Graphically encoded ablation tags according to anatomical regions

Abstract

To execute tagging of ablation sites, including on EA maps.SOLUTION: A method includes receiving at least one of locations of multiple ablation sites and coordinates of one or more anatomical regions over a surface of a heart. The at least one of ablation sites and ablation regions is categorized according to predefined categories. The at least one of sites and anatomical regions is graphically encoded on an anatomical map according to their respective categories. The graphically encoded anatomical map is displayed to a user.SELECTED DRAWING: Figure 1

Description

[Technical field]

[0001] The present disclosure relates generally to the analysis of electroanatomical (EA) maps, and more particularly to systems and methods for performing ablation site tagging including EA maps. [Background technology]

[0002] The analysis of ablation points located on the inner wall of a cardiac ventricle has already been proposed in the patent literature. For example, US Patent No. 8,900,225 describes a method of performing a medical procedure that includes contacting a probe with an organ inside a patient's body. A map of the organ is displayed and the position of the probe relative to the map is tracked. Therapy is applied via the probe at multiple tissue sites in the organ that are in contact with the probe. While applying the therapy, the stability of the contact between the probe and the tissue sites is evaluated. In response to the evaluated stability, the map is automatically marked to indicate the tissue sites to which the therapy has been applied.

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

[0004] A more complete understanding of the present disclosure will be obtained from the following detailed description of the embodiments of the present disclosure when read in conjunction with the drawings. [Brief description of the drawings]

[0005] [Figure 1] FIG. 1 is a schematic, pictorial illustration of a catheter-based electroanatomical (EA) mapping and ablation system, according to one embodiment of the present disclosure. [Figure 2A]1 is an EA map visually coded according to anatomical region and overlaid with ablation sites visually coded according to type of ablation source, according to one embodiment of the present disclosure. [Figure 2B] 1 is an EA map visually coded according to anatomical region and overlaid with ablation sites visually coded according to type of ablation source, according to one embodiment of the present disclosure. [Diagram 3] FIG. 1 is a schematic diagram of a graphical user interface (GUI) used to classify and visually encode EA maps according to anatomical regions and user-specified categories, according to one embodiment of the present disclosure. [Figure 4A] 1 is an EA map overlaid with ablation sites and anatomical regions visually coded according to anatomical region and according to user points of interest, according to one embodiment of the present disclosure. [Figure 4B] 1 is an EA map overlaid with ablation sites and anatomical regions visually coded according to anatomical region and according to user points of interest, according to one embodiment of the present disclosure. [Diagram 5] 1 is a flow chart that generally illustrates a method for visually encoding ablation sites and ablation regions on an EA map, according to one embodiment of the present disclosure. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0006] overview In a typical medical ablation procedure, such as pulmonary vein isolation (PVI) to treat atrial fibrillation, a physician ablates tissue within a specific anatomical region (e.g., the ostium of the PV). To verify that a region was successfully isolated with PVI, the physician looks for conduction gaps in the ablation line caused by tissue that was not properly ablated. This is done by visually identifying gaps between visual ablation tags, which indicate tissue locations where energy was delivered, among other techniques.

[0007] When ablating at multiple locations and / or with a multi-electrode catheter, many ablation tags are created, which creates visual clutter that makes it difficult for the physician to distinguish between visual ablation tags in different anatomical regions, making ablation gaps more difficult to identify.

[0008] Furthermore, due to the 3D visualization of anatomical structures depicted on a 2D display, ablation tags displayed in the background may be visually confused with tags of the area currently of interest to the physician for ablation.

[0009] Some embodiments of the disclosure described herein provide techniques including algorithms and graphical user interfaces (GUIs) that allow a user to classify (e.g., define) anatomical regions, associate ablation visual tags with these regions, and visually encode each region with distinct graphics (e.g., color).

[0010] In some examples, the disclosed techniques enable a user to quickly and easily classify visual ablation tags, for example, via a GUI, into various categories that may represent different cardiac anatomical regions (e.g., areas), such as the left superior pulmonary vein (LSPV), right superior pulmonary vein (RIPV), and cavotricuspid isthmus (CTI).

[0011] In other embodiments, the disclosed techniques allow for the assignment of visual ablation tags according to categories (eg, according to anatomical region or ablation stage), either prospectively or retrospectively. o Prospectively means, for example, that the user sets a current tag region before beginning ablation of a region (e.g., LSPV). Then, all further ablation visual tags created are associated with that region and visually coded (e.g., colored) accordingly, until the user sets another tag region. o Retrospectively means that the user can select and assign visual tags and / or ablation sessions to previously created ablation regions.

[0012] In one embodiment, the disclosed technique provides a system (e.g., an EA mapping and ablation system) having a GUI that includes a list of predefined regions and associated shortcut keys for setting ablation visual tags on the regions that can be defined by the user.

[0013] In another example, the disclosed techniques allow a user to apply different visual encodings (e.g., colors) to ablation visual tags delivered from any ablation energy type, such as, but not limited to, radiofrequency (RF) or pulsed field (PF). The techniques also allow a user to visually encode (e.g., color) ablation visual tags delivered from different ablation catheters, such as tip catheters, balloon catheters, and basket catheters.

[0014] Selection of ablation visual tags can be done within the 3D map viewer by GUI tools such as a "brush" tool that allows the user to click or drag the mouse cursor to select ablation tags directly from the map view.

[0015] The disclosed techniques allow the processor to apply / de-apply (using GUI controls or shortcut keys) a "color by area" color display on existing ablation visual tags without losing existing information about the tag's original characteristics or original color.

[0016] The disclosed techniques allow a user to focus on a particular region. For example, a physician may 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 tags become semi-transparent or fully transparent, thereby allowing the user to focus visual attention only on the ablation tags in the desired region.

[0017] In yet another embodiment, the disclosed techniques enable a processor to provide ablation result statistics within a visually encoded region. Such statistics may include details regarding total net and total ablation times within the encoded region, as well as minimum and maximum distances between ablation tags within the region. Having such statistics available per region may be beneficial for research reports that currently must be calculated manually.

[0018] System Description FIG. 1 is a schematic, pictorial illustration of a catheter-based electroanatomical (EA) mapping and ablation system 10, according to one embodiment of the present disclosure.

[0019] The system 10 includes multiple catheters that are percutaneously inserted by the physician 24 through the patient's vascular system into the cavities or vasculature of the heart 12 (see inset 45). Typically, a delivery sheath catheter is inserted into a ventricle, such as into the left or right atrium, near the desired location of the heart 12. The multiple catheters can then be inserted into the delivery sheath catheter to reach the desired location. The multiple catheters can 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 exemplary catheter 14 shown herein is configured to sense bipolar electrograms. The physician 24 brings a distal tip 28 (hereinafter also referred to as "distal end assembly 28") of the catheter 14 into contact with the heart wall to sense the target site of the heart 12. For ablation, the physician 24 similarly brings the distal end of an ablation catheter to the target site.

[0020] As seen in inset 65, catheter 14 is an exemplary catheter including a basket-like distal end 28 including one, preferably multiple electrodes 26, optionally distributed across multiple splines 22 at distal tip 28, and configured to sense IEGM signals. Catheter 14 may further include a position sensor 29 embedded in or near distal tip 28 on shaft 46 of catheter 14 to track the position and orientation of distal tip 28. Optionally and preferably, position sensor 29 is a magnetic-based position sensor including three magnetic coils for sensing three-dimensional (3D) position and orientation. As seen, distal tip 28 further includes an expand / collapse rod 42 of expandable assembly 28, which is mechanically connected to basket assembly 28 at distal edge 41 of assembly 28.

[0021] The magnetic-based position sensor 29 may operate in conjunction with a location pad 25 that includes a plurality of magnetic coils 32 configured to generate a magnetic field within a predetermined working volume. The real-time position of the distal tip 28 of the catheter 14 may be tracked based on the magnetic fields generated by the location pad 25 and sensed by the magnetic-based position sensor 29. Details of magnetic-based position sensing technology are described in U.S. Patent Nos. 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.

[0022] The system 10 includes one or more electrode patches 38 positioned for skin contact on the patient 23 to establish a positional reference for the location pads 25 and impedance-based tracking of the electrodes 26. For impedance-based tracking, a current is directed to the electrodes 26 and sensed at the electrode skin patch 38, so that the location of each electrode can be triangulated via the electrode patch 38. Details of impedance-based position tracking technology are described in U.S. Patent Nos. 7,536,218, 7,756,576, 7,848,787, 7,869,865, and 8,456,182.

[0023] Recorder 11 displays cardiac signals 21 (e.g., electrograms acquired at each tracked cardiac tissue location) acquired using body surface ECG electrodes 18, and intracardiac electrograms acquired using electrodes 26 of catheter 14. Recorder 11 may include pacing capability for pacing the cardiac rhythm and / or may be electrically connected to a stand-alone pacer.

[0024] The system 10 may include an ablation energy generator 50 adapted to deliver 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, radio frequency (RF) energy or pulsed-field ablation (PFA) energy, including monopolar or bipolar high voltage direct current pulses used to produce irreversible electroporation (IRE), or combinations thereof.

[0025] The patient interface unit (PIU) 30 is an interface configured to establish electrical communication between the catheters, electrophysiology equipment, power source, and workstation 55 to control the operation of system 10 and to receive EA signals from the catheters. The electrophysiology equipment of system 10 may include, for example, multiple catheters, location pads 25, body surface ECG electrodes 18, electrode patches 38, ablation energy generator 50, and recorder 11. Optionally and preferably, the PIU 30 additionally includes processing capabilities to perform real-time calculations of catheter position and execute ECG calculations.

[0026] The workstation 55 includes a processor 56 unit having a memory 57, a memory or storage device loaded with suitable operating software, and a user interface function. The workstation 55 may optionally provide multiple functions including (i) modeling the endocardial anatomical structures in three dimensions (3D) and rendering a model or anatomical map 20 for display on the display device 27, (ii) displaying activation sequences (or other data) compiled from the recorded cardiac signals 21 in a representative visual display or image superimposed on the rendered anatomical map 20 on the display device 27, (iii) displaying real-time positions and orientations of multiple catheters within the cardiac chambers, and (iv) displaying sites of interest, such as locations where ablation energy is applied, on the display device 27. One commercially available product embodying elements of the system 10 is available as the CARTO™ 3 system, available from Biosense Webster, Inc., 31A Technology Drive, Irvine, Calif., 92618.

[0027] In disclosed embodiments, processor 56 executes algorithms that allow physician 24 to define anatomical regions, associate ablation visual tags with those regions, and visually code (e.g., color) each region with a distinct graphic (e.g., color). In some embodiments, the disclosed techniques allow a user, for example, via GUI 111, to quickly and easily categorize ablation visual tags into various categories that can represent different cardiac anatomical regions (e.g., areas), as shown in Figures 2-4.

[0028] In some embodiments, processor 56 typically comprises a general-purpose computer that is programmed with software to perform the functions described herein. The software may be downloaded to the computer in electronic form, for example over a network, or alternatively or additionally may be provided and / or stored on a non-transitory, tangible medium, such as magnetic, optical, or electronic memory.

[0029] This configuration of system 10 is provided as an example to illustrate the particular problem addressed by the embodiments of the present disclosure and to demonstrate the application of these embodiments in improving the performance of such systems. However, the embodiments of the present disclosure are in no way limited to this particular type of exemplary system, and the principles described herein may be applied to other types of medical systems as well. For example, other multi-electrode catheter types may be used, such as OCTARAY™ catheters or flat catheters.

[0030] Visual coding of ablation sites by category As mentioned above, the disclosed technique allows for visual coding of ablation sites on the EA map according to their respective categories. The visual coding can be done manually by using a GUI or automatically by using a coding algorithm.

[0031] 2A and 2B are EA maps 202 and 222, respectively, overlaid with ablation sites visually coded according to anatomical region (204, 206, 208, 210) and according to type of ablation source (224, 226), in accordance with an embodiment of the present disclosure.

[0032] FIG. 2A shows four PV ostial regions (214, 216, 218, 220) in the left atrium that require PVI to isolate the arrhythmia. As can be seen, some regions form contiguous regions. The disclosed visual coding technique allows the physician to more easily identify conduction gaps in the ablation line that affect a particular ostium.

[0033] Figure 2B allows the physician to distinguish ablation tags belonging to RF ablations (224) from those belonging to PF ablations (226). Based on the visually encoded information, the physician can estimate the ablation results and, if necessary, apply corrections to specific regions. In Figure 2B, these regions are divided into left and right PV ostia.

[0034] Because RF and PF have different effects on tissue, including side effects (such as potential damage to the esophagus), different regions may be optimally treated with specific ablation methods. The disclosed visual coding can improve decision-making by physicians, thereby improving the safety and effectiveness of medical procedures.

[0035] 3 is a schematic diagram of a graphical user interface (GUI) 111 used to classify and visually encode EA maps according to anatomical regions and user-specified categories, according to one embodiment of the present disclosure. The exemplary GUI 111 includes a site tab 304 and a region tab 304. The illustrated GUI is for the left atrium and includes a list of left atrial regions 308. The GUI 111 further includes a list of user-defined regions 306. In the GUI 111, visual encoding of the ablation sites and ablation regions is performed by assigning them different colorings.

[0036] 4A and 4B are, respectively, an EA map 402 overlaid with ablation sites (404, 406, 408, 410) visually coded according to anatomical region (e.g., PV ostium) and (4B) is an EA map 444 overlaid with ablation sites (446, 448) visually coded according to user points of interest, in accordance with one embodiment of the present disclosure.

[0037] The visual encoding of Figure 4A enhances the physician's awareness of both anatomical regions and planned and / or previously performed ablations. In Figure 4A, the physician has visually encoded the anatomical regions and their associated ablation visual tags (404, 406, 408, 410) by coloring the sites within each region with distinct graphics (e.g., colors), as well as by coloring the ablation sites.

[0038] 4B allows the physician to focus on a current region of interest for ablation and select (e.g., highlight) one or more regions on which to focus. All other ablation visual tags 446 in other regions then change to semi-transparent or fully transparent. Thus, the user can focus visual attention only on the ablation tags 448 in the desired region.

[0039] A method for visually encoding ablation sites by category 5 is a flow chart that illustrates a schematic of a method for visually encoding ablation sites and ablation regions on an EA map, according to one embodiment of the present disclosure. The algorithm performs a process that, according to the presented embodiment, starts in an ablation workflow step 502 with planning an ablation using the system 10 or performing an ablation at multiple sites belonging to different regions of an organ, such as the left atrium.

[0040] The system's processor or another processor (eg, in a workstation) then receives the coordinates of the ablation site and / or ablation region in an ablation data receiving step 504 .

[0041] In a coloring step 506, the processor visually codes the ablation sites on the EA map according to predefined criteria, as selected by the user using the GUI 111.

[0042] Finally, in a presentation step 508, the processor presents the resulting EA map to the user, overlaid with visually encoded (e.g., colored) ablation sites, for example as seen in FIG. 4A.

[0043] The flow chart shown in Figure 5 has been chosen solely for the purposes of conceptual clarity. Other examples of the present technique may include different algorithmic steps, such as those that result in the encodings seen in Figures 2A, 2B, and 4B. EXAMPLES

[0044] Example 1 The method includes receiving (30) at least one of a plurality of ablation site locations and coordinates of one or more anatomical regions (214, 216, 218, 220) on a surface of the heart (12). Classifying (304, 306, 308) at least one of the ablation sites and ablation regions according to a predefined category. Visually encoding (204, 206, 208, 210, 224, 226, 404, 406, 408, 410, 446, 448) at least one of the sites and anatomical regions on an anatomical map (202, 222, 402, 444) according to its respective category. Displaying (27) the visually encoded anatomical map (202, 222, 402, 444) to a user.

[0045] Example 2 2. The method of example 1, wherein receiving (30) the locations of the plurality of ablation sites includes receiving at least one of planned ablation sites and created ablation sites.

[0046] Example 3 The method of any of Examples 1 and 2, wherein the categories (304, 306, 308) include at least one of an anatomical region (214, 216, 218, 220), a type of ablation source (224, 226), and a type of ablation catheter.

[0047] Example 4 4. The method of any of the preceding claims, wherein the visual encoding (204, 206, 208, 210, 224, 226, 404, 406, 408, 410, 446, 448) comprises at least one of coloring and texturing.

[0048] Example 5 The method of any of Examples 1-3, wherein visually encoding (204, 206, 208, 210, 224, 226, 404, 406, 408, 410, 446, 448) the site comprises tagging the site.

[0049] Example 6 4. The method of any of the preceding claims, wherein the visual encoding (204, 206, 208, 210, 224, 226, 404, 406, 408, 410, 446, 448) comprises using a graphical user interface (GUI) (111).

[0050] Example 7 7. The method of any of Examples 1-6, wherein the visual encoding (204, 206, 208, 210, 224, 226, 404, 406, 408, 410, 446, 448) comprises using an automated algorithm.

[0051] Example 8 The method of any of Examples 1-7, wherein the visual encoding (204, 206, 208, 210, 224, 226, 404, 406, 408, 410, 446, 448) comprises varying the visibility of at least one of the encoded sites and regions between opaque, semi-transparent, and fully transparent.

[0052] Example 9 The method according to any of the preceding claims, wherein the anatomical map (202, 222, 402, 444) is an electroanatomical (EA) map.

[0053] Example 10 10. The method of any of Examples 1-9, comprising providing statistics of ablation results within at least one of the visual coding (204, 206, 208, 210) regions (214, 216, 218, 220).

[0054] Example 11 The system (10) includes an interface (30) and a processor (56). The interface (30) is configured to receive at least one of a plurality of ablation site locations and coordinates of one or more anatomical regions (214, 216, 218, 220) on a surface of the heart (12). The processor (56) is configured to (i) classify (304, 306, 308) at least one of the ablation sites and regions according to predefined categories, (ii) visually encode (204, 206, 208, 210, 224, 226, 404, 406, 408, 410, 446, 448) at least one of the sites and anatomical regions on an anatomical map (202, 222, 402, 444) according to the respective category, and (iii) display the visually encoded anatomical map (202, 222, 402, 444) to a user.

[0055] Although the embodiments described herein primarily address cardiac diagnostic applications, the methods and systems described herein may also be used in other medical applications.

[0056] It will be understood that the embodiments described above are given by way of example, and that the present disclosure is not limited to what has been particularly shown and described hereinabove. Rather, the scope of the present disclosure includes both combinations and subcombinations of the various features described hereinabove, as well as variations and modifications thereof not disclosed in the prior art that would occur to one skilled in the art upon reading the foregoing description.

[0057] [Embodiment] (1) receiving at least one of a plurality of ablation site locations and coordinates of one or more anatomical regions on a surface of the heart; classifying at least one of the ablation sites and regions according to a predetermined category; visually encoding at least one of the sites and anatomical regions on an anatomical map according to their respective categories; and displaying the visually encoded anatomical map to a user. (2) The method of embodiment 1, wherein receiving the locations of multiple ablation sites includes receiving at least one of planned ablation sites and created ablation sites. (3) The method of embodiment 1, wherein the categories include at least one of anatomical region, type of ablation source, and type of ablation catheter. (4) The method of embodiment 1, wherein visually encoding comprises at least one of coloring and texturing. (5) The method of embodiment 1, wherein visually encoding the site comprises tagging the site.

[0058] (6) The method of embodiment 1, wherein visually encoding includes using a graphical user interface (GUI). (7) The method of embodiment 1, wherein visually encoding comprises using an automated algorithm. (8) The method of embodiment 1, wherein visually encoding includes varying the visibility of at least one of the encoded sites and regions between opaque, semi-transparent, and fully transparent. (9) The method of embodiment 1, wherein the anatomical map is an electroanatomical (EA) map. (10) The method of embodiment 1, further comprising providing statistics of ablation results within at least one of the visually encoded regions.

[0059] (11) an interface configured to receive at least one of a plurality of ablation site locations and coordinates of one or more anatomical regions on a surface of the heart; a processor, the processor comprising: classifying at least one of the ablation sites and regions according to a predetermined category; visually encoding at least one of the sites and anatomical regions on an anatomical map according to their respective categories; The system is configured to display the visually encoded anatomical map to a user. (12) The system of embodiment 11, wherein the processor is configured to receive locations of multiple ablation sites by receiving at least one of planned ablation sites and created ablation sites. (13) The system of embodiment 11, wherein the categories include at least one of anatomical region, type of ablation source, and type of ablation catheter. (14) The system of claim 11, wherein the processor is configured to visually encode by at least one of coloring and texturing. (15) The system of embodiment 11, wherein the processor is configured to visually encode the site by tagging the site.

[0060] (16) The system of embodiment 11, wherein the processor is configured to visually encode by using a graphical user interface (GUI). (17) The system of embodiment 11, wherein the processor is configured to visually encode by using an automated algorithm. (18) The system of embodiment 11, wherein the processor is configured to visually encode at least one of the encoded sites and regions by varying visibility between opaque, semi-transparent, and fully transparent. (19) The system described in embodiment 11, wherein the anatomical map is an EA map. (20) The system of embodiment 11, wherein the processor is further configured to provide statistics of ablation results within at least one of the visually encoded regions.

Claims

1. an interface configured to receive at least one of a plurality of ablation site locations and coordinates of one or more anatomical regions on a surface of the heart; a processor, the processor comprising: classifying at least one of the ablation sites and regions according to a predetermined category; visually encoding at least one of the sites and anatomical regions on an anatomical map according to their respective categories; The system is configured to display the visually encoded anatomical map to a user.

2. The system of claim 1 , wherein the processor is configured to receive locations of a plurality of ablation sites by receiving at least one of planned ablation sites and created ablation sites.

3. The system of claim 1 , wherein the categories include at least one of an anatomical region, an ablation source type, and an ablation catheter type.

4. The system of claim 1 , wherein the processor is configured to visually encode by at least one of coloring and texturing.

5. The system of claim 1 , wherein the processor is configured to visually encode the sites by tagging the sites.

6. The system of claim 1 , wherein the processor is configured to visually encode by using a graphical user interface (GUI).

7. The system of claim 1 , wherein the processor is configured to visually encode by using an automated algorithm.

8. 2. The system of claim 1, wherein the processor is configured to visually encode by varying visibility of at least one of the encoded sites and regions between opaque, semi-transparent, and fully transparent.

9. The system of claim 1 , wherein the anatomical map is an EA map.

10. The system of claim 1 , wherein the processor is further configured to provide statistics of ablation results within at least one of the visually encoded regions.

11. receiving at least one of a plurality of ablation site locations and coordinates of one or more anatomical regions on a surface of the heart; classifying at least one of the ablation sites and regions according to a predetermined category; visually encoding at least one of the sites and anatomical regions on an anatomical map according to their respective categories; and displaying the visually encoded anatomical map to a user.

12. The method of claim 11 , wherein receiving locations of a plurality of ablation sites comprises receiving at least one of planned ablation sites and created ablation sites.

13. The method of claim 11 , wherein the categories include at least one of an anatomical region, an ablation source type, and an ablation catheter type.

14. The method of claim 11 , wherein visually encoding comprises at least one of coloring and texturing.

15. The method of claim 11 , wherein visually encoding the site comprises tagging the site.

16. The method of claim 11 , wherein visually encoding comprises using a graphical user interface (GUI).

17. The method of claim 11 , wherein visually encoding comprises using an automated algorithm.

18. 12. The method of claim 11, wherein visually encoding comprises varying visibility of at least one of the encoded sites and regions between opaque, semi-transparent, and fully transparent.

19. The method of claim 11 , wherein the anatomical map is an electroanatomical (EA) map.

20. The method of claim 11 , comprising providing statistics of ablation results within at least one of the visually encoded regions.

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