System and method for tracking anatomical focus

Abstract

In one embodiment, a method includes obtaining an electroanatomical map that maps a portion of a heart when the heart experiences an arrhythmia; obtaining a sequence of images of the heart acquired by an ultrasound probe, the sequence comprising one or more cardiac arrhythmia images acquired when the heart experiences the cardiac arrhythmia and one or more cardiac rhythm images acquired when the heart is in a sinus cardiac rhythm, the ultrasound probe comprising a sensor, the sensor outputs a signal indicative of a position and orientation of the probe in a coordinate system of the electroanatomical map during acquisition of the sequence of images; based on the signal, identifying, in one of the arrhythmia images, an anatomical portion represented by a particular portion of the electroanatomical map; identifying the anatomical portion in at least one of the cardiac rhythm images by tracking the anatomical portion in the sequence of images; and displaying an output in response thereto.

Description

Technical Field

[0001] The present disclosure relates generally to the field of electrophysiology, and in particular to the treatment of cardiac arrhythmias. Background Art

[0002] U.S. Patent 11,147,497, commonly assigned to Ziv-Ari et al., describes a method that includes receiving multiple sets of signals during multiple cardiac cycles, each set of signals indicating, for a probe inserted into a cardiac chamber, a 3D position of a distal end of the probe, an electrical potential measured at that position, and a corresponding time at which the electrical potential was measured during a given cycle. The received measurements and corresponding times are compared with a first template of sinus rhythm cycles and a second template of non-sinus rhythm cycles to identify a sequence of cycles including a continuous first cycle, a second cycle, and a third cycle, wherein the first cycle and the second cycle match the first template, and the third cycle matches the second template. A physical map is generated based on the positions. Based on the received positions and corresponding electrical potentials, an electroanatomical map including local activation times of non-sinus rhythm cycles superimposed on the physical map is rendered to a display. BRIEF DESCRIPTION OF THE DRAWINGS

[0003] The present disclosure will be more fully understood through the following detailed description of examples of the present disclosure in conjunction with the accompanying drawings, in which:

[0004] Figure 1 is a schematic diagram of a mapping and ablation system according to some examples of the present disclosure;

[0005] Figure 2 are schematic diagrams of two electroanatomical maps according to some examples of the present disclosure;

[0006] Figure 3 is a schematic diagram of a technique for tracking an anatomical portion according to some examples of the present disclosure; and

[0007] Figure 4 is a flow chart of an algorithm for constructing a hybrid electroanatomical map according to some examples of the present disclosure. DETAILED DESCRIPTION

[0008] Overview

[0009] Ablation of a focus of an arrhythmia, such as premature ventricular contractions (PVCs), is often performed when the heart is in sinus rhythm. In such cases, it may be helpful to display a "rhythm" map during the ablation procedure that represents the relevant anatomy during sinus rhythm and is annotated to indicate the location of the focus. However, in order to find the focus, the physician needs to see the electrical activity of the heart during the arrhythmia, which the "rhythm" map does not show.

[0010] One solution to this challenge is to construct a hybrid electroanatomical map that includes an annotated rhythm anatomy map to show the electrical properties of the heart during arrhythmias. After the hybrid map is constructed, the physician can mark the focal points on the hybrid map and then refer to the hybrid map during the procedure. However, a potential problem with this approach is that arrhythmic electrical properties may not be correctly mapped to the rhythm anatomy due to morphological differences between the rhythm state and the arrhythmic state.

[0011] Therefore, the present disclosure provides an alternative solution to the aforementioned challenges. According to the solution, the data acquired by the mapping probe is used to construct a cardiac rhythm electroanatomical map and an arrhythmia electroanatomical map. In addition, when the heart changes from sinus rhythm to the onset of an arrhythmia or the onset of an arrhythmia changes to sinus rhythm, a sequence of ultrasound images showing the focal area is acquired by the ultrasound probe. The mapping probe and the ultrasound probe are tracked by the same tracking system so that the ultrasound image is registered to each map in the map.

[0012] First, the physician marks the focal point on the arrhythmia electroanatomical map. Using registration of the map with the ultrasound image, the processor locates the focal point in one of the "arrhythmia images" (i.e., one of the images acquired during the onset of an arrhythmia). The processor then tracks the focal point forward or backward in the sequence until it reaches one of the "rhythm images," i.e., one of the images acquired during sinus rhythm. (Typically, both the starting arrhythmia image and the ending rhythm image are acquired at the same phase in the cardiac cycle, which phase is represented by the two maps.) Then, using the registration, the processor marks the focal point on the rhythm map. The physician can then refer to the rhythm map to locate the focal point during the procedure.

[0013] In other examples, the processor constructs a more accurate hybrid electroanatomical map relative to conventional techniques. Optionally, the focal point or any other point of interest may then be marked on the hybrid map.

[0014] To construct the hybrid map, the processor first selects a plurality of representative portions of the arrhythmia map. For each of the representative portions, the processor uses the ultrasound-based technique described above to locate a corresponding portion of the rhythm anatomy map that represents the relevant anatomical structure during sinus rhythm. The processor then associates the electrical characteristic values ​​associated with the representative portion of the arrhythmia map with the corresponding portion of the rhythm anatomy map. After performing any required interpolation of the values ​​on the rhythm map, the processor annotates the rhythm map to indicate the values.

[0015] System Description

[0016] First reference Figure 1 , which is a schematic diagram of a mapping and ablation system 20 according to some examples of the present disclosure.

[0017] The system 20 includes a mapping and ablation probe 22, which is proximally connected to a mapping console 24. The probe 22 includes one or more electrodes 25 at its distal end. The electrodes 25 are configured to acquire intracardiac signals from tissue of a heart 26 of a subject 28 and to apply ablation signals to the tissue. The probe 22 also includes a tracking sensor 29 at its distal end, which is configured to output a signal indicating the position and orientation of the sensor 29. The probe can be controlled using a control handle 32.

[0018] The probe 22 is inserted by a physician 30, for example, via the superior vena cava of a subject 28, into a chamber of the heart 26, such as the left ventricle. Typically, the probe is inserted through a sheath 23, the proximal end of which may be connected to a handle 47. After inserting the probe 22 into the heart chamber, the physician moves the distal end of the probe along the tissue of the chamber while the electrode 25 acquires intracardiac signals from the tissue.

[0019] The system 20 also includes a mapping processor 39, which is typically housed in the mapping console 24. Based on the signals from the sensors 29, the mapping processor 39 calculates the location of each of the acquired intracardiac signals in the heart 26. Based on the signals and the location information, the processor constructs an electroanatomical map 55 of the tissue.

[0020] The system 20 also includes an ultrasound (US) probe 21 proximally connected to a mapping console 24 and an ultrasound console 43. The US probe 21 includes a two-dimensional (e.g., 32×64) array 50 of ultrasound transducers 53 and a tracking sensor 52 at its distal end. The sensor 52 is configured to output a signal indicating the position and orientation of the sensor. The US probe 21 can be controlled using a control handle 40.

[0021] The system 20 also includes an ultrasound processor 41, which is typically housed in an ultrasound console 43. Based on the signals output by the transducer 53, the processor 41 constructs an ultrasound image, which is typically three-dimensional.

[0022] The mapping processor 39 and the ultrasound processor 41 are configured to exchange communications with each other via any suitable wireless or wired communication medium 45. For example, the ultrasound processor 41 may communicate each of the ultrasound images to the mapping processor 39. Based on the signals from the sensors 52 and the predefined registration of the sensors with the array 50, the mapping processor 39 may calculate the position and orientation of the anatomical structures represented in each of the ultrasound images.

[0023] The system 20 also includes a memory 37, which may include any suitable type of volatile memory, such as random access memory (RAM), and / or non-volatile memory, such as flash memory. The memory 37 may be accessed by the mapping processor 39 and / or the ultrasound processor 41. The memory 37 may store ultrasound images and / or any other data.

[0024] The physician 30 inserts the US probe 21 into the heart 26, for example, via the superior vena cava of the subject 28. The physician then uses the US probe 21 to acquire ultrasound images of anatomical structures that are mapped using the mapping and ablation probe 22. The contours shown in at least some of these images may be marked manually (e.g., by the physician 30) or automatically (e.g., by the mapping processor 39), and the marked images may then supplement the anatomical data used to construct the map 55. Alternatively or in addition, as described below with reference to Figure 3 As further described, at least some of the images may be used to track a focus of the arrhythmia and / or other portions of the subject's anatomy.

[0025] In some examples, the system 20 includes one or more magnetic field generators 36 configured to generate a magnetic field near the subject 28, and each of the tracking sensors includes one or more coils. Based on the signals induced in the coils by the magnetic field, the mapping processor 39 tracks the position and orientation of each of the probes. For example, such tracking techniques are disclosed in U.S. Patents 5,391,199, 5,443,489, and 6,788,967 to Ben-Ham, U.S. Patent 6,690,963 to Ben-Ham et al., U.S. Patent 5,558,091 to Acker et al., and U.S. Patent 6,177,792 to Govari, the corresponding disclosures of which are incorporated herein by reference.

[0026] In other examples, each of the tracking sensors includes one or more probe electrodes, and the processor tracks each of the probes based on a current or voltage distribution between the probe electrodes and a reference electrode coupled to the subject's body. Such techniques can utilize a position map calibrated in advance using an electromagnetic sensor, as described, for example, in U.S. Pat. No. 7,536,218 to Govari et al. and U.S. Pat. No. 8,456,182 to Bar-Tal et al., the corresponding disclosures of which are incorporated herein by reference. Alternatively, the processor can pass a current between the reference electrodes and measure the resulting voltage at the probe electrodes, as described, for example, in U.S. Pat. No. 5,983,126 to Wittkampf and U.S. Pat. No. 5,944,022 to Nardella, the corresponding disclosures of which are incorporated herein by reference.

[0027] In some examples, US probe 21 and mapping and ablation probe 22 are simultaneously located in the heart of the subject. As a specific example, probe 22 can map the left ventricle of heart 26 while the US probe images the left ventricle from the left atrium of the heart. In other examples, one of the probes is inserted into the heart only after the other probe is removed.

[0028] In some examples, US probe 21 includes at least one electrode 56 with which the US probe performs some or all of the functions of mapping and ablation probe 22. Provided that the US probe performs all of the functions of probe 22, probe 22 may be omitted from system 20.

[0029] In other examples, the system 20 includes three probes: a US probe 21 , another probe for mapping, and another probe for ablation.

[0030] The system 20 also includes electrocardiogram (ECG) electrodes (not shown) coupled to the body of the subject 28 and connected to the console 24. Based on the signals from the ECG electrodes, the mapping processor 39 determines the corresponding phase in the ECG cycle in which the intracardiac signal and the ultrasound image are acquired. In addition, based on the ECG signals, the mapping processor can determine whether the heart is in sinus rhythm or is experiencing an arrhythmia.

[0031] The system 20 also includes a circuit 38 that is typically disposed in the console 24. The circuit 38 may include an interface circuit that is configured to interface between a mapping processor 39 and each of the probes. For example, the interface circuit may digitize intracardiac signals received from the distal end of the mapping and ablation probe 22 and transmit the digitized signals to the mapping processor 39. Alternatively or in addition, the circuit 38 may include a generator circuit that is configured to generate ablation signals and transmit these signals to the distal end of the probe 22.

[0032] In some examples, system 20 also includes a driver circuit 34 , which is typically disposed in console 24 and is configured to drive a magnetic field generator 36 .

[0033] Typically, system 20 also includes a display 27 on which mapping processor 39 can display electroanatomical map 55, one or more ultrasound images, and / or any other suitable output.

[0034] In some examples, the US probe 21 acquires transthoracic or transesophageal ultrasound images rather than intracardiac images.

[0035] Although the present description generally assumes that the mapping processor 39 implements the processes described herein, it should be noted that any one or more processors may collaboratively implement any of these processes. For example, the ultrasound processor 41 may implement any of these processes alone or in collaboration with the mapping processor 39. As a specific example, the ultrasound processor 41 may perform the tracking functions described herein and communicate the output of the tracking to the mapping processor 39.

[0036] Generally speaking, each processor in the processor described herein can be embodied as a single processor, or as a group of collaborative networked or clustered processors. The function of the processor can be implemented only in hardware, for example, using one or more fixed-function or general-purpose integrated circuits, application-specific integrated circuits (ASICs) and / or field programmable gate arrays (FPGAs). Alternatively, the function can be implemented at least in part in software. For example, the processor can be embodied as a programmed processor including, for example, a central processing unit (CPU) and / or a graphics processing unit (GPU). Program code (including software programs and / or data) can be loaded to be executed and processed by a CPU and / or GPU. For example, program code and / or data can be downloaded to the processor in electronic form via a network. Alternatively or in addition thereto, program code and / or data can be provided and / or stored on a non-transient tangible medium, such as a magnetic, optical or electronic memory. Such program code and / or data, when provided to the processor, generates a machine or a special-purpose computer configured to perform the tasks described herein.

[0037] Locating focal points in electroanatomical cardiac rhythm maps

[0038] Reference now Figure 2 , which is a schematic diagram of two electroanatomical maps according to some examples of the present disclosure.

[0039] Figure 2 Depicted is an electroanatomical map of arrhythmia 55a, which is a map 55 ( Figure 1 ) example. The arrhythmia electroanatomical map 55a provides an example of the heart 26 ( Figure 1 ) is mapped. Typically, map 55a is colored and / or otherwise annotated to indicate the values ​​of corresponding local activation times (LATs), activation voltages, and / or any other electrical properties at different points on the tissue. Map 55a may represent a portion of the heart at the beginning of a QRS complex, the beginning of a T wave, the beginning of a P wave, or any other suitable phase of the cardiac cycle.

[0040] Processor 39 ( Figure 1 ) is configured to obtain the mapping map 55a. For example, the processor may be as described above with reference to Figure 1Alternatively, for example, the processor may retrieve the data from memory 37 ( Figure 1 ) to load a map or receive a map via a computer network.

[0041] Figure 2 Also shown are markings 44 marking a particular portion 42a of the map 55a. Portion 42a, which may be of any shape and area, may correspond to a focus of an arrhythmia or any other anatomical portion of interest.

[0042] In some examples, the processor receives input from a user indicating portion 42a. For example, portion 42a may be indicated by physician 30 ( Figure 1 ) mark, and the map 55a is displayed on the display 27. Alternatively, the portion 42a can be automatically identified by the processor. (Note that the mark 44 does not necessarily need to be displayed by the processor).

[0043] Figure 2 Also shown is a cardiac rhythm electroanatomical map 55r, which is also a map 55 ( Figure 1 ). Cardiac rhythm electroanatomical map 55r maps the same portion of the heart as map 55a in the same coordinate system and at the same phase of the cardiac cycle when the heart is in sinus rhythm. Map 55r differs from map 55a due to differences in morphology and electrical conduction between the arrhythmic state and the rhythmic state of the heart.

[0044] Processor 39 ( Figure 1 ) is configured to obtain map 55r, as described above for map 55a. For example, the processor can construct two maps in parallel. In particular, mapping and ablation probe 22 ( Figure 1 ) can acquire intracardiac signals during one or more sinus rhythm cycles and one or more arrhythmia cycles. For each intracardiac signal received from the probe, the processor can examine the subject's ECG. If the ECG indicates that the heart is in sinus rhythm, the processor can assign the signal (with its associated position) to map 55r; otherwise, the processor can assign the signal to map 55a.

[0045] In some examples, such as the following reference Figure 3 As further described, the processor is configured to identify portion 42r of map 55r that corresponds to portion 42a of map 55a by virtue of representing the same anatomical portion. After identifying portion 42r, the processor may display map 55r with indicia 44 superimposed on portion 42r.

[0046] Now see further Figure 3 , which is a schematic diagram of techniques for tracking anatomical parts according to some examples of the present disclosure.

[0047] Mapping processor 39 ( Figure 1 ) is configured to obtain the Figure 1 ) of the heart. For example, the mapping processor may receive the sequence from the ultrasound processor 41, load the sequence from the memory 37, or receive the sequence from a remote computer via a computer network.

[0048] The sequence 46 includes one or more arrhythmia images 48a acquired when the heart is experiencing an arrhythmia, and one or more rhythm images 48r acquired when the heart is in sinus rhythm. The arrhythmia image 48a may be acquired before or after the rhythm image 48r. In other words, during the acquisition of the sequence, the heart may transition from an arrhythmia to sinus rhythm or from sinus rhythm to an arrhythmia. Typically, the images 48 (which may also be referred to as "frames") in the sequence 46 are acquired at a rate of at least 30 frames per second (fps), such as 30-60fps. At least some of the images 48 may be acquired with different corresponding fields of view.

[0049] for Figure 3 Each of the images shown in 48, Figure 3 Also shown is a portion of a subject's ECG waveform 58, with markers 60 indicating the phase in the cardiac cycle at which the image was acquired. By way of example, Figure 3 The portion of the ECG waveform 58 shown in FIG. 5 includes a QRS complex. When the heart is experiencing an arrhythmia, the QRS complex may be abnormal, such as Figure 3 shown.

[0050] In some examples, the raw data used to construct the map 55a and the raw data used to construct the arrhythmia image 48a are acquired during the same arrhythmia episode. For example, when the episode occurs, the US probe 21 and the mapping and ablation probe 22 ( Figure 1 ) may be simultaneously located in the heart of the subject. In other examples, the raw data used to construct the map 55a and the raw data used to construct the arrhythmia image 48a are acquired during different corresponding arrhythmia episodes.

[0051] As mentioned above Figure 1 As described, the same tracking system is used to track the US probe 21 and the mapping and ablation probe 22, or alternatively, the same probe is used for both mapping and ultrasound. In either case, the tracking sensor 52 ( Figure 1) outputs a signal indicating the position and orientation of the US probe in the coordinate system of maps 55a and 55r; in other words, image 48 is registered to maps 55a and 55r. Thus, based on the tracking signal, the mapping processor identifies in arrhythmia image 48a' the anatomical portion 54 represented by portion 42a of map 55a.

[0052] Typically, the arrhythmia image 48a' is acquired at a phase of the cardiac cycle that is approximately the same as the phase represented by the map 55a and is closer to the cardiac rhythm image than any other arrhythmia image acquired at such a phase. For example, for the case where the arrhythmia image precedes the cardiac rhythm image, the mapping processor may identify the arrhythmia image 48a' by starting with the last arrhythmia image and moving backward in the sequence 46 until the cardiac phase is within a predefined threshold of the phase represented by the map 55a. For the case where the arrhythmia image follows the cardiac rhythm image, the mapping processor may start with the first arrhythmia image and move forward in the sequence 46 until the cardiac phase is within a predefined threshold of the phase represented by the map 55a.

[0053] After identifying the anatomical portion 54 in the arrhythmia image 48a', the mapping processor tracks the anatomical portion across the image sequence, such as Figure 3 48a', and the processor tracks the anatomical portion forward in the sequence; otherwise, the processor tracks the anatomical portion backward in the sequence. In either case, by tracking the anatomical portion 54, the processor identifies the anatomical portion in at least one of the cardiac rhythm images. In particular, the processor may stop tracking when the anatomical portion is identified in cardiac rhythm image 48r', which is acquired at approximately the same stage as arrhythmia image 48a' and is closer to the arrhythmia image than any other cardiac rhythm image acquired at such a stage.

[0054] Typically, the mapping processor uses speckle tracking techniques to track the anatomical parts, such as the techniques described in Bohs, Laurence N. and Gregg E. Trahey, "A novel method for angle independent ultrasonic imaging of blood flow and tissue motion," IEEE Transactions on biomedical engineering 38.3 (1991): 280-286, the disclosure of which is incorporated herein by reference.

[0055] The mapping processor then displays an output (e.g., on the display 27 ( Figure 1 )superior).

[0056] In some examples, the output includes a cardiac rhythm image 48r' and / or any other cardiac rhythm image in which an anatomical portion is identified, with superimposed markers (such as Figure 3 The anatomical sections are marked with the markings shown in FIG.

[0057] Alternatively or in addition, in response to identifying anatomical portion 54 in cardiac rhythm image 48r' and based on the signal output by the tracking sensor, the processor can identify portion 42r of map 55r that corresponds to portion 42a of map 55a by virtue of representing anatomical portion 54. In other words, the processor can identify portion 42r by virtue of cardiac rhythm image 48r' being registered to map 55r and being at approximately the same cardiac phase as map 55r. The processor can then mark portion 42r, as described above with reference to Figure 2 described.

[0058] Constructing a hybrid electroanatomical map

[0059] In other examples, the mapping processor constructs and displays a hybrid electroanatomical map in which an anatomical map representing a portion of the heart during sinus rhythm is annotated to indicate corresponding values ​​of electrical properties (such as LAT) at multiple anatomical portions during arrhythmia. The hybrid map can then be labeled to show the location of the focal point or any other point of interest.

[0060] In particular, the processor may perform the above reference processing for a plurality of anatomical portions represented by different respective representative portions of the arrhythmia electroanatomical map. Figures 2 to 3 If a single sequence does not show the entire portion of the heart, tracking may be performed on multiple sequences, ie at least one of the anatomical portions may be tracked on a different sequence than another one of the anatomical portions.

[0061] Based on the tracking, the processor can identify, for each representative portion of the arrhythmia electroanatomical map, a corresponding portion of the anatomical map that represents the portion of the heart when the heart is in sinus rhythm. The processor can then associate a value of the electrical characteristic at the corresponding portion of the arrhythmia map with each identified portion of the anatomical map.

[0062] For further details, refer now to Figure 4 , which is a flow chart of an algorithm 64 for constructing a hybrid electroanatomical map according to some examples of the present disclosure.

[0063] Algorithm 64 begins with a portion selection step 66, where the processor selects a plurality of representative portions of the arrhythmia electroanatomical map. For example, the processor may select a portion of the map corresponding to a portion of the arrhythmia electroanatomical map formed by one of electrodes 25 ( Figure 1 ) rather than selecting the portion of the map associated with the interpolated value. Alternatively, for example, the processor may select each portion of the map, including the portion associated with the interpolated value.

[0064] After the part selection step 66, the processor checks at a check step 67 whether there is a portion of the image that includes both the cardiac rhythm image and the arrhythmia image (as described above with reference to Figure 3 If not, the processor aborts the construction of the hybrid electroanatomical map. Otherwise, at a sequence selection step 68, the processor selects an ultrasound sequence that has not been selected.

[0065] Next, at an image recognition step 70, the processor identifies an arrhythmia image in the selected sequence that is suitable for starting tracking. Figure 3 Arrhythmia images 48a' depict example criteria for identifying such images.

[0066] Subsequently, at an anatomical portion identification step 72, the processor identifies any anatomical portions represented by corresponding representative portions of the arrhythmia map in the identified "starting" arrhythmia image. Then, at a tracking step 74, the processor tracks the identified anatomical portions in a sequence until an "ending" arrhythmia image is reached, which "ending" arrhythmia image may be described above with reference to Figure 3 The heart rhythm image 48r' is identified as described.

[0067] Next, the processor checks at a check step 76 whether any of the representative portions have not been considered. If so, the processor returns to the check step 67. Otherwise, at an identification step 78, the processor identifies the portion of the cardiac rhythm anatomical map corresponding to the tracked anatomical portion. Subsequently, at an association step 80, the processor associates the values ​​of the electrical characteristic (such as LAT) at the representative portion of the arrhythmia map with the identified corresponding portion of the anatomical map, respectively.

[0068] Next, at an interpolation step 81, the processor interpolates the value of the electrical characteristic on the cardiac rhythm anatomical map. (In the case where the representative portion includes the entire arrhythmia map, relatively little or no interpolation may be required.) Finally, at an annotation step 82, the processor annotates the cardiac rhythm anatomical map to indicate the value of the electrical characteristic.

[0069] Example

[0070] The following examples relate to various non-exhaustive ways in which the teachings herein may be combined or applied. It should be understood that the following examples are not intended to limit the coverage of any claims that may be provided at any time in this patent application or in the subsequent submissions of this patent application. It is not intended to make a disclaimer. The following examples are provided only for illustrative purposes. It is envisioned that the various teachings herein may be arranged and applied in a variety of other ways. It is also envisioned that some variations may omit certain features mentioned in the following examples. Therefore, any of the aspects or features mentioned below should not be considered decisive unless otherwise explicitly indicated by the inventor or the successor with an interest in the inventor at a later date. If any claim proposed in this patent application or in the subsequent submissions related to this patent application includes additional features other than those mentioned below, these additional features should not be assumed to be added for any reason related to patentability.

[0071] Example 1

[0072] A system (20) includes a display (27) and one or more processors (39, 41) configured to collaboratively implement a process. The process includes obtaining an electroanatomical map (55a) that maps a portion of a heart (26) of a subject (28) while the heart is experiencing an arrhythmia. The process also includes obtaining a sequence (46) of images (48) of the heart acquired by an ultrasound probe (21), the sequence including one or more arrhythmia images (48a) acquired while the heart is experiencing the arrhythmia and one or more rhythm images (48r) acquired while the heart is in sinus rhythm, the ultrasound probe including a sensor (52) that outputs a signal indicating a position and orientation of the probe in a coordinate system of the electroanatomical map during acquisition of the sequence of images. The processor also includes identifying, in one of the arrhythmia images, an anatomical portion (54) represented by a particular portion (42a) of the electroanatomical map based on the signal. The process also includes identifying the anatomical portion in at least one of the cardiac rhythm images by tracking the anatomical portion in the sequence of images, and displaying an output on the display (27) in response to identifying the anatomical portion in the at least one of the cardiac rhythm images.

[0073] Example 2

[0074] A system (20) according to Example 1, wherein the output includes at least one of the cardiac rhythm images (48r) having a superimposed marking marking the anatomical portion (54).

[0075] Example 3

[0076] According to the system (20) described in embodiment 1,

[0077] wherein the electroanatomical map is an arrhythmia electroanatomical map (55a),

[0078] The process further comprises obtaining a cardiac rhythm electroanatomical map (55r) while the heart (26) is in sinus rhythm, the cardiac rhythm electroanatomical map mapping the portion of the heart in the coordinate system, and

[0079] The output shown includes:

[0080] identifying, in response to identifying the anatomical portion (54) in the at least one of the cardiac rhythm images (48r) and based on the signal, a portion (42r) of the cardiac rhythm electroanatomical map corresponding to the particular portion (42a) of the arrhythmia electroanatomical map by means of representing the anatomical portion (54), and

[0081] Displaying a cardiac rhythm electroanatomical map with superimposed markings at the identified portion of the cardiac rhythm electroanatomical map

[0082] (44) The electroanatomical mapping of cardiac rhythm.

[0083] Example 4

[0084] According to the system (20) described in embodiment 1,

[0085] wherein the electroanatomical map is an arrhythmia electroanatomical map (55a),

[0086] wherein the specific portion (42a) is one representative portion of a plurality of representative portions of the arrhythmia electroanatomical map,

[0087] wherein the anatomical part (54) is one of a plurality of anatomical parts respectively represented by the representative parts,

[0088] wherein the sequence (46) is one of one or more sequences,

[0089] wherein the process includes tracking each of the anatomical parts in a corresponding one of the sequences, and

[0090] The output shown includes:

[0091] constructing a hybrid electroanatomical map wherein an anatomical map representing the portion of the heart during sinus rhythm is annotated to indicate corresponding values ​​of electrical properties at the anatomical portion during the arrhythmia, and

[0092] The hybrid electroanatomical map is displayed.

[0093] Example 5

[0094] A system (20) according to any one of embodiments 1 to 4, wherein the anatomical portion (54) includes a focus of the arrhythmia.

[0095] Example 6

[0096] A system (20) according to any one of embodiments 1 to 5, wherein the arrhythmia comprises premature ventricular contractions (PVCs).

[0097] Example 7

[0098] A system (20) according to any one of embodiments 1 to 6, wherein the arrhythmia image (48a) is acquired before the cardiac rhythm image (48r).

[0099] Example 8

[0100] A system (20) according to any one of embodiments 1 to 6, wherein the arrhythmia image (48a) is acquired after the cardiac rhythm image (48r).

[0101] Example 9

[0102] A system (20) according to any one of embodiments 1 to 8, wherein the process further includes receiving input from a user indicating the specific portion (42a) of the electroanatomical map (55a).

[0103] Example 10

[0104] A method includes obtaining an electroanatomical map (55a) that maps a portion of a heart (26) of a subject (28) while the heart is experiencing an arrhythmia. The method also includes obtaining a sequence (46) of images (48) of the heart acquired by an ultrasound probe (21), the sequence including one or more arrhythmia images (48a) acquired while the heart is experiencing the arrhythmia and one or more rhythm images (48r) acquired while the heart is in sinus rhythm, the ultrasound probe including a sensor (52) that outputs a signal indicating a position and orientation of the probe in a coordinate system of the electroanatomical map during acquisition of the sequence of images. The method also includes identifying an anatomical portion (54) represented by a specific portion (42a) of the electroanatomical map in one of the arrhythmia images based on the signal. The method also includes identifying the anatomical portion in at least one of the cardiac rhythm images by tracking the anatomical portion in the sequence of images, and displaying an output in response to identifying the anatomical portion in the at least one of the cardiac rhythm images.

[0105] Embodiment 11

[0106] A method according to Example 10, wherein the output includes at least one of the heart rhythm images (48r) having a superimposed marking marking the anatomical portion (54).

[0107] Example 12

[0108] The method according to embodiment 10,

[0109] wherein the electroanatomical map is an arrhythmia electroanatomical map (55a),

[0110] The method further comprises obtaining a cardiac rhythm electroanatomical map (55r) when the heart (26) is in sinus rhythm, the cardiac rhythm electroanatomical map mapping the portion of the heart in the coordinate system, and

[0111] The output shown includes:

[0112] identifying, in response to identifying the anatomical portion (54) in the at least one of the cardiac rhythm images (48r) and based on the signal, a portion (42r) of the cardiac rhythm electroanatomical map corresponding to the particular portion (42a) of the arrhythmia electroanatomical map by representing the anatomical portion (54); and

[0113] The electroanatomical map of the cardiac rhythm is displayed with superimposed markings (44) at the identified portion of the electroanatomical map of the cardiac rhythm.

[0114] Example 13

[0115] The method according to embodiment 10,

[0116] wherein the electroanatomical map is an arrhythmia electroanatomical map (55a),

[0117] wherein the specific portion (42a) is one representative portion of a plurality of representative portions of the arrhythmia electroanatomical map,

[0118] wherein the anatomical part (54) is one of a plurality of anatomical parts respectively represented by the representative parts,

[0119] wherein the sequence (46) is one of one or more sequences,

[0120] wherein the method comprises tracking each of the anatomical parts in a corresponding one of the sequences, and

[0121] The output shown includes:

[0122] constructing a hybrid electroanatomical map wherein an anatomical map representing the portion of the heart during sinus rhythm is annotated to indicate corresponding values ​​of electrical properties at the anatomical portion during the arrhythmia; and

[0123] The hybrid electroanatomical map is displayed.

[0124] Embodiment 14

[0125] A method according to any one of Examples 10 to 13, wherein the anatomical portion (54) includes a focus of the arrhythmia.

[0126] Embodiment 15

[0127] A method according to any one of Examples 10 to 14, wherein the arrhythmia comprises premature ventricular contractions (PVCs).

[0128] Example 16

[0129] A method according to any one of embodiments 10 to 15, wherein the arrhythmia image is acquired before the cardiac rhythm image.

[0130] Embodiment 17

[0131] A method according to any one of embodiments 10 to 15, wherein the arrhythmia image is acquired after the cardiac rhythm image.

[0132] Embodiment 18

[0133] The method according to any one of Examples 10 to 17 further includes receiving input from a user indicating the specific portion of the electroanatomical map.

[0134] Embodiment 19

[0135] A computer software product comprising a tangible, non-transitory computer-readable medium having program instructions stored therein. When read by a processor (39, 41), the instructions cause the processor to obtain an electroanatomical map (55a) that maps a portion of a heart (26) of a subject (28) when the heart is experiencing an arrhythmia. The instructions also cause the processor to obtain a sequence (46) of images (48) of the heart acquired by an ultrasound probe (21), the sequence comprising one or more arrhythmia images (48a) acquired when the heart is experiencing the arrhythmia and one or more rhythm images (48r) acquired when the heart is in sinus rhythm, the ultrasound probe comprising a sensor (52) that outputs a signal indicating the position and orientation of the probe in a coordinate system of the electroanatomical map during acquisition of the sequence of images. The instructions also cause the processor to identify, based on the signal, in one of the arrhythmia images, an anatomical portion (54) represented by a particular portion (42a) of the electroanatomical map. The instructions also cause the processor to track the anatomical portion in the sequence of images so as to identify the anatomical portion in at least one of the cardiac rhythm images, and to display an output in response to identifying the anatomical portion in the at least one of the cardiac rhythm images.

[0136] Embodiment 20

[0137] The computer software product according to embodiment 19,

[0138] wherein the electroanatomical map is an arrhythmia electroanatomical map,

[0139] wherein the instructions further cause the processor to obtain a cardiac rhythm electroanatomical map when the heart is in sinus rhythm, the cardiac rhythm electroanatomical map mapping the portion of the heart in the coordinate system, and

[0140] The instructions cause the processor to display the output by:

[0141] identifying, in response to identifying the anatomical portion in the at least one of the cardiac rhythm images and based on the signal, a portion of the cardiac rhythm electroanatomical map corresponding to the portion of the arrhythmia electroanatomical map by representing the anatomical portion, and

[0142] The electro-anatomical map of the cardiac rhythm is displayed with superimposed markings at the identified portion of the electro-anatomical map of the cardiac rhythm.

[0143] It should be understood by those skilled in the art that the present disclosure is not limited to the contents specifically shown and described above. On the contrary, the scope of the present disclosure includes the combinations and sub-combinations of the various features described above, as well as variations and modifications that are not within the scope of the prior art that may occur to those skilled in the art when reading the above description. The documents incorporated by reference into this patent application are considered an integral part of this application, unless any term defined in these incorporated documents conflicts with the definition explicitly or implicitly given in this specification, then only the definition in this specification shall be considered.

Claims

1. A system comprising: monitor; and One or more processors configured to cooperatively implement a process comprising: obtaining an electroanatomical map that maps a portion of the subject's heart while the heart is experiencing an arrhythmia, obtaining a sequence of images of the heart acquired by an ultrasound probe, the sequence comprising one or more arrhythmia images acquired while the heart is experiencing the arrhythmia and one or more rhythm images acquired while the heart is in sinus rhythm, The ultrasound probe comprises a sensor that outputs a signal indicative of the position and orientation of the probe in a coordinate system of the electroanatomical map during acquisition of the sequence of images, identifying, based on the signal, in one of the arrhythmia images, an anatomical portion represented by a particular portion of the electroanatomical map, identifying the anatomical portion in at least one of the cardiac rhythm images by tracking the anatomical portion in the sequence of images, and In response to identifying the anatomical portion in the at least one of the cardiac rhythm images, an output is displayed on the display.

2. The system according to claim 1, wherein: The output includes the at least one of the heart rhythm images with a superimposed marking of the anatomical portion.

3. The system according to claim 1, in, The electroanatomical map is an arrhythmia electroanatomical map, The process further comprises obtaining a cardiac rhythm electroanatomical map when the heart is in sinus rhythm, wherein the cardiac rhythm electroanatomical map maps the portion of the heart in the coordinate system, and Wherein, displaying the output includes: identifying, in response to identifying the anatomical portion in the at least one of the cardiac rhythm images and based on the signal, a portion of the cardiac rhythm electroanatomical map corresponding to the particular portion of the arrhythmia electroanatomical map by representing the anatomical portion, and The electro-anatomical map of the cardiac rhythm is displayed with superimposed markings at the identified portion of the electro-anatomical map of the cardiac rhythm.

4. The system according to claim 1, in, The electroanatomical map is an arrhythmia electroanatomical map, wherein the specific portion is a representative portion of a plurality of representative portions of the arrhythmia electroanatomical map, wherein the anatomical part is one of a plurality of anatomical parts respectively represented by the representative parts, wherein the sequence is one of one or more sequences, wherein the process includes tracking each of the anatomical parts in a corresponding one of the sequences, and Wherein, displaying the output includes: constructing a hybrid electroanatomical map wherein an anatomical map representing the portion of the heart during sinus rhythm is annotated to indicate corresponding values ​​of electrical properties at the anatomical portion during the arrhythmia, and The hybrid electroanatomical map is displayed.

5. The system according to claim 1, wherein: The anatomical portion includes a focus of the arrhythmia.

6. The system according to claim 1, wherein: The arrhythmias include premature ventricular contractions (PVCs).

7. The system according to claim 1, wherein: The arrhythmia image is acquired before the cardiac rhythm image.

8. The system according to claim 1, wherein: The arrhythmia image is acquired after the cardiac rhythm image.

9. The system according to claim 1, wherein: The process also includes receiving input from a user indicating the particular portion of the electroanatomical map.

10. A method comprising: obtaining an electroanatomical map that maps a portion of a subject's heart while the heart is experiencing an arrhythmia; obtaining a sequence of images of the heart acquired by an ultrasound probe, the sequence comprising one or more arrhythmia images acquired while the heart is experiencing the arrhythmia and one or more rhythm images acquired while the heart is in sinus rhythm, The ultrasound probe includes a sensor that outputs a signal indicative of the position and orientation of the probe in a coordinate system of the electroanatomical map during acquisition of the sequence of images; identifying, based on the signal, in one of the arrhythmia images, an anatomical portion represented by a particular portion of the electroanatomical map; identifying the anatomical portion in at least one of the cardiac rhythm images by tracking the anatomical portion in the sequence of images; and displaying an output in response to identifying the anatomical portion in the at least one of the cardiac rhythm images.

11. The method according to claim 10, wherein: The output includes the at least one of the heart rhythm images with a superimposed marking of the anatomical portion.

12. The method according to claim 10, in, The electroanatomical map is an arrhythmia electroanatomical map, The method further comprises obtaining a cardiac rhythm electroanatomical map when the heart is in sinus rhythm, wherein the cardiac rhythm electroanatomical map maps the portion of the heart in the coordinate system, and Wherein, displaying the output includes: identifying, in response to identifying the anatomical portion in the at least one of the cardiac rhythm images and based on the signal, a portion of the cardiac rhythm electroanatomical map corresponding to the particular portion of the arrhythmia electroanatomical map by representing the anatomical portion; and The electro-anatomical map of the cardiac rhythm is displayed with superimposed markings at the identified portion of the electro-anatomical map of the cardiac rhythm.

13. The method according to claim 10, in, The electroanatomical map is an arrhythmia electroanatomical map, wherein the specific portion is a representative portion of a plurality of representative portions of the arrhythmia electroanatomical map, wherein the anatomical part is one of a plurality of anatomical parts respectively represented by the representative parts, wherein the sequence is one of one or more sequences, wherein the method comprises tracking each of the anatomical parts in a corresponding one of the sequences, and Wherein, displaying the output includes: constructing a hybrid electroanatomical map wherein an anatomical map representing the portion of the heart during sinus rhythm is annotated to indicate corresponding values ​​of electrical properties at the anatomical portion during the arrhythmia; and The hybrid electroanatomical map is displayed.

14. The method according to claim 10, wherein: The anatomical portion includes a focus of the arrhythmia.

15. The method according to claim 10, wherein: The arrhythmias include premature ventricular contractions (PVCs).

16. The method according to claim 10, wherein: The arrhythmia image is acquired before the cardiac rhythm image.

17. The method according to claim 10, wherein: The arrhythmia image is acquired after the cardiac rhythm image.

18. The method of claim 10, further comprising receiving input from a user indicating the particular portion of the electroanatomical map.

19. A computer software product comprising a tangible, non-transitory computer-readable medium having program instructions stored therein, the instructions, when read by a processor, causing the processor to: obtaining an electroanatomical map that maps a portion of the subject's heart while the heart is experiencing an arrhythmia, obtaining a sequence of images of the heart acquired by an ultrasound probe, the sequence comprising one or more arrhythmia images acquired while the heart is experiencing the arrhythmia and one or more rhythm images acquired while the heart is in sinus rhythm, The ultrasound probe comprises a sensor that outputs a signal indicative of the position and orientation of the probe in a coordinate system of the electroanatomical map during acquisition of the sequence of images, identifying, based on the signal, in one of the arrhythmia images, an anatomical portion represented by a particular portion of the electroanatomical map, identifying the anatomical portion in at least one of the cardiac rhythm images by tracking the anatomical portion in the sequence of images, and An output is displayed in response to identifying the anatomical portion in the at least one of the cardiac rhythm images.

20. The computer software product according to claim 19, in, The electroanatomical map is an arrhythmia electroanatomical map, The instructions further cause the processor to obtain a cardiac rhythm electroanatomical map when the heart is in sinus rhythm, the cardiac rhythm electroanatomical map mapping the portion of the heart in the coordinate system, and The instructions cause the processor to display the output by: identifying, in response to identifying the anatomical portion in the at least one of the cardiac rhythm images and based on the signal, a portion of the cardiac rhythm electroanatomical map corresponding to the portion of the arrhythmia electroanatomical map by representing the anatomical portion, and The electro-anatomical map of the cardiac rhythm is displayed with superimposed markings at the identified portion of the electro-anatomical map of the cardiac rhythm.

Images