corresponding sampling site markers 62 indicating the catheter 40 at the corresponding sampling site ( Figure 2 ) calculated sampling position. As mentioned previously, the calculated sampling position is projected onto the surface 64 of the chamber. Each sampling site marker 62 is represented by Figure 3 The sampling site marker 62 can be represented by two concentric circles in . The sampling site marker 62 can be represented by any suitable symbol or shape (for example, a circle, a square, or a triangle).

[0075] In some embodiments, sampling sites that are considered unstable due to catheter motion exceeding a threshold during the sampling time may be formatted and / or represented differently from other sampling site markers 62. Figure 3 In the example of , a stripe in the sampling site marker 62 - 1 is used to indicate an unstable sampling site. The threshold value may be any suitable value in the range of, for example, but not limited to, 0.5 mm to 10 mm.

[0076] Figure 3 Also shown is a user cursor 66 hovering over the sampling site marker 62-2 prior to selection of the sampling site marker 62-2. In some embodiments, the sampling site marker 62-2 may be selected by touching a touch-sensitive screen.

[0077] Now see Figure 4 , which shows the Figure 3 Schematic diagram of a 3D representation 60 of a selection of a sampling site marker 62-2. Processing circuit 41 ( Figure 1 ) receives user input selecting the sampling site marker 62-2. The processing circuit 41 updates the presented 3D representation 60 in response to the received user input to include electrode markers 68 (only some are labeled for simplicity) that indicate when the catheter 40 ( Figure 2 ) the corresponding (projected) electrode position of the corresponding catheter electrode 55 (projected onto the surface 64) when sampling the electrical activity of the tissue at the sampling site corresponding to the selected sampling site marker 62-2. Figure 4 The electrode markers 68 are shown arranged as five lines separated from the sampling site marker 62-2. The five lines correspond to the five splines of the catheter 40, which in this example is a PENTARAY catheter. In other embodiments, any suitable catheter may be used.

[0078] Each electrode marker 68 is represented by a square. The electrode markers 68 may be represented using any suitable symbol or shape (eg, a circle or a triangle).

[0079] When a sampling site marker 62-2 is selected, the processing circuit 41 updates the presented 3D representation 60 to highlight the selected sampling site marker 62-2, for example, by surrounding it with another circle. In addition or alternatively, the sampling site marker 62-2 can be highlighted by increasing its brightness and / or changing its color. Illustration 70 shows one of the sampling site markers 62 that is not selected and therefore not highlighted. Illustration 72 shows the sampling site marker 62-2 highlighted after selection.

[0080] Now see Figure 5 , which is a diagram showing a pair according to an alternative embodiment Figure 3 Schematic diagram of a selected 3D representation 60 of a sampling site marker 62 - 2 . Figure 5 Some of the electrode markers 68-1, 68-2, 68-3, 68-4 in the diagram are represented differently (e.g., enlarged and / or colored and / or shaded differently) than the other electrode markers 68. Specifically, the electrode markers 68-1, 68-2 are represented as larger squares than the squares of the other electrode markers 68, while the electrode markers 68-3, 68-4 are formatted with a black fill. The electrode markers 68-1, 68-2 may represent areas of electrical activity of interest, such as focal activity or rotational activity of tissue sensed by the corresponding electrode 55. Figure 2 ). In addition, electrode marker 68-1 has a lighter fill color than electrode marker 68-2, indicating that the electrical activity associated with electrode marker 68-1 has a lower intensity than the electrical activity associated with electrode marker 68-2. Electrode markers 68-3, 68-4 can represent electrical activity below a threshold sensed by the corresponding electrode 55. The electrical activity associated with electrode markers 68-3, 68-4 can be excluded from certain calculations, such as calculations used to determine regions of interest such as focal activity and / or rotational activity.

[0081] The processing circuitry 41 may update the presented 3D representation 60 in response to the received user input to include electrode markers 68, wherein at least one of the electrode markers 68-1, 68-2, 68-3, 68-4 has a different representation type than the other electrode markers 68 in response to identified electrical activity of tissue sensed by the corresponding catheter electrode (corresponding to markers 68-1, 68-2, 68-3, 68-4). The identified electrical activity may be associated with any one or more of: electrical activity below a threshold activity level, focal activity, and / or rotational activity. By way of example only, the one or more different representation types may include using an electrode marker 68 that is larger than the other electrode markers 68, and / or an electrode marker 68 that is a different color than the other electrode markers 68, and / or a different shape, shading, pattern, and / or brightness.

[0082] The processing circuit 41 can be based on the corresponding catheter electrode 55 ( Figure 2 ) The one or more electrode markers 68-1, 68-2, 68-3, 68-4 are formatted according to the intensity of the identified electrical activity of the sensed tissue. By way of example, the format may include color, shading, pattern and / or brightness.

[0083] In all embodiments described herein, the various markers can optionally be displayed over other mapping schemes, for example, maps colored according to local activation time (LAT) or bipolar voltage.

[0084] Now see Figure 6 , which is according to an alternative embodiment comprising Figure 1 Schematic diagram of a three-dimensional (3D) representation 74 of a chamber of the heart with corresponding sampling site markers 76 and electrode markers 78 presented by the system 20 . Figure 6 Electrode markers 78 are shown associated with sampling site markers 76 even when none of the sampling site markers 76 is selected by the user. Electrode markers 78 may be associated with areas of interest such as focal activity or rotational activity. Figure 6 Also shown is user cursor 66 hovering over electrode marker 78 - 1 prior to selection of electrode marker 78 - 1 .

[0085] Now see Figure 7 , which shows the Figure 6 Schematic diagram of a 3D representation 74 of a selected electrode marker 78-1. Selecting electrode marker 78-1 causes the 3D representation 74 to be updated to show other electrode markers 80 (only some of which are labeled for simplicity) associated with the sampling site marker 76-1 with which electrode marker 78-1 is associated. Similarly, selecting any of the electrode markers 78 causes the 3D representation 74 to be updated to show the electrode markers 80 associated with the sampling site marker 76 with which the selected electrode marker 78 is associated. Additionally, selecting sampling site marker 76-1 causes the electrode marker 80 associated with sampling site marker 76-1 to be shown.

[0086] Now see Figure 8 , which is Figure 7Schematic diagram of a 3D representation 74 of during recalculation. A user can select to perform a recalculation to identify electrical activity of tissue sensed by electrode 55 at any of the sampling sites associated with one of the sampling site markers 76, such as a region of interest. For example, a recalculation can be performed after the user excludes or includes the sensed electrical activity of tissue sensed by one or more of electrodes 55 at one of the sampling sites. The user can exclude or include the sensed electrical activity of tissue sensed by one or more of electrodes 55 via selection of the associated one or more electrode markers 80 (e.g., by right-clicking on the one or more electrode markers 80 with a mouse and selecting, e.g., "Recalculate" from a list in a pop-up window, or using any other suitable selection method). Recalculation can be triggered by selecting the associated sampling site marker 76, e.g., by right-clicking on the sampling site marker 76 with a mouse and selecting, e.g., "Recalculate" from a list in a pop-up window, or using any other suitable selection method. During recalculation, the electrode markers 80 may be shown differently, for example, with a grey fill, and the selected sampling site marker 76 - 1 may show the progress of the recalculation using a black fill that increases as the recalculation progresses.

[0087] Now see Figure 9 , which includes Figure 1 Flowchart 90 of the steps in a method of operating the system 20.

[0088] Catheter 40( Figure 2 ) is configured to be inserted (block 92) into the heart 26 of a living subject ( Figure 1 ) chamber and manipulated between multiple sampling sites to use the catheter electrode 55 ( Figure 2 ) to sample the electrical activity of the tissue in the chamber.

[0089] Processing circuit 41 ( Figure 1 ) is configured to receive (block 94) a catheter 40 ( Figure 2 ) and in response thereto, calculates (block 96) for each sampling site the sampling position of the catheter 40 and the catheter electrode 55 ( Figure 2 ). In some embodiments, the processing circuit 41 is configured to calculate, for each sampling site, the sampling position and the electrode position as the average position of the catheter 40 and the catheter electrode 55, respectively, averaged over the sampling time of the sampling site.

[0090] Processing circuit 41 ( Figure 1) is configured to identify (block 98) the electrical activity of the tissue sensed by the respective ones of the catheter electrodes 55 sampling at the respective sampling sites. The processing circuit 41 is configured to present (block 100) to a display the corresponding sampling site marker 62 ( Figure 4 )、76( Figure 7 ) of the chamber 60( Figure 4 )、74( Figure 7 ), indicating the calculated sampling position of the catheter 40 at the corresponding sampling site. The processing circuit 41 is configured to receive (block 102) a user input selecting one of the sampling site markers 62, 76.

[0091] Processing circuit 41 ( Figure 1 ) is configured to update (block 104) the rendered 3D representation 60, 74 in response to received user input to include the electrode markers 68 ( Figure 4 )、80( Figure 7 ), the electrode marker indicates when the catheter 40 ( Figure 2 ) when sampling the electrical activity of the tissue at the corresponding sampling site of the sampling sites corresponding to the selected sampling site markers 62, 76. Figure 2 ) of the corresponding electrode positions. In some embodiments, the processing circuit 41 ( Figure 1 ) is configured to update the rendered 3D representation 60 , 74 to highlight (block 106 ) the selected sampling site marker 62 , 76 .

[0092] Processing circuit 41 ( Figure 1 ) is configured to update the presented 3D representation 60, 74 in response to the received user input to include (block 108) electrode markers 68, 80, wherein at least one of the electrode markers 68, 80 has a different representation type than other of the electrode markers 68, 80 in response to identified electrical activity of the tissue sensed by at least one corresponding catheter electrode 55. The identified electrical activity may include electrical activity below a threshold activity level, and / or focal activity and / or rotational activity. By way of example, the different representation type may include using an electrode marker that is larger than the other electrode markers, and / or an electrode marker that is a different color than the other electrode markers, and / or a different shape, shading, pattern, and / or brightness.

[0093] Processing circuit 41 ( Figure 1) is configured to format (block 110) any of the electrode markers 68, 80 according to the intensity of the identified electrical activity of the tissue sensed by the corresponding catheter electrode 55. By way of example, the format may include color, shading, pattern, and / or brightness.

[0094] As used herein, the term "about" or "approximately" for any numerical value or range indicates a suitable dimensional tolerance that allows the component or collection of elements to achieve its intended purpose as described herein. More specifically, "about" or "approximately" can refer to a range of ±20% of the value of the recited value, for example, "about 90%" can refer to a range of values ​​from 71% to 99%.

[0095] For clarity, various features of the invention described in the context of separate embodiments may also be provided in combination in a single embodiment. Conversely, for simplicity, various features of the invention are described in the context of a single embodiment and may also be provided separately or in any suitable subcombination.

[0096] The above embodiments are cited by way of example, and the present invention is not limited by what has been specifically shown and described hereinabove. On the contrary, the scope of the present invention includes combinations and subcombinations of the various features described above, as well as variations and modifications thereof, which will occur to those skilled in the art upon reading the above description and which are not disclosed in the prior art.

Claims

1. A medical system comprising: a catheter comprising a distal portion and catheter electrodes disposed at respective locations on the distal portion, the catheter being configured to be inserted into a chamber of a heart of a living subject and maneuvered between a plurality of sampling sites to sample electrical activity of tissue of the chamber using respective ones of the catheter electrodes at each of the sampling sites; monitor; as well as a processing circuit configured to: receiving a signal provided by the catheter and, in response to the signal, calculating, for each of the sampling sites, a sampling position of the catheter and a corresponding electrode position of the corresponding one of the catheter electrodes; presenting a three-dimensional (3D) representation of the chamber to the display, the three-dimensional (3D) representation including respective sampling site markers indicating the calculated sampling positions of the catheter at respective ones of the sampling sites and not including electrode markers indicating the calculated electrode positions; receiving a user input selecting one of the sampling site markers; as well as The rendered 3D representation is updated in response to the received user input to include electrode markers indicating the respective electrode positions of the respective catheter electrodes when the catheter was sampling the electrical activity of the tissue at the respective ones of the sampling sites corresponding to the selected sampling site markers.

2. The system of claim 1 , wherein the processing circuit is configured to calculate, for each of the sampling sites, the sampling position and the electrode position as average positions of the catheter and the catheter electrode, respectively, averaged over a sampling time. 3 . The system of claim 1 , wherein the processing circuit is configured to update the rendered 3D representation to highlight the selected sampling site marker.

4. The system of claim 1 , wherein the processing circuit is configured to: identifying electrical activity of the tissue sensed by respective ones of the catheter electrodes sampling at respective sampling sites; and The rendered 3D representation is updated in response to the received user input to include the electrode markers, wherein at least one of the electrode markers has a different type of appearance than other of the electrode markers in response to the identified electrical activity of the tissue sensed by at least one corresponding one of the catheter electrodes. The system of claim 4 , wherein the identified electrical activity is electrical activity below a threshold activity level. The system of claim 4 , wherein the identified electrical activity is focal activity. The system of claim 4 , wherein the identified electrical activity is rotational activity.

8. The system of claim 4, wherein the different presentation type comprises using electrode markers that are larger than the other electrode markers.

9. The system of claim 4, wherein the different presentation type comprises using an electrode marker of a different color than the other electrode markers.

10. The system of claim 4, wherein the processing circuit is configured to format the at least one electrode marker according to an intensity of the identified electrical activity of the tissue sensed by the at least one corresponding one of the catheter electrodes.

11. A software product comprising a non-transitory computer-readable medium having program instructions stored therein, the instructions, when read by a central processing unit (CPU), causing the CPU to: receiving signals provided by a catheter, the catheter comprising a distal portion and catheter electrodes disposed at respective locations on the distal portion, the catheter being configured to be inserted into a chamber of a heart of a living subject and maneuvered between a plurality of sampling sites to sample electrical activity of tissue of the chamber using respective ones of the catheter electrodes at each of the sampling sites; calculating, in response to the signal, a sampling position of the catheter and a corresponding electrode position of the corresponding one of the catheter electrodes for each of the sampling sites; presenting a three-dimensional (3D) representation of the chamber to a display, the three-dimensional (3D) representation including respective sampling site markers indicating the calculated sampling positions of the catheter at respective ones of the sampling sites and not including electrode markers indicating the calculated electrode positions; receiving a user input selecting one of the sampling site markers; as well as The rendered 3D representation is updated in response to the received user input to include electrode markers indicating the respective electrode positions of the respective catheter electrodes when the catheter was sampling the electrical activity of the tissue at the respective ones of the sampling sites corresponding to the selected sampling site markers.

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