Method and system for assisting user in guiding catheter during cardiac surgery

Abstract

The present disclosure relates to a method, apparatus and computer program product, the method comprising: obtaining electrical information from a plurality of electrodes disposed on a distal end assembly of a catheter within a heart of a patient while the catheter is manipulated within the heart; dynamically identifying a portion of the 5 distal end assembly displaced from a tissue wall of the heart based on the electrical information received from the plurality of electrodes; generating a visual representation of the distal end assembly; dynamically deforming the visual representation by twisting the identified portion of the distal end assembly; and presenting the dynamically deformed visual representation to a display device.

Description

Technical Field

[0001] This disclosure relates in general to medical applications, and more specifically to a user interface for guiding a user to navigate a catheter. Background Technology

[0002] Catheters can be used to diagnose and / or treat a variety of heart conditions. The type of catheter can be selected based on the task at hand, such as a diagnostic catheter, an ablation catheter, or another type of catheter.

[0003] For example, arrhythmias can be caused by problems with the heart's electrical conduction system, particularly by electrical activity at one or more points or regions on the walls of the heart chambers. Atrial fibrillation is a type of arrhythmia characterized by disordered signals that cause the atria (left and / or right atria) to squeeze very rapidly and be in an asynchronous rhythm.

[0004] A common treatment for atrial fibrillation (also known as A-fib) is ablation. Ablation uses energy to create a scar on one or more active areas of the heart wall to block the erroneous electrical signals that contribute to the disorder and restore a normal heartbeat. An electroanatomical model of the heart chambers can be easily created, and the position of the catheter within the modeled chamber can also be tracked. Additionally or alternatively, fluorescence fluoroscopy can be used to determine the current position of the catheter, allowing ablation to be applied where it is most effective. Attached Figure Description

[0005] This disclosure will be more fully understood through the following detailed description of embodiments thereof, taken in conjunction with the accompanying drawings, in which:

[0006] Figure 1 This is a schematic diagram of a catheter-based electrophysiological (EP) mapping and ablation system according to some exemplary embodiments of this disclosure;

[0007] Figure 2 This is a schematic diagram of an example distal head assembly of a catheter according to some exemplary embodiments of the present disclosure;

[0008] Figure 3 This is an illustration of an example virtual representation of the distal end assembly of a catheter displayed to a user when the distal end assembly is positioned at a first location within the heart, according to some exemplary embodiments of this disclosure;

[0009] Figure 4A This is an illustration of an example virtual representation of the distal end assembly of a balloon catheter according to some exemplary embodiments of the present disclosure;

[0010] Figure 4B This is an illustration of an example virtual representation of the distal end assembly of a balloon catheter displayed to a user when the distal end assembly is positioned at a second location within the heart, according to some exemplary embodiments of this disclosure;

[0011] Figure 5 This is a flowchart of the steps in a method for guiding a user's navigation catheter during cardiac surgery, according to some embodiments of this disclosure; and

[0012] Figure 6 This is a schematic block diagram of a computing platform for guiding a user's navigation catheter during cardiac surgery, according to some exemplary embodiments of this disclosure. Detailed Implementation

[0013] In the following description, numerous specific details are set forth in order to provide a thorough understanding of the invention. However, it will be apparent to those skilled in the art that the invention may be practiced without these specific details. In other instances, details of well-known circuits, control logic components, and computer program instructions for conventional algorithms and processes have not been shown in detail so as not to unnecessarily obscure the invention.

[0014] Software programming code embodying aspects of the invention is typically stored in a permanent storage device such as a computer-readable medium. In a client-server environment, such software programming code may be stored on a client or a server. This software programming code may be contained in any of a variety of known media used with a data processing system. This includes, but is not limited to, magnetic and optical storage devices such as disk drives, magnetic tapes, optical discs (CDs), digital video discs (DVDs), and computer instruction signals contained in a transmission medium having or not having a carrier wave of a modulated signal. For example, the transmission medium may include a communication network such as the Internet. Furthermore, while the invention may be embodied in computer software, the functionality required to implement the invention may alternatively be embodied, in part or entirely, using hardware components such as application-specific integrated circuits (ASICs) or other hardware, or some combination of hardware components and software.

[0015] Overview

[0016] When using catheters for diagnostic procedures and / or ablation treatments, physicians must skillfully manipulate the distal end assembly of the catheter within the heart chambers to map the chambers and / or reach locations of interest, such as the pulmonary veins (PV). Care must be taken to avoid excessive pressure on the tissue walls.

[0017] Before or without mapping, physicians may lack visual guidance on where to manipulate catheters. Traditionally, fluoroscopy is used to provide real-time imaging and tracking of the target's movement in the form of video of the heart and its movement within it. Fluoroscopy allows X-rays to pass through the body over a period of time, and naturally, the longer the procedure, the higher the radiation dose required. It should be understood that fluoroscopy poses risks not only to patients but also to staff, including physicians.

[0018] Therefore, it is advantageous to guide a physician to a location of interest within a cardiac chamber without or with significantly reduced use of fluoroscopy or other methods involving radiation or hazardous substances. Accordingly, embodiments of this disclosure provide a system and method for assisting a physician in navigating a catheter and / or navigating to a location of interest within a cardiac chamber, such as a location designated for treatment, like a passage from the atrium to the PV.

[0019] In some examples, the distal end assembly of a catheter (e.g., a diagnostic and / or therapeutic catheter) may have an inflatable configuration in the form of a balloon or basket comprising multiple splined segments. The distal end assembly may include multiple electrodes distributed in a 3D configuration; for example, each spline of a basket-type catheter may carry one or more electrodes.

[0020] The electrodes can be connected to a circuit configured to track impedance near each of the multiple electrodes in real time as the physician navigates the catheter. Optionally, the tissue proximity index (TPI) of each of the multiple electrodes can be tracked based on impedance measurements. When navigating the catheter within the chamber, for example, and entering the PV, it is desirable that the distal end assembly not presses against the heart wall with excessive force, but rather advances along the direction of the internal space of the chamber (hereinafter also referred to as the cavity).

[0021] According to this disclosure, in the absence of sufficient anatomical information (e.g., a model, mapping, or image of the chamber, and the position of the distal end assembly relative to the anatomical structure of the chamber), a virtual representation of the distal end assembly can be displayed to a user via a display device. The visual representation can be visually manipulated in a manner that indicates the direction in which the catheter can be guided, to avoid the dome effect of the distal end assembly of the catheter pushing against the heart wall and to advance away from the wall into the cavity. For example, the representation may include deformation of the distal end assembly to indicate orientation.

[0022] In some examples, the distal end assembly may be shown schematically as deformed. For instance, in a basket catheter, the representation may show the same number of splines as included in the distal end assembly of the catheter, with one or more splines twisted, elongated, enlarged, or “pulled” in the direction in which the distal end assembly should move. For balloon catheters, their overall shape may be “flattened,” for example, by deflation or narrowing in one or more areas. Thus, the representation can “guide” the user in possible directions and away from the cardiac wall navigation catheter. Cardiac mapping may or may not be shown along with the distal end assembly shown therein.

[0023] In some implementations, when the mapping points are collected by the distal end assembly, an estimated profile of the wall can be drawn.

[0024] Therefore, the distal end assembly is shown in an optional, unrealistic manner, as it is schematically drawn and deformed, for example, one or more splines are twisted, which of course would not happen on actual splines. However, this unrealistic approach suggests to the user how to guide the conduit to the desired location.

[0025] In some examples, deformation can be performed only when the catheter is in motion, and avoided when the catheter is stationary. Therefore, the user can receive guidance while moving the catheter, but it is displayed in a more realistic manner when it reaches the desired location or otherwise stops.

[0026] In some examples, the transformation can be performed based on the user's preferences or settings, allowing the user to turn the feature on and off according to their preferences (which can be changed during operation). System Description

[0027] refer to Figure 1 This figure illustrates an example catheter-based electrophysiological mapping and ablation system 10. System 10 includes multiple catheters that can be inserted by a physician 24 through the skin across the vascular system of a patient 23 into the chambers or vascular structures of the heart 12. Typically, a delivery sheath catheter is inserted into the left or right atrium near a desired location within the heart 12. One or more catheters can then be inserted into the delivery sheath catheter to reach the desired location within the heart 12. The multiple catheters may include catheters specifically for sensing intracardiac electrogram (IEGM) signals, catheters specifically for ablation, and / or catheters specifically for both sensing and ablation. An example catheter 14 is illustrated herein. The physician 24 can place the distal end assembly 28 of catheter 14 within a blood pool or in contact with the heart wall to sense different regions within the heart 12. For example, for ablation, the physician 24 can position the distal tip of the ablation catheter to contact the target site to ablate tissue.

[0028] The term distal tip can be used interchangeably with the term distal end assembly.

[0029] The distal end assembly 28 of catheter 14 may include a plurality of electrodes 26 optionally distributed on a plurality of spline 22, the spline being configured to sense IEGM signals and / or apply ablation energy at a location. Catheter 14 may additionally include a position sensor 29 embedded in or near the distal end assembly 28 for tracking the position and orientation of the distal end assembly 28. Optionally and preferably, the position sensor 29 is a magneto-based position sensor comprising three magnetic coils for sensing three-dimensional (3D) position and orientation.

[0030] The magnetic-based position sensor 29 operates in conjunction with a positioning pad 25, which includes a plurality of magnetic coils 32 configured to generate a magnetic field in a predetermined workspace. The real-time position of the distal end assembly 28 of the conduit 14 can be tracked based on the magnetic field generated by the positioning pad 25 and sensed by the magnetic-based position sensor 29. Details of the 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] Additionally or alternatively, system 10 may include one or more electrode patches 38 positioned to contact 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 to 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 positioning and 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 can record and display electrograms 21 captured using surface ECG electrodes 18 and IEGM captured using electrodes 26 of catheter 14. Recorder 11 may include pacing capability for pacing rhythms and / or may be electrically connected to a separate pacemaker.

[0033] System 10 may include an ablation energy generator 50 adapted to conduct ablation energy to one or more electrodes at the distal end assembly of a catheter configured for ablation. The energy generated by the ablation energy generator 50 may include, but is not limited to, radio frequency (RF) energy or pulsed field ablation (PFA) energy (including monopolar or bipolar high-voltage DC pulses that can be used to achieve irreversible electroporation (IRE)) or combinations thereof.

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

[0035] Workstation 55 includes a memory, a processor unit having a memory or storage device in which appropriate operating software is stored, and user interface capabilities. Workstation 55 may provide a variety of functions, optionally including modeling the current position and orientation of the catheter or its distal end assembly, determining the absolute or relative distance of each electrode to tissue, calculating deformations of one or more portions of the distal end assembly, and, where applicable and if the user desires, displaying a schematic diagram 20 of the catheter or its distal end assembly, including deformations, on display device 27. In some embodiments, the outline of tissue such as the heart wall may also be displayed, as estimated by the distance from the electrodes. A commercial product embodying the elements of system 10 could be CARTO. TM The system was purchased from Biosense Webster, Inc., 31A Technology Drive, Irvine, CA 92618.

[0036] Now for reference Figure 2 The diagram illustrates a specific distal end assembly 28 according to some exemplary embodiments of the present disclosure. The distal end assembly 28 includes 10 splines, such as splines 204, 208, 212, 216, 220, and 224 (all similar to...). Figure 1 The spline 22), each spline carrying several electrodes 26. It should be understood that the catheter 14 and the distal end assembly 28 are merely exemplary, and this disclosure is equally applicable to other types of catheters.

[0037] Now for reference Figure 3 The illustration 20 shows some exemplary embodiments of the present disclosure that can be presented to a user via display device 27 during operation.

[0038] Currently, accurate mapping of the cardiac region is unavailable without the use of fluorescence fluoroscopy or similar techniques. Instead, estimated mappings can be displayed and obtained, for example, based on prior knowledge, the distance between the electrodes and the walls, the known geometric relationships between the electrodes, and previously applied fluorescence fluoroscopy. Thus, walls 300 and 304 indicate a two-dimensional projection of the estimated shape of the region where the distal end assembly 28 is currently located.

[0039] like Figure 3 As shown, the distal end assembly 28 is closer to the projection wall 300 than to the projection wall 304, and therefore needs to be guided by the physician in the direction of arrow 308, moving it from a narrower area to a wider space. Therefore, it can be twisted, such that the shape of one or more splines, such as splines 204, 208, and 212, is distorted to indicate to the user the direction in which the catheter should be guided, keeping it away from the heart wall and towards a larger space (i.e., the gap). It should be understood that arrow 308 may or may not be part of Figure 20.

[0040] Therefore, spline 204 is twisted to a certain extent in the direction of wall 304, and splines 208, 212 and 220 are twisted to increasingly smaller degrees, so that it appears as if the splines are being “pulled” in the direction in which the distal end assembly 28 is to be guided.

[0041] It should be understood that the actual shape of the distal end component 28 is unchanged and is merely manipulated to guide the user's visualization in the desired direction, lacking an accurate mapping of the heart and the precise location of the distal end component 28 within it.

[0042] It should be understood that this is merely an example, and other representations can be used. For instance, splines can be twisted in the opposite direction to make them appear closer to the wall and should be guided away.

[0043] In another example, one or more arrows may be displayed near the visual representation of the distal end component, whereby, instead of or in addition to distorting the visual representation of the distal end component, the arrows may indicate the desired or possible direction.

[0044] Now for reference Figure 4A and Figure 4B . Figure 4A A balloon catheter distal end assembly 404 is shown according to some exemplary embodiments of the present disclosure. Figure 4B An illustration shows an example virtual representation of the distal end assembly 408 of a balloon catheter that may be shown to a user when passing through a narrow region, according to some exemplary embodiments of the present disclosure. Thus, when passing through a narrow region, the distal end assembly 408 of the balloon catheter is identical to the distal end assembly 404 of the balloon catheter. This region can be surrounded by walls projected as walls 408 and 412. To guide the physician not to press against the walls, the distal end assembly 408 of the balloon catheter is flattened, for example, flattened or narrowed in the middle, thereby indicating that it can move in the vertical direction. Therefore, arrows 420 and 424 are optionally shown to indicate these directions.

[0045] Therefore, by observing the distal end of the distal end assembly, the user can perceive the position and orientation of the distal end assembly relative to the surrounding tissue, thereby perceiving the available direction in which the catheter can be guided, without the need for fluoroscopy.

[0046] It should be understood that this method can be used during certain parts of the procedure, allowing fluoroscopy to be used in a shorter time, thereby reducing radiation exposure and risks to patients and staff. For example, fluoroscopy should only be used when navigation in a smaller area is required, such as when reaching the ablation site.

[0047] Now for reference Figure 5 The diagram illustrates a flowchart of steps in a method for guiding a catheter during cardiac surgery according to some exemplary embodiments of the present disclosure.

[0048] At step 500, electrical information such as impedance or TPI can be obtained from multiple electrodes disposed on the distal end assembly of the catheter. Impedance can be measured based on signal transmission between the electrodes on the distal end assembly or based on signal transmission between an electrode on the distal end assembly and a reference electrode. The reference electrode can be located on the distal end assembly of the catheter axis or on the patient's skin. The catheter can be any basket catheter, balloon catheter, or expandable catheter.

[0049] At step 504, based on electrical information, the portion of the distal end assembly displaced from the tissue wall can be identified. In some examples, the distance between each electrode and the nearest tissue can be determined, and one or more portions can be selected based on that distance. In some examples, the distance can be absolute, such as in mm, micrometers, etc., where the distance of the electrode closest to the tissue wall needs to exceed a predetermined threshold. In other examples, the distance can be relative, for example, the distance between the farthest electrode on the tissue and the nearest location can be 1.7 times the distance between the second farthest electrode and its corresponding nearest location. It should be understood that since some electrodes may be adjacent to each other, the distance can be calculated for a group of electrodes.

[0050] At step 508, a visual representation of the distal end component can be obtained. This representation can be dynamically calculated, obtained from a storage device, previously created and loaded, etc.

[0051] The representation can be three-dimensional, so that although it is projected onto a two-dimensional plane, the representation automatically updates to indicate the projection onto the changing view plane when the user rotates the view.

[0052] The representation can be schematic, for example, in a basket conduit, which can show the correct number of splines, with electrode indicators (such as circles) marked at proportional positions above the splines.

[0053] At step 512, the representation can be deformed, for example, by twisting at least the displaced portion of the distal end assembly. Deformation can refer to elongating or widening the relevant portion. For example, one or more splines of a basket catheter can be twisted, for instance, by being pulled in the direction the catheter should move, whether toward a cavity or toward tissue. Similarly, the shape of a balloon catheter can be flattened, for example, by narrowing or deflating it.

[0054] It should be understood that multiple splines of a basket conduit can be twisted at different angles and to different degrees, such as, for example Figure 3 As shown, spline 204 is twisted more and at a sharper angle than spline 208. The degree and direction of twisting can be determined based on the proximity of the spline direction to the desired direction, the distance from the wall, etc.

[0055] For example, a balloon catheter can be partially or completely flattened to indicate its proximity to the wall.

[0056] At step 516, the representation can be presented to a display device, including projecting three-dimensional information onto a two-dimensional plane.

[0057] In some examples, based on this distance, an available direction for guiding the catheter is determined (e.g., calculated). This direction should be toward the gap and / or the distal end assembly of the catheter, allowing it to advance freely thereafter. In some example implementations, the determined direction may be toward the pulmonary vein orifice. In other cases, such as when the user wants to perform ablation, the direction determined based on the distance may be toward guiding the distal end assembly of the tissue.

[0058] In some examples, the contours of the tissue near the catheter can be estimated based on its distance from the electrode and should also be presented so that the user can have a sense of the catheter's position relative to the wall. In some examples, estimating the tissue contours may also utilize prior knowledge about the structure of the patient's heart, such as information that may have been obtained earlier.

[0059] In some examples, the distorted distal end assembly can be presented on the monitor along with fluorescence examination. The distorted distal end assembly can be used in conjunction with anatomical mapping. Figure 1 It is presented to provide users with guidance on the direction in which the catheter will be guided.

[0060] Users have an option enabled via the user interface: whether to eliminate the distorted representation and continue using fluorescent perspective or other methods, or whether to use the directional indicator. It should be understood that users can enable and disable this option at their discretion.

[0061] In some examples, users can also choose whether to activate the option continuously or only when the conduit is moved.

[0062] In some examples, if the user wishes to use this option, the user can further instruct whether they want the representation of the catheter to be distorted so that it appears to be guided toward a void or toward tissue.

[0063] If an anatomical mapping is available, the distal end assembly can be represented at its precise location on the mapping, such as, for example, from electrode 29.

[0064] In some examples, an audio prompt can be played to warn a physician if the distal end component is estimated to be too close, such as when the distance between the distal end component and the heart wall is below a threshold, or even when the distal end component is pressed against the heart wall.

[0065] It should be understood that this disclosure can also be used for mapping purposes. During mapping, it is necessary to collect location information of points within the chamber and along the tissue wall, while avoiding bulging that may occur when the distal end assembly pushes the tissue wall out. In this case, the collected points will cause the chamber to appear larger than it actually is due to stretching. Therefore, it is important to visually indicate to the user the direction in which the distal end assembly can move without pressing on the tissue wall.

[0066] Now for reference Figure 6 A schematic block diagram of a computing platform 600 for guiding a user's navigation catheter during cardiac surgery is shown, according to some exemplary embodiments of the present disclosure.

[0067] It should be understood that the computing platform 600 may be embedded within the workstation 55, but it may also be a standalone computing platform or embedded elsewhere and communicating operationally with the workstation 55.

[0068] The computing platform 600 can be implemented as one or more computing platforms operatively interconnected. For example, it may be one or more remote computing platforms, such as those implemented on a cloud computer. Other computing platforms may be part of a computer network of an associated organization. In other embodiments, all functionality may be provided by one or more computing platforms that are all part of an organization's network.

[0069] The computing platform 600 may include one or more processors 604, which may be located on or not on the same computing platform. These processors may be one or more central processing units (CPUs), microprocessors, electronic circuits, integrated circuits (ICs), etc. The processors 604 may be configured to provide the required functions, for example, by loading software modules into memory and activating software modules stored on storage device 612, which is described in detail below.

[0070] The computing platform 600 may include a communication device 608 for communicating with other devices or other computing platforms (e.g., obtaining information from a conduit insertion controller, storing data to a remote storage device, and retrieving data from a remote storage device). The communication module 608 may be adapted to interface with any communication channel (such as a local area network (LAN), wide area network (WAN), cellular network, etc.) and use any relevant communication protocol.

[0071] The computing platform 600 may include a storage device 612, such as a hard disk drive, flash drive, random access memory (RAM), memory chip, etc. In some exemplary embodiments, the storage device 612 may hold program code that is operable to cause the processor 604 to execute any of the modules listed below or those described above. Figure 5 The steps of the method are associated with actions. Program code may include one or more executable units, such as functions, libraries, stand-alone programs, etc., suitable for performing instructions described in detail below.

[0072] Alternatively or additionally, the provided instructions may be stored on a non-transitory tangible computer-readable medium, such as magnetic, optical, or electronic memory.

[0073] Storage device 612 may include a display and I / O module 616 for presenting to the user displays to be displayed on display device 27, such as illustrations of the catheter or its distal end assembly, wall outlines, anatomical mappings (if available), etc.

[0074] The display and I / O module 616 is also operable to receive instructions and operating parameters from the user, such as whether to activate the catheter display or switch to using fluoroscopy (or other methods), whether to distort the spline continuously or only when the catheter is moving, and whether to deform the catheter in the direction of the gap or tissue.

[0075] Storage device 612 may include a communication module 620 for transmitting data to and receiving data from other systems (such as ablation systems, external storage devices, etc.). For example, communication module 620 may be operable to receive information from various electrodes, such as impedance, TPI, etc.

[0076] Storage device 612 may include a distance calculation and selection module 624 for calculating the distance between each part of the distal end assembly (such as an electrode, electrode group, one or more splines, etc.) and the nearest point in the tissue. This distance may be absolute or relative. It should be understood that since some electrodes may be adjacent to each other, the distance can be calculated for a group of electrodes (collectively referred to as "electrodes"). Based on the distance, the part of the distal end assembly furthest from the tissue wall can be selected.

[0077] Storage device 612 may include a representation acquisition module 628 for generating a visual representation of the distal end component. This visual representation may be calculated earlier during operation, dynamically calculated, received from the storage device, etc.

[0078] Storage device 612 may include deformation calculation module 632. Deformation calculation module 628 may be configured to determine whether and how at least a portion of the distal end assembly furthest from the tissue wall is deformed, for example, in the case of a basket catheter. Deformation calculation module 632 may determine the degree, direction, and location of twist on one or more splines based on the distance of the electrode from the tissue and the direction of twist. For example, the spline with the electrode furthest from the tissue and closest to the void may be deformed such that it twists toward the void and “pulls” the catheter in that direction. Therefore, it should be understood that two or more splines may be twisted in different ways or to different degrees.

[0079] In some examples, the spline on which the electrode is positioned to contact the tissue may appear flat to indicate that it is pressed against the tissue.

[0080] The calculation module 628 can be further configured to calculate the contour of the wall based on the known spatial relationship between the distance between the electrode and the tissue and the position of the electrode.

[0081] The storage device 612 may include a direction calculation module 636, which is used to determine the direction in which the conduit should be guided.

[0082] The storage device 612 may include a presentation module 640 for presenting a representation of a catheter with deformable portions to a 2D device, and optionally presenting tissue outlines, directional arrows, mappings of heart chambers, etc.

[0083] Storage device 612 may include a data and control flow management module 644, which is used to operate the above-mentioned module as needed, for example, to provide a distorted representation if the user indicates it using a user interface control, or to avoid distorting the duct diagram according to the user's preferences, etc.

[0084] It should be understood that the steps and modules disclosed above are supplementary to the software, hardware, firmware, or other modules required for operating the conduit, etc. Further details of the methods and systems can be found, for example, in US8676305 and US9629567, the entire contents of which are incorporated herein by reference for any purpose.

[0085] This invention can be a system, method, and / or computer program product. A computer program product may include a computer-readable storage medium (or media) having computer-readable program instructions thereon for causing a processor to perform aspects of the invention.

[0086] Computer-readable storage media can be tangible means for retaining and storing instructions for use by an instruction execution device. Computer-readable storage media can be, for example, but not limited to, electronic storage devices, magnetic storage devices, optical storage devices, electromagnetic storage devices, semiconductor storage devices, or any suitable combination of the foregoing. A less complete list of more specific examples of computer-readable storage media includes: portable computer disks, hard disks, random access memory (RAM), read-only memory (ROM), erasable programmable read-only memory (EPROM or flash memory), static random access memory (SRAM), portable compact disc read-only memory (CD-ROM), digital multifunction disc (DVD), memory sticks, floppy disks, mechanically encoded devices such as punched cards or raised structures in recesses with instructions recorded thereon, and any suitable combination of the foregoing. As used herein, computer-readable storage media should not be construed as transient signals themselves, such as radio waves or other freely propagating electromagnetic waves, electromagnetic waves propagating through waveguides or other transmission media (e.g., light pulses passing through fiber optic cables), or electrical signals transmitted through wires.

[0087] The computer-readable program instructions described herein can be downloaded from a computer-readable storage medium to a corresponding computing / processing device, or downloaded via a network (e.g., the Internet, a local area network, a wide area network, and / or a wireless network) to an external computer or external storage device. The network may include copper transmission cables, fiber optic cables, wireless transmissions, routers, firewalls, switches, gateway computers, and / or edge servers. A network adapter card or network interface in each computing / processing device receives the computer-readable program instructions from the network and forwards them to a computer-readable storage medium within the corresponding computing / processing device.

[0088] Computer-readable program instructions used to perform the operations of this invention may be assembly instructions, instruction set architecture instructions, machine instructions, machine-dependent instructions, microcode, firmware instructions, state setting data, or source code or object code written in any combination of one or more programming languages ​​(such as Java, C, C++, Python, etc.). The computer-readable program instructions may execute entirely on the user's computer, partially on the user's computer, as a standalone software package, partially on the user's computer and partially on a remote computer, or entirely on a remote computer or server. In the latter case, the remote computer may be connected to the user's computer via any type of network (including a local area network (LAN) or a wide area network (WAN)) or may be connected to an external computer (e.g., via the Internet provided by an Internet service provider). In some embodiments, to perform aspects of this invention, electronic circuits, including, for example, programmable logic circuits, field-programmable gate arrays (FPGAs), or programmable logic arrays (PLAs), may execute the computer-readable program instructions to personalize the electronic circuits by utilizing state information from the computer-readable program instructions.

[0089] This document describes aspects of the invention with reference to flowchart illustrations and / or block diagrams of methods, apparatus (systems), and computer program products according to embodiments of the invention. It should be understood that each block in the flowchart illustrations and / or block diagrams, and combinations of blocks in the flowchart illustrations and / or block diagrams, can be implemented by computer-readable program instructions.

[0090] These computer-readable program instructions may be provided to the processor of a general-purpose computer, a special-purpose computer, or other programmable data processing apparatus to produce a machine, such that the instructions, which execute via the processor of the computer or other programmable data processing apparatus, create a mechanism for implementing flowcharts and / or blocks. Figure 1 Tools specifying functions / actions in one or more boxes. These computer-readable program instructions may also be stored in a computer-readable storage medium that can direct a computer, programmable data processing device, and / or other means to operate in a particular manner, such that the computer-readable storage medium having the instructions stored therein includes implementation flowcharts and / or boxes. Figure 1 An artifact of instructions specifying aspects of a function / action in one or more boxes.

[0091] Computer-readable program instructions may also be loaded onto a computer, other programmable data processing apparatus, or other device to cause a series of operational steps to be performed on the computer, other programmable apparatus, or other device to produce a computer-implemented process, and to implement the instructions as a flowchart and / or block diagram. Figure 1 The function / action specified in one or more boxes.

[0092] The flowcharts and block diagrams in the accompanying drawings illustrate the architecture, functionality, and operation of possible specific implementations of systems, methods, and computer program products according to various embodiments of the invention. In this regard, each block in a flowchart or block diagram may represent a module, segment, or portion of instructions comprising one or more executable instructions for implementing a specified logical function. In some alternative implementations, the functions indicated in the blocks may not occur in the order shown in the drawings. For example, depending on the function involved, two consecutively shown blocks may actually be executed substantially simultaneously, or the blocks may sometimes be executed in reverse order. It should also be noted that each block in the block diagrams and / or flowcharts, and combinations of blocks in the block diagrams and / or flowcharts, may be implemented by a system based on dedicated hardware that performs the specified function or action, or by a combination of dedicated hardware and computer instructions.

[0093] Example

[0094] Example 1

[0095] One method includes:

[0096] When the catheter is manipulated inside the patient's heart, electrical information is obtained from multiple electrodes on the distal end assembly of the catheter located inside the heart;

[0097] Based on the electrical information received from the plurality of electrodes, the portion of the distal end assembly that has shifted from the tissue wall of the heart is dynamically identified;

[0098] Generate a visual representation of the distal end component;

[0099] The visual representation is dynamically deformed by distorting the identified portion of the distal end assembly; and

[0100] The dynamically deformed visual representation is presented to the display device.

[0101] Example 2

[0102] According to the method of Example 1, the portion is identified as displaced from the tissue wall within at least a predetermined threshold.

[0103] Example 3

[0104] According to the method of Embodiment 1, the portion is identified as being displaced further from the tissue wall than other portions of the distal end assembly.

[0105] Example 4

[0106] According to the method described in Example 1, the representation is calculated in three dimensions.

[0107] Example 5

[0108] According to the method described in Example 1, the electrical information is impedance.

[0109] Example 6

[0110] According to the method of Embodiment 1, the catheter is a basket catheter, the basket catheter includes a plurality of splines, the electrode is disposed on the plurality of splines, and wherein deforming the representation includes twisting at least one of the plurality of splines.

[0111] Example 7

[0112] According to the method of Embodiment 1, the catheter is a balloon catheter, and the deformation of the representation includes deflating or narrowing at least a portion of the balloon catheter.

[0113] Example 8

[0114] According to the method of Embodiment 1, the deformation of the representation is performed while the catheter moves within the heart.

[0115] Example 9

[0116] According to the method of Example 1, the visualization of the distal end assembly is presented without deformation during the ablation of the patient's tissue.

[0117] Example 10

[0118] According to the method described in Embodiment 1, the deformation of the representation depends on the user's selection.

[0119] Example 11

[0120] The method according to Embodiment 1 further includes tracking the position and orientation of the distal end assembly.

[0121] Example 12

[0122] The method according to Embodiment 1 further includes generating a mapping map of the heart chamber based on the position of the distal end assembly within the heart chamber, wherein the visualization of the deformed distal end assembly is presented on the mapping map at the current position of the distal end assembly.

[0123] Example 13

[0124] According to the method described in Example 12, the tracking is performed using magnetic position tracking.

[0125] Example 14

[0126] The method according to Embodiment 1 further includes determining the direction in which the catheter will be guided and presenting a visual indication of the direction in the vicinity of the visual representation of the distal end assembly.

[0127] Example 15

[0128] The method according to Embodiment 1 further includes presenting an estimated profile of the tissue wall near the distal end assembly.

[0129] Example 16

[0130] According to the method described in Example 15, the contour is estimated based on the distance of each electrode from the tissue wall.

[0131] Example 17

[0132] A computerized device having a processor coupled to a memory cell, the processor being adapted to perform the following steps:

[0133] When the catheter is manipulated inside the patient's heart, electrical information is obtained from multiple electrodes on the distal end assembly of the catheter located inside the heart;

[0134] Based on the electrical information received from the plurality of electrodes, the portion of the distal end assembly that has shifted from the tissue wall of the heart is dynamically identified;

[0135] Generate a visual representation of the distal end component;

[0136] The visual representation is dynamically deformed by distorting the identified portion of the distal end assembly; and

[0137] The dynamically deformed visual representation is presented to the display device.

[0138] Example 18

[0139] According to the computerized device of Embodiment 17, the conduit is a basket conduit comprising a plurality of splines, the electrode being disposed on the plurality of splines, and wherein causing the representation deformation comprises twisting at least one of the plurality of splines.

[0140] Example 19

[0141] According to the computerized device of embodiment 17, the catheter is a balloon catheter, and the deformation of the representation includes deflating or narrowing at least a portion of the balloon catheter.

[0142] Example 20

[0143] A computer program product includes a non-transitory computer-readable medium storing program instructions that, when read by a processor, cause the processor to execute:

[0144] When the catheter is manipulated inside the patient's heart, electrical information is obtained from multiple electrodes on the distal end assembly of the catheter located inside the heart;

[0145] Based on the electrical information received from the plurality of electrodes, the portion of the distal end assembly that has shifted from the tissue wall of the heart is dynamically identified;

[0146] Generate a visual representation of the distal end component;

[0147] The visual representation is dynamically deformed by distorting the identified portion of the distal end assembly; and

[0148] The dynamically deformed visual representation is presented to the display device.

[0149] Although the embodiments described herein are primarily for cardiac diagnostic applications, the methods and systems described herein can also be used in other medical applications.

[0150] It should be understood that the above embodiments are cited by way of example, and this disclosure is not limited to the content specifically shown and described above. Rather, the scope of this disclosure includes combinations and sub-combinations of the various features described above, as well as variations and modifications thereof, which should be apparent 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: When the catheter is manipulated inside the patient's heart, electrical information is obtained from multiple electrodes on the distal end assembly of the catheter located inside the heart; Based on the electrical information received from the plurality of electrodes, the portion of the distal end assembly that has shifted from the tissue wall of the heart is dynamically identified; Generate a visual representation of the distal end component; The visual representation is dynamically deformed by twisting the identified portion of the distal end assembly; as well as The dynamically deformed visual representation is presented to the display device.

2. The method according to claim 1, wherein, The portion is identified as having shifted from the tissue wall within at least a predetermined threshold.

3. The method according to claim 1, wherein, The portion was identified as being displaced further from the tissue wall than other portions of the distal end assembly.

4. The method according to claim 1, wherein, The representation is calculated in three dimensions.

5. The method according to claim 1, wherein, The electrical information is impedance.

6. The method according to claim 1, wherein, The catheter is a basket catheter, which includes a plurality of splines, the electrode is disposed on the plurality of splines, and wherein causing the representation deformation includes twisting at least one of the plurality of splines.

7. The method according to claim 1, wherein, The catheter is a balloon catheter, and the deformation of the representation includes deflating or narrowing at least a portion of the balloon catheter.

8. The method according to claim 1, wherein, The deformation of the representation is performed while the catheter moves within the heart.

9. The method according to claim 1, wherein, During the ablation of the patient's tissue, the visualization of the distal end assembly was presented without deformation.

10. The method according to claim 1, wherein, The deformation of the representation depends on the user's selection.

11. The method of claim 1, further comprising tracking the position and orientation of the distal end assembly.

12. The method of claim 1, further comprising generating a mapping map of the heart chamber based on the position of the distal end assembly within the heart chamber, wherein visualization of the deformed distal end assembly is presented on the mapping map at the current position of the distal end assembly.

13. The method according to claim 12, wherein, The tracking is performed using magnetic position tracking.

14. The method of claim 1, further comprising determining the direction in which the catheter will be guided, and presenting a visual indication of the direction in the vicinity of the visual representation of the distal end assembly.

15. The method of claim 1, further comprising presenting an estimated profile of the tissue wall near the distal end assembly.

16. The method according to claim 15, wherein, The profile is estimated based on the distance of each electrode from the tissue wall.

17. A computerized device having a processor coupled to a memory cell, the processor being adapted to perform the following steps: When the catheter is manipulated inside the patient's heart, electrical information is obtained from multiple electrodes on the distal end assembly of the catheter located inside the heart; Based on the electrical information received from the plurality of electrodes, the portion of the distal end assembly that has shifted from the tissue wall of the heart is dynamically identified; Generate a visual representation of the distal end component; The visual representation is dynamically deformed by twisting the identified portion of the distal end assembly; as well as The dynamically deformed visual representation is presented to the display device.

18. The device according to claim 17, wherein, The catheter is a basket catheter, which includes a plurality of splines, the electrode is disposed on the plurality of splines, and wherein causing the representation deformation includes twisting at least one of the plurality of splines.

19. The device according to claim 17, wherein, The catheter is a balloon catheter, and the deformation of the representation includes deflating or narrowing at least a portion of the balloon catheter.

20. A computer program product comprising a non-transitory computer-readable storage medium storing program instructions configured to cause a processor to perform actions, the program instructions implementing: When the catheter is manipulated inside the patient's heart, electrical information is obtained from multiple electrodes on the distal end assembly of the catheter located inside the heart; Based on the electrical information received from the plurality of electrodes, the portion of the distal end assembly that has shifted from the tissue wall of the heart is dynamically identified; Generate a visual representation of the distal end component; dynamically deform the visual representation by distorting the identified portion of the distal end component; as well as The dynamically deformed visual representation is presented to the display device.

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