Ablation tag according to graphic coding of region of anatomical structure

Abstract

The invention discloses an ablation tag encoded according to a graph of a region of an anatomical structure. A method includes receiving at least one of locations of a plurality of ablation sites and coordinates of one or more anatomical regions on a surface of a heart. At least one of the ablation site and the region is classified according to a predefined category. At least one of a site and an anatomical region is graphically encoded on an anatomical map according to a category of each of the site and the anatomical region. The graphically encoded anatomical map is displayed to a user.

Description

Technical Field

[0001] The present disclosure relates generally to analysis of electroanatomical (EA) maps, and particularly to a system and method for performing ablation site marking, including on an EA map. Background Art

[0002] The analysis of ablation points located on the inner wall of a cardiac chamber has been previously proposed in the patent literature. For example, U.S. Patent 8,900,225 describes a method for performing a medical procedure that includes contacting a probe with an organ within a patient's body. A map of the organ is displayed and the position of the probe relative to the map is tracked. Treatment is applied via the probe at a plurality of tissue sites within the organ contacted by the probe. While the treatment is being applied, the stability of contact between the probe and the tissue sites is assessed. In response to the assessed stability, the map is automatically marked to indicate the tissue sites to which the treatment is to be applied.

[0003] As another example, U.S. Patent No. 9,757,182 describes a method comprising receiving locations of a plurality of ablation sites formed on a surface of a heart. Based on the locations, distances between at least some of the ablation sites are measured. One or more gaps between the ablation sites that meet a warning criterion are identified. The identified gaps are indicated to an operator.

[0004] 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: BRIEF DESCRIPTION OF THE DRAWINGS

[0005] Figure 1 is a schematic illustration of a catheter-based electroanatomical (EA) mapping and ablation system according to an example of the present disclosure;

[0006] Figure 2A is an EA map superimposed with ablation sites graphically coded according to anatomical regions according to an example of the present disclosure, and Figure 2B is an EA map superimposed with ablation sites graphically coded according to the type of ablation source according to an example of the present disclosure;

[0007] Figure 3 is a schematic diagram of an example graphical user interface (GUI) for classifying and graphically encoding EA maps according to anatomical regions and user-specified categories according to the present disclosure;

[0008] Figure 4A is an EA map superimposed with ablation sites and anatomical regions graphically coded according to anatomical regions according to an example of the present disclosure, and Figure 4Bis an EA map superimposed with ablation sites and anatomical regions graphically encoded according to a user's focus, according to an example of the present disclosure; and

[0009] Figure 5 is a flow chart schematically illustrating a method of graphically encoding ablation sites and regions on an EA map according to an example of the present disclosure. DETAILED DESCRIPTION

[0010] Overview

[0011] In a typical medical ablation procedure, such as pulmonary vein isolation (PVI) for the treatment of atrial fibrillation, a physician ablates tissue in a specific anatomical region (e.g., the ostium of a PV). To verify that the region has been successfully isolated in PVI, the physician looks for conductive gaps in the ablation line caused by improperly ablated tissue. In other techniques, this is accomplished by visually identifying gaps between visual ablation markers, which indicate the locations of tissue where energy has been delivered.

[0012] When ablations are performed at multiple locations and / or with multi-electrode catheters, numerous ablation labels are generated, which can create visual clutter and make it difficult for the physician to distinguish visual ablation labels from different anatomical regions, making it more difficult to identify ablation gaps.

[0013] Furthermore, due to the 3D visualization of the anatomical structure represented on the 2D display, the ablation labels displayed in the background may be visually confused with the labels of the ablation region currently focused on by the physician.

[0014] Some examples of the present disclosure described herein provide techniques including algorithms and a graphical user interface (GUI) that allow a user to classify (e.g., set) anatomical regions, associate ablation visual labels to those regions, and graphically encode each region using different graphics (e.g., colors).

[0015] In some examples, the disclosed technology allows a user to quickly and easily classify visual ablation labels into various categories, for example via a GUI, that can represent different cardiac anatomical regions (e.g., zones), such as the left superior pulmonary vein (LSPV), the right superior pulmonary vein (RIPV), and the isthmus of the tricuspid valve (CTI).

[0016] In other examples, the disclosed techniques allow for the assignment of visual ablation labels prospectively or retrospectively according to category (eg, according to anatomical region or ablation stage).

[0017] o Prospectively means, for example, that before starting to ablate a region (e.g., LSPV), the user sets the current label region. All further ablation visual labels created will then be associated with that region and graphically encoded (e.g., colored) accordingly,

[0018] Until the user sets another label area.

[0019] o Retrospectively means that the user can select and assign visual labels and / or ablation sessions to previously created ablation regions.

[0020] In an example, the disclosed technology provides a system (eg, an EA mapping and ablation system) having a GUI that includes a list of predefined regions and associated shortcut keys for setting ablation visual labels to user-definable regions.

[0021] In another example, the disclosed technology allows a user to apply different graphical encodings (e.g., coloring) to ablation visual labels originating from any ablation energy type, such as, but not limited to, radiofrequency (RF) or pulsed field (PF). The technology also allows a user to graphically encode (e.g., colorize) ablation visual labels originating from different ablation catheters, such as tip catheters, balloon catheters, and basket catheters.

[0022] Selecting ablation visual labels can be accomplished in the 3D map viewer through GUI tools, such as a "brush" tool, which allows the user to click or drag the mouse cursor to select ablation labels directly from the map view.

[0023] The disclosed technology may enable a processor to apply / unapply (using GUI controls or shortcut keys) a "Color by Region" color display on an existing ablation visual label without losing existing information about the label's original attributes or original color.

[0024] The disclosed technology allows a user to focus on a specific area. For example, a physician can select a current region of interest for ablation by selecting (e.g., highlighting) one or more regions. Once one or more regions are highlighted, all other ablation visual labels become semi-transparent or completely transparent, allowing the user to focus visual attention only on the ablation labels within the desired region.

[0025] In yet another example, the disclosed technology allows a processor to provide ablation result statistics within a graphically encoded region. Such statistics may include details on the total net ablation time and total ablation time within the encoded region, as well as the minimum and maximum distances between ablation labels within the region. Providing such statistics by region may be beneficial for study reports, which currently must be calculated manually.

[0026] System Description

[0027] Figure 1 is a schematic illustration of a catheter-based electroanatomical (EA) mapping and ablation system 10 according to an example of the present disclosure.

[0028] The system 10 includes a plurality of catheters that are inserted percutaneously by a physician 24 through the patient's vascular system into a chamber or vascular structure of the heart 12 (see illustration 45). Typically, a delivery sheath catheter is inserted into a cardiac chamber (such as the left atrium or right atrium) near a desired location in the heart 12. Multiple catheters can then be inserted into the delivery sheath catheter to reach the desired location. The multiple catheters may include catheters dedicated to pacing, catheters for sensing intracardiac electrogram signals, catheters dedicated to ablation, and / or catheters dedicated to both EA mapping and ablation. The example catheter 14 shown herein is configured for sensing bipolar electrograms. The physician 24 brings the distal end 28 of the catheter 14 (hereinafter also referred to as the distal end assembly 28) into contact with the heart wall for sensing a target site in the heart 12. For ablation, the physician 24 similarly brings the distal end of the ablation catheter to the target site.

[0029] As shown in inset 65, the catheter 14 is an example catheter that includes a basket-shaped distal end 28, which includes one, preferably a plurality of electrodes 26, which are optionally distributed on a plurality of splines 22 at the distal tip 28 and are configured to sense IEGM signals. The catheter 14 may further include a position sensor 29 embedded in or near the distal tip 28 on the shaft 46 of the catheter 14 to track the position and orientation of the distal tip 28. Optionally and preferably, the position sensor 29 is a magnetic-based position sensor that includes three magnetic coils for sensing three-dimensional (3D) position and orientation. As shown, the distal tip 28 also includes an expansion / collapse rod 42 of the expandable assembly 28, which is mechanically connected to the basket assembly 28 at the distal edge 41 of the assembly 28.

[0030] The magnetic-based position sensor 29 can operate in conjunction with the positioning mat 25, which includes a plurality of magnetic coils 32 configured to generate a magnetic field in a predefined working space. The real-time position of the distal tip 28 of the catheter 14 can be tracked based on the magnetic field generated by the positioning mat 25 and sensed by the magnetic-based position sensor 29. Details of magnetic-based position sensing technology are described in U.S. Patents 5,5391,199, 5,443,489, 5,558,091, 6,172,499, 6,239,724, 6,332,089, 6,484,118, 6,618,612, 6,690,963, 6,788,967, and 6,892,091.

[0031] System 10 includes one or more electrode patches 38 positioned in contact with the skin of patient 23 to establish a position reference for impedance-based tracking of positioning pad 25 and electrodes 26. For impedance-based tracking, current is directed toward electrodes 26 and sensed at electrode skin patches 38, allowing the position of each electrode to be triangulated via electrode patches 38. Details of impedance-based position tracking techniques are described in U.S. Patents 7,536,218, 7,756,576, 7,848,787, 7,869,865, and 8,456,182.

[0032] Recorder 11 displays cardiac signals 21 acquired using surface ECG electrodes 18 (e.g., electrograms acquired at separately tracked cardiac tissue locations) and intracardiac electrograms acquired using electrodes 26 of catheter 14. Recorder 11 may include pacing capabilities for pacing the cardiac rhythm and / or may be electrically connected to a standalone pacemaker.

[0033] The system 10 may include an ablation energy generator 50 adapted to conduct ablation energy to one or more electrodes at the distal tip of a catheter configured for ablation. The energy generated by the ablation energy generator 50 may include, but is not limited to, radiofrequency (RF) energy or pulsed field ablation (PFA) energy (including monopolar or bipolar high voltage DC pulses to achieve irreversible electroporation (IRE)), or a combination thereof.

[0034] The patient interface unit (PIU) 30 is an interface configured to establish electrical communication between the catheter, electrophysiology equipment, power supply, and workstation 55 to control the operation of the system 10 and receive EA signals from the catheter. The electrophysiology equipment of the system 10 may include, for example, multiple catheters, positioning pads 25, surface ECG electrodes 18, electrode patches 38, ablation energy generator 50, and recorder 11. Optionally and preferably, the PIU 30 further includes processing capabilities for enabling real-time calculation of catheter position and for performing ECG calculations.

[0035] The workstation 55 includes a memory 57, a processor 56 unit with memory or storage loaded with appropriate operating software, and user interface capabilities. The workstation 55 can provide multiple functions, optionally including: (i) three-dimensional (3D) modeling of the endocardial anatomy and rendering the model or anatomical map 20 for display on the display device 27; (ii) displaying on the display device 27 an activation sequence (or other data) compiled from the recorded cardiac signals 21 as representative visual markers or images superimposed on the rendered anatomical map 20; (iii) displaying the real-time position and orientation of multiple catheters within the cardiac chambers; and (iv) displaying on the display device 27 sites of interest (such as where ablation energy has been applied). A commercial product embodying elements of the system 10 can be CARTO TM 3System was purchased from Biosense Webster, Inc., 31 A Technology Drive, Irvine, CA 92618.

[0036] In the disclosed example, the processor 56 runs an algorithm that allows the physician 24 to set anatomical regions, associate ablation visual labels to these regions, and graphically encode (e.g., colorize) each region with a different graphic (e.g., color). In some examples, the disclosed technology allows the user to quickly and easily classify ablation visual labels into various categories that can represent different cardiac anatomical regions (e.g., zones), such as shown in Figures 2 to 4, for example, via the GUI 111.

[0037] In some examples, processor 56 typically comprises a general-purpose computer that is programmed in 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.

[0038] This configuration of system 10 is shown by way of example in order to illustrate certain problems solved by the examples of the present disclosure and to demonstrate the application of these examples in enhancing the performance of such systems. However, the examples of the present disclosure are by no means limited to this particular class of example systems, and the principles described herein may be similarly applied to other classes of medical systems. For example, other multipolar catheter types, such as OCTARAY, may be used. TM catheter or flat catheter.

[0039] Graphical encoding of ablation sites according to category

[0040] As described above, the disclosed technology allows for graphical coding of ablation sites on an EA map according to their respective categories. The graphical coding can be done manually using a GUI or automatically using a coding algorithm.

[0041] Figure 2A is an EA map 202 superimposed with ablation sites graphically coded (204, 206, 208, 210) according to an example of the present disclosure, and Figure 2B 2 is an EA map 222 superimposed with ablation sites graphically coded ( 224 , 226 ) according to the type of ablation source, according to an example of the present disclosure.

[0042] Figure 2A Four PV ostium regions (214, 216, 218, 220) of the left atrium that require PVI to isolate arrhythmias are shown. As shown, some regions form contiguous regions. The disclosed pattern coding technique allows physicians to more easily identify conduction gaps in the ablation line that affect specific ostia.

[0043] Figure 2B Allows the physician to distinguish between ablation tags belonging to RF ablations (224) and ablation tags belonging to PF ablations (226). Based on the graphically encoded information, the physician can estimate the results of the ablations and, if necessary, apply corrections at specific areas. Figure 2B In the pulmonary artery, these areas are divided into the right and left pulmonary vein ostia.

[0044] Because RF and PF have different effects on tissue, including side effects (e.g., potential damage to the esophagus), different areas may be best treated with specific ablation methods. The disclosed graphical coding can improve physician decision-making, thereby improving the safety and effectiveness of medical procedures.

[0045] Figure 3 1 is a schematic diagram of an example graphical user interface (GUI) 111 for classifying and graphically encoding EA maps according to anatomical regions and user-specified categories according to the present disclosure. The example GUI 111 includes a Sites and Regions tab 304. The illustrated GUI is for the left atrium and includes a list 308 of left atrial regions. The GUI 111 also includes a list 306 of user-defined regions. In the GUI 111, graphical encoding of ablation sites and regions is performed by assigning different colors to the ablation sites and regions.

[0046] Figure 4A is an EA map 402 superimposed with ablation sites (404, 406, 408, 410) graphically coded according to anatomical regions (eg, PV ostium) according to an example of the present disclosure, and Figure 4B 4 is an EA map 444 superimposed with ablation sites graphically coded ( 446 , 448 ) according to a user's focus point, according to an example of the present disclosure.

[0047] Figure 4A Graphical coding in improves the physician's awareness of both the anatomical region and the planned and / or previously performed ablations. Figure 4A In FIG. 4 , the physician graphically encodes anatomical regions and ablation visual labels ( 404 , 406 , 408 , 410 ) associated with these regions by coloring the sites in each region and coloring the ablation sites with different graphics (eg, colors).

[0048] Figure 4B The graphical coding in allows the physician to focus on the current region of interest for ablation and select (e.g., highlight) one or more regions to focus on. All other ablation visual labels 446 for other regions then become semi-transparent or completely transparent. Thus, the user will be able to focus visual attention only on the ablation labels 448 within the desired region.

[0049] Method for graphically encoding ablation sites according to categories

[0050] Figure 5 is a flow chart schematically illustrating a method for graphically encoding ablation sites and regions on an EA map according to an example of the present disclosure. According to the presented example, the algorithm performs the following process, which begins at ablation workflow step 502, using the system 10 to plan or perform ablation at multiple sites belonging to different regions of an organ, such as the left atrium.

[0051] Next, at an ablation data receiving step 504, the system's processor or another processor (eg, a processor of a workstation) receives coordinates of ablation sites and / or regions.

[0052] At a coloring step 506 , the processor graphically encodes the ablation sites on the EA map according to predefined criteria, as selected by the user using the GUI 111 .

[0053] Finally, at a presentation step 508, the processor presents the resulting EA map to the user with the graphically encoded (eg, colored) ablation sites superimposed, for example, as shown in FIG. Figure 4A As seen in.

[0054] Figure 5 The flowchart shown is chosen solely for conceptual clarity. Other examples of the technology may include different algorithmic steps, such as generating Figure 2A 、 Figure 2B and Figure 4BThe algorithm steps of the encoding are seen in .

[0055] Example

[0056] Example 1

[0057] A method includes receiving (30) at least one of the locations of a plurality of ablation sites on a surface of a heart (12) and the coordinates of one or more anatomical regions (214, 216, 218, 220). At least one of the ablation sites and the regions is classified (304, 306, 308) according to a predefined category. At least one of the sites and the anatomical regions is graphically encoded (204, 206, 208, 210, 224, 226, 404, 406, 408, 410, 446, 448) on an anatomical map (202, 222, 402, 444) according to its respective category. The graphically encoded anatomical map (202, 222, 402, 444) is displayed (27) to a user.

[0058] Example 2

[0059] The method of embodiment 1, wherein receiving (30) the locations of the plurality of ablation sites comprises receiving at least one of the planned and formed ablation sites.

[0060] Example 3

[0061] The method of any one of embodiments 1 and 2, wherein the category (304, 306, 308) includes at least one of an anatomical region (214, 216, 218, 220), a type of ablation source (224, 226), and a type of ablation catheter.

[0062] Example 4

[0063] The method of any one of embodiments 1 to 3, wherein the graphics encoding (204, 206, 208, 210, 224, 226, 404, 406, 408, 410, 446, 448) includes at least one of shading and texturing.

[0064] Example 5

[0065] The method of any one of embodiments 1 to 3, wherein graphically encoding the site (204, 206, 208, 210, 224, 226, 404, 406, 408, 410, 446, 448) comprises labeling the site.

[0066] Example 6

[0067] The method of any one of embodiments 1 to 3, wherein the graphical encoding (204, 206, 208, 210, 224, 226, 404, 406, 408, 410, 446, 448) comprises using a graphical user interface (GUI) (111).

[0068] Example 7

[0069] The method of any one of embodiments 1 to 6, wherein encoding the pattern (204, 206, 208, 210, 224, 226, 404, 406, 408, 410, 446, 448) comprises using an automatic algorithm.

[0070] Example 8

[0071] The method of any one of embodiments 1 to 7, wherein the graphical encoding (204, 206, 208, 210, 224, 226, 404, 406, 408, 410, 446, 448) comprises changing the visibility of at least one of the encoded sites and regions between opaque, semi-transparent, and fully transparent.

[0072] Example 9

[0073] The method according to any one of embodiments 1 to 8, wherein the anatomical map (202, 222, 402, 444) is an electroanatomical (EA) map.

[0074] Example 10

[0075] The method according to any one of embodiments 1 to 9, and comprising providing statistics of ablation results within at least one of the graphically encoded (204, 206, 208, 210) regions (214, 216, 218, 220).

[0076] Example 11

[0077] A system (10) includes an interface (30) and a processor (56). The interface (30) is configured to receive at least one of the locations of a plurality of ablation sites on a surface of a heart (12) and the coordinates of one or more anatomical regions (214, 216, 218, 220). The processor (56) is configured to (i) classify (304, 306, 308) at least one of the ablation sites and the regions according to a predefined category, (ii) graphically encode (204, 206, 208, 210, 224, 226, 404, 406, 408, 410, 446, 448) at least one of the sites and the anatomical regions on an anatomical map (202, 222, 402, 444) according to their respective categories, and (iii) display the graphically encoded anatomical map (202, 222, 402, 444) to a user.

[0078] Although the examples described herein are primarily directed to cardiac diagnostic applications, the methods and systems described herein can also be used in other medical applications.

[0079] It should be understood that the above examples are cited by way of example only, and the present disclosure is not limited to what has been specifically shown and described above. On the contrary, the scope of the present disclosure 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 method comprising: receiving at least one of locations of a plurality of ablation sites on a surface of the heart and coordinates of one or more anatomical regions; classifying the at least one of the ablation site and the region according to a predefined category; graphically encoding the at least one of the site and the anatomical region on the anatomical map according to their respective categories; as well as The graphically encoded anatomical map is displayed to the user.

2. The method according to claim 1, wherein: Receiving the locations of the plurality of ablation sites includes receiving at least one of the planned and formed ablation sites.

3. The method according to claim 1, wherein: The category includes at least one of an anatomical region, a type of ablation source, and a type of ablation catheter.

4. The method according to claim 1, wherein: Graphics encoding includes at least one of shading and texturing.

5. The method according to claim 1, wherein: Graphically encoding the sites includes labeling the sites.

6. The method according to claim 1, wherein: Graphical coding involves the use of a graphical user interface (GUI).

7. The method according to claim 1, wherein: Graphics coding involves the use of automatic algorithms.

8. The method according to claim 1, wherein: Graphical encoding includes changing the visibility of at least one of the encoded sites and areas between opaque, semi-transparent and fully transparent.

9. The method according to claim 1, wherein: The anatomical map is an electroanatomical (EA) map.

10. The method of claim 1, and comprising providing statistics of ablation results within at least one of the graphically encoded regions.

11. A system comprising: an interface configured to receive at least one of locations of a plurality of ablation sites on a surface of the heart and coordinates of one or more anatomical regions; and A processor, the processor being configured to: classifying the at least one of the ablation site and the region according to a predefined category; graphically encoding the at least one of the site and the anatomical region on the anatomical map according to their respective categories; as well as The graphically encoded anatomical map is displayed to the user.

12. The system according to claim 11, wherein: The processor is configured to receive the locations of the plurality of ablation sites by receiving at least one of the planned and formed ablation sites.

13. The system according to claim 11, wherein: The category includes at least one of an anatomical region, a type of ablation source, and a type of ablation catheter.

14. The system according to claim 11, wherein: The processor is configured to perform graphics encoding by at least one of shading and texturing.

15. The system according to claim 11, wherein: The processor is configured to graphically encode the locations by marking the locations.

16. The system according to claim 11, wherein: The processor is configured to perform graphics encoding using a graphical user interface (GUI).

17. The system of claim 11, wherein: The processor is configured to use an automated algorithm for graphics encoding.

18. The system of claim 11, wherein: The processor is configured to perform graphic encoding by changing the visibility of at least one of the encoded sites and regions between opaque, semi-transparent and fully transparent.

19. The system of claim 11, wherein: The anatomical map is an EA map.

20. The system of claim 11, the processor further configured to provide statistics of ablation results within at least one of the graphically encoded regions.

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