Systems and methods for tracking anatomical focal points

Abstract

The method includes acquiring an electro-anatomical map mapping portions of the heart while the heart is experiencing an arrhythmia; acquiring a sequence of images of the heart acquired by an ultrasound probe, the sequence including one or more arrhythmia images acquired while the heart is experiencing the arrhythmia and one or more rhythm images acquired while the heart is in sinus rhythm, the ultrasound probe including a sensor that outputs a signal indicating the position and orientation of the probe in a coordinate system of the electro-anatomical map based on signals during acquisition of the sequence of images; identifying an anatomical portion represented by a particular portion of the electro-anatomical map in one of the arrhythmia images by tracking the anatomical portion through the sequence of images; identifying the anatomical portion in at least one of the rhythm images; and displaying an output in response thereto.

Description

[Technical Field]

[0001] The present invention relates generally to the field of electrophysiology, and specifically to the treatment of cardiac arrhythmias. [Background technology]

[0002] Co-assigned U.S. Patent No. 11,147,497 to Ziv-Ari et al. discloses a method that includes receiving sets of signals during multiple cardiac cycles, each set indicating, for a probe inserted into a cardiac chamber, the 3D location of the distal tip of the probe, the electrical potentials measured at that location, and the respective times during a given cycle when the electrical potentials were measured. The received measurements and their respective times are compared to a first template for sinus rhythm cardiac cycles and a second template for non-sinus rhythm cardiac cycles to identify a series of cardiac cycles including consecutive first, second, and third cardiac cycles, with the first and second cardiac cycles conforming to the first template and the third cardiac cycle matching the second template. A physical map is generated based on the locations. Based on the received locations and corresponding electrical potentials, an electroanatomical map is rendered on a display, including regional activation times for non-sinus rhythm cardiac cycles overlaid on the physical map. [Brief explanation of the drawings]

[0003] 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. [Figure 1] 1 is a schematic diagram of a mapping and ablation system according to some embodiments of the present disclosure. [Figure 2] 1A-1C are schematic diagrams of two electroanatomical maps, according to some embodiments of the present disclosure. [Figure 3] 1 is a schematic illustration of a technique for tracking anatomical parts, according to some embodiments of the present disclosure. [Figure 4]FIG. 1 is a flow diagram of an algorithm for constructing a hybrid electro-anatomical map, according to some embodiments of the present disclosure. DETAILED DESCRIPTION OF THE INVENTION

[0004] overview Ablation of cardiac arrhythmia foci, such as premature ventricular contractions (PVCs), is often performed while the heart is in sinus rhythm. In such cases, it can be useful during the ablation procedure to display a "rhythm" map that represents the relevant anatomical structures during sinus rhythm and is annotated to indicate the location of the foci. However, to find the foci, the physician needs to see the heart's electrical activity during the arrhythmia, which is not shown on a "rhythm" map.

[0005] One solution to this problem is to construct a hybrid electro-anatomical map, which includes a rhythmic anatomical map annotated to show the electrical characteristics of the heart during arrhythmia. After constructing the hybrid map, the physician may mark a focal point on the hybrid map and then refer to the hybrid map during the procedure. However, a potential problem with this approach is that the electrical characteristics of the arrhythmia may not be correctly mapped to the rhythmic anatomical structure due to morphological differences between the rhythmic and arrhythmic states.

[0006] Therefore, the present disclosure provides an alternative solution to the aforementioned problem. According to this solution, rhythmic and arrhythmia electroanatomical maps are constructed using data acquired by a mapping probe. In addition, a series of ultrasound images showing the region of focus are acquired by the ultrasound probe while the heart transitions from sinus rhythm to an arrhythmic episode, or vice versa. The mapping probe and ultrasound probe are tracked by the same tracking system so that the ultrasound images are registered to each of the maps.

[0007] First, the physician marks a focal point on the arrhythmia electroanatomical map. Using the registration of the map to the ultrasound image, the processor locates the focal point in one of the "arrhythmia images," i.e., one of the images acquired during the arrhythmia episode. The processor then tracks the focal point forward or backward through the sequence until it reaches one of the "rhythm images," i.e., one of the images acquired during sinus rhythm. (Typically, both the beginning and ending arrhythmia images are acquired at the same phase of the cardiac cycle, and this phase is represented by both maps.) Then, using the registration, the processor marks the focal point on the rhythm map. The physician can then refer to the rhythm map to locate the focal point during the procedure.

[0008] In another embodiment, the processor constructs a more accurate hybrid electro-anatomical map compared to the prior art. Optionally, points of focus or any other interest can be marked on the hybrid map.

[0009] To construct the hybrid map, the processor first selects multiple representative portions of the arrhythmia map. For each representative portion, the processor uses the ultrasound-based techniques described above to locate a corresponding portion of the rhythm anatomical map that represents the associated anatomical structure during sinus rhythm. The processor then associates the values ​​of the electrical properties associated with the representative portion of the arrhythmia map with the corresponding portion of the rhythm anatomical map. After performing any necessary interpolation of values ​​on the rhythm map, the processor annotates the rhythm map to indicate the values.

[0010] System Description Reference is first made to FIG. 1, which is a schematic, illustrative illustration of a mapping and ablation system 20, according to some embodiments of the present disclosure.

[0011] The system 20 includes a mapping / ablation probe 22 proximally connected to a mapping console 24. The probe 22 includes one or more electrodes 25 at its distal end. The electrodes 25 are configured to acquire intracardiac signals from and apply ablation signals to tissue in a heart 26 of a subject 28. The probe 22 further includes a tracking sensor 29 at its distal end configured to output signals indicative of the position and orientation of the sensor 29. The probe can be controlled using a control handle 32.

[0012] Probe 22 is inserted by physician 30 into a cardiac chamber, such as the left ventricle, of heart 26, for example, via the superior vena cava of subject 28. Typically, the probe is inserted through sheath 23, the proximal end of which may be connected to handle 47. After inserting probe 22 into the cardiac chamber, the physician moves the distal end of the probe along the tissue of the cardiac chamber, with electrodes 25 acquiring intracardiac signals from the tissue.

[0013] System 20 further includes a mapping processor 39, which is typically included in mapping console 24. Based on signals from sensors 29, mapping processor 39 calculates the location within heart 26 where each of the intracardiac signals was acquired. Based on the signal and location information, the processor constructs an electroanatomical map 55 of the tissue.

[0014] The system 20 further comprises an ultrasound (US) probe 21 connected proximally to the mapping console 24 and the ultrasound console 43. The US probe 21 includes at its distal end a two-dimensional (e.g., 32×64) array 50 of ultrasound transducers 53 and a tracking sensor 52. The sensor 52 is configured to output a signal indicative of the sensor's position and orientation. The US probe 21 can be controlled using a control handle 40.

[0015] System 20 further comprises an ultrasound processor 41, which is typically contained in an ultrasound console 43. Based on the signals output by transducer 53, processor 41 constructs an ultrasound image, which is typically three-dimensional.

[0016] The mapping processor 39 and the ultrasound processor 41 are configured to exchange communications with each other via any suitable wireless or wired communication medium 45. For example, the ultrasound processor 41 can communicate each of the ultrasound images to the mapping processor 39. Based on the signals from the sensors 52 and the predetermined alignment of the sensors relative to the array 50, the mapping processor 39 can calculate the position and orientation of the anatomical structures represented in each of the ultrasound images.

[0017] System 20 further includes memory 37, which may comprise any suitable type of volatile memory, such as random access memory (RAM), and / or non-volatile memory, such as flash memory. Memory 37 may be accessed by mapping processor 39 and / or ultrasound processor 41. Memory 37 may store ultrasound images and / or any other data.

[0018] A physician 30 inserts an US probe 21 into the heart 26, for example, via the superior vena cava of the subject 28. The physician then uses the US probe 21 to acquire ultrasound images of the anatomical structure to be mapped using the mapping ablation probe 22. Contours shown in at least some of these images may be marked manually (e.g., by the physician 30) or automatically (e.g., by the mapping processor 39), and the marked images may then complement the anatomical data used to construct the map 55. Alternatively or additionally, at least some of the images may be used to track arrhythmia foci and / or other parts of the subject's anatomy, as further described below with reference to FIG. 3 .

[0019] In some embodiments, system 20 includes one or more magnetic field generators 36 configured to generate a magnetic field near subject 28, and each of the tracking sensors includes one or more coils. A mapping processor 39 tracks the position and orientation of each probe based on signals induced in the coils by the magnetic field. Such tracking techniques are disclosed, for example, in U.S. Patent Nos. 5,391,199, 5,443,489, and 6,788,967 to Ben-Haim, U.S. Patent No. 6,690,963 to Ben-Haim et al., U.S. Patent No. 5,558,091 to Acker et al., and U.S. Patent No. 6,177,792 to Govari, the disclosures of each of which are incorporated herein by reference.

[0020] In other examples, each of the tracking sensors includes one or more probe electrodes, and the processor tracks each of the probes based on the current or voltage distribution between the probe electrodes and reference electrodes coupled to the subject's body. Such techniques can utilize a position map pre-calibrated using electromagnetic sensors, as described, for example, in U.S. Patent No. 7,536,218 to Govari et al. and U.S. Patent No. 8,456,182 to Bar-Tal et al., the disclosures of each of which are incorporated herein by reference. Alternatively, the processor can pass a current between the reference electrodes and measure the resulting voltage at the probe electrodes, as described, for example, in U.S. Patent No. 5,983,126 to Wittkampf and U.S. Patent No. 5,944,022 to Nardella, the disclosures of which are incorporated herein by reference.

[0021] In some embodiments, the US probe 21 and the mapping / ablation probe 22 are simultaneously positioned within the subject's heart. As a particular example, the probe 22 can map the left ventricle of the heart 26, with the US probe imaging the left ventricle from the left atrium of the heart. In other embodiments, one of the probes is inserted into the heart only after the other probe has been withdrawn.

[0022] In some embodiments, the US probe 21 includes at least one electrode 56, and the US probe uses this electrode to perform some or all of the functions of the mapping / ablation probe 22. If the US probe performs all of the functions of the probe 22, the probe 22 may be omitted from the system 20.

[0023] In yet another embodiment, the system 20 comprises three probes: a US probe 21, another probe for mapping, and another probe for ablation.

[0024] System 20 further includes electrocardiogram (ECG) electrodes (not shown) coupled to the body of subject 28 and connected to console 24. Based on signals from the ECG electrodes, mapping processor 39 ascertains the respective phases in the ECG cycle at which intracardiac signals and ultrasound images are acquired. Further, based on the ECG signals, the mapping processor can ascertain whether the heart is in sinus rhythm or experiencing an arrhythmia.

[0025] System 20 further includes circuitry 38, typically located within console 24. Circuitry 38 may include interface circuitry configured to interface between a mapping processor 39 and each of the probes. For example, the interface circuitry may digitize intracardiac signals received from the distal end of mapping ablation probe 22 and pass the digitized signals to mapping processor 39. Alternatively or additionally, circuitry 38 may include generator circuitry configured to generate ablation signals and transmit these signals to the distal end of probe 22.

[0026] In some embodiments, system 20 further comprises a driver circuit 34 , typically located within console 24 , configured to drive magnetic field generator 36 .

[0027] Typically, system 20 further includes a display 27 on which mapping processor 39 can display electroanatomical map 55, one or more ultrasound images, and / or any other suitable output.

[0028] In some embodiments, the US probe 21 acquires transthoracic or transesophageal ultrasound images rather than intracardiac images.

[0029] While this description generally assumes that mapping processor 39 performs the processes described herein, it should be noted that any one or more processors may cooperatively perform any one of these processes. For example, ultrasound processor 41 may perform any one of these processes alone or in cooperation with mapping processor 39. As a specific example, ultrasound processor 41 may perform the tracking functions described herein and communicate the output of the tracking to mapping processor 39.

[0030] Generally, each processor described herein may be embodied as a single processor or as a set of cooperatively networked or clustered processors. Some functions of the processor may be implemented solely in hardware, e.g., using one or more fixed-function or general-purpose integrated circuits, application-specific integrated circuits (ASICs), and / or field-programmable gate arrays (FPGAs). Alternatively, the functionality may be implemented at least in part in software. For example, the processor may be embodied as a programmed processor, e.g., including a central processing unit (CPU) and / or a graphics processing unit (GPU). Program code and / or data, including a software program, may be loaded for execution and processing by the CPU and / or GPU. The program code and / or data may be downloaded to the processor in electronic form, e.g., over a network. Alternatively or additionally, the program code and / or data may be provided to and / or stored on a non-transitory, tangible medium, such as a magnetic, optical, or electronic memory. Such program code and / or data, when provided to the processor, produces a machine or special-purpose computer configured to perform the tasks described herein.

[0031] Localization of foci in rhythmic electroanatomical maps Reference is now made to FIG. 2, which is a schematic illustration of two electroanatomical maps, according to some embodiments of the present disclosure.

[0032] 2 shows an arrhythmia electroanatomical map 55a, which is an instance of map 55 (FIG. 1). Arrhythmia electroanatomical map 55a maps a portion of heart 26 (FIG. 1) while the heart is experiencing an arrhythmia, including, for example, a premature ventricular contraction (PVC). Typically, map 55a is colored and / or otherwise annotated to indicate the values ​​of respective local activation times (LAT), activation voltages, and / or any other electrical properties at various points on the tissue. Map 55a may represent a portion of the heart at the onset of the QRS complex, the onset of the T wave, the onset of the P wave, or any other suitable phase of the cardiac cycle.

[0033] Processor 39 (FIG. 1) is configured to obtain map 55a. For example, the processor may construct the map as described above with reference to FIG. 1. Alternatively, for example, the processor may load the map from memory 37 (FIG. 1) or receive the map over a computer network.

[0034] 2 further shows markers 44 marking specific portions 42a of map 55a. The portions 42a, which may have any shape and area, may correspond to arrhythmia foci or any other anatomical portion of interest.

[0035] In some embodiments, the processor receives input from a user indicating portion 42a. For example, portion 42a may be marked by physician 30 (FIG. 1) while map 55a is displayed on display 27. Alternatively, portion 42a may be automatically identified by the processor. (Note that marker 44 does not necessarily have to be displayed by the processor.)

[0036] 2 further illustrates rhythmic electroanatomical map 55r, which is also an instance of map 55 (FIG. 1). Rhythmic electroanatomical map 55r maps the same portion of the heart as map 55a, in the same coordinate system, and at the same phase of the cardiac cycle while the heart is in sinus rhythm. Map 55r differs from map 55a due to differences in morphology and electrical conduction between arrhythmia and rhythmic states of the heart.

[0037] Processor 39 (FIG. 1) is configured to acquire map 55r as described above for map 55a. For example, the processor may construct both maps in parallel. In particular, mapping ablation probe 22 (FIG. 1) may acquire intracardiac signals over one or more periods of sinus rhythm and one or more periods of arrhythmia. For each intracardiac signal received from the probe, the processor may check the subject's ECG. If the ECG indicates that the heart is in sinus rhythm, the processor may assign the signal (along with its associated location) to map 55r. Otherwise, the processor may assign the signal to map 55a.

[0038] In some embodiments, the processor is configured to identify a portion 42r of the map 55r that corresponds to the portion 42a of the map 55a by representing the same anatomical portion, as described further below with reference to Figure 3. After identifying the portion 42r, the processor can display the map 55r with the marker 44 overlying the portion 42r.

[0039] Reference is now made to FIG. 3, which is a schematic illustration of a technique for tracking anatomical sites, according to some embodiments of the present invention.

[0040] The mapping processor 39 (FIG. 1) is configured to acquire a sequence 46 of cardiac images 48 acquired by the US probe 21 (FIG. 1). For example, the mapping processor can receive the sequence from the ultrasound processor 41, load the sequence from the memory 37, or receive the sequence from a remote computer via a computer network.

[0041] A sequence 46 includes one or more arrhythmia images 48a acquired while the heart is experiencing an arrhythmia and one or more rhythm images 48r acquired while the heart is in sinus rhythm. The arrhythmia images 48a may be acquired before or after the rhythm images 48r. In other words, during acquisition of a sequence, the heart may transition from arrhythmia to sinus rhythm or from sinus rhythm to arrhythmia. Typically, the images 48 (sometimes referred to as "frames") in a sequence 46 are acquired at a rate of at least 30 frames per second (fps), such as 30-60 fps. At least some of the images 48 may be acquired in different respective fields of view.

[0042] For each image 48 shown in Figure 3, Figure 3 also shows a portion of the subject's ECG waveform 58, along with a marker 60 indicating the phase in the cardiac cycle at which the image was acquired. By way of example, the portion of the ECG waveform 58 shown in Figure 3 includes the QRS complex. Although the heart is arrhythmic, the QRS complex may be abnormal, as shown in Figure 3.

[0043] In some embodiments, the raw data used to construct map 55a and the raw data used to construct arrhythmia image 48a are acquired during the same episode of arrhythmia. For example, US probe 21 and mapping / ablation probe 22 (FIG. 1) may be simultaneously positioned within the subject's heart while the episode is occurring. In other embodiments, the raw data used to construct map 55a and the raw data used to construct arrhythmia image 48a are acquired during different episodes of arrhythmia.

[0044] As described above with reference to FIG. 1, the US probe 21 and the mapping ablation probe 22 are tracked using the same tracking system, or alternatively, the same probe is used for both mapping and ultrasound. In either case, the signals output by the tracking sensor 52 (FIG. 1) indicate the position and orientation of the US probe in the coordinate system of the maps 55a and 55r. That is, the image 48 is registered to the maps 55a, 55r. Thus, based on the tracking signals, the mapping processor identifies, in the arrhythmia image 48a′, the anatomical portion 54 represented by the portion 42a of the map 55a.

[0045] Typically, arrhythmia image 48a' is acquired at approximately the same cardiac cycle phase as the phase represented by map 55a and is closer to the rhythm image than any other arrhythmia image acquired at such phase. For example, if an arrhythmia image precedes a rhythm image, the mapping processor can identify arrhythmia image 48a' by starting with the last arrhythmia image and moving backward through sequence 46 until the cardiac phase is within a predetermined threshold of the phase represented by map 55a. If an arrhythmia image follows a rhythm image, the mapping processor may start with the first arrhythmia image and move forward through sequence 46 until the cardiac phase is within a predetermined threshold of the phase represented by map 55a.

[0046] Following identification of the anatomical portion 54 in the arrhythmia image 48a', the mapping processor tracks the anatomical portion through the sequence of images, as indicated in FIG. 3 by the tracking indicator 62. If the rhythm image 48r follows the arrhythmia image 48a, the processor tracks the anatomical portion forward through the sequence. Otherwise, the processor tracks the anatomical portion backward through the sequence. In either case, by tracking the anatomical portion 54, the processor identifies the anatomical portion in at least one of the rhythm images. In particular, the processor may stop tracking upon identifying an anatomical portion in rhythm image 48r' that is acquired at approximately the same phase as the arrhythmia image 48a' and that is closer to the arrhythmia image than any other rhythm image acquired at such phase.

[0047] Typically, the mapping processor tracks anatomical structures using speckle tracking techniques such as those described in Bohs, Laurence N., and Gregg E. Trahey, "A novel method for angle independent ultrasonic imaging of blood flow and tissue motion," IEEE Transactions on biomedical engineering 38.3(1991):280-286, the disclosure of which is incorporated herein by reference.

[0048] The mapping processor then displays an output (eg, on display 27 (FIG. 1)) in response to identifying anatomical portion 54 in at least one of the rhythm images.

[0049] In some embodiments, the output includes rhythmic image 48r′, and / or any other rhythmic image in which anatomical parts have been identified, with overlaid markers (such as those shown in FIG. 3) marking the anatomical parts.

[0050] Alternatively or additionally, in response to identifying anatomical portion 54 in rhythm image 48r' and based on signals output by the tracking sensor, the processor can identify portion 42r of map 55r that corresponds to portion 42a of map 55a by representing anatomical portion 54. In other words, rhythm image 48r' is registered to map 55r and is at approximately the same cardiac phase as map 55r, thereby allowing the processor to identify portion 42r. The processor can then mark portion 42r as described above with reference to FIG. 2.

[0051] Construction of hybrid electroanatomical maps In another example, the mapping processor constructs and displays a hybrid electro-anatomical map in which an anatomical map representing portions of the heart during sinus rhythm is annotated to indicate respective values ​​of electrical properties, such as LAT, in multiple anatomical portions during the arrhythmia. The hybrid map may then be marked to indicate the location of a focus or any other point of interest.

[0052] In particular, the processor may perform the tracking described above with reference to Figures 2-3 for multiple anatomical portions represented by different respective representative portions of the arrhythmia electroanatomical map. If a single sequence does not represent the entire heart portion, the tracking may be performed over multiple sequences, i.e., at least one of the anatomical portions may be tracked over a different sequence than another one of the anatomical portions.

[0053] Based on the tracking, the processor can identify, for each representative portion of the arrhythmia electro-anatomical map, a corresponding portion of the anatomical map that represents the portion of the heart while the heart is in sinus rhythm. The processor can then associate with each identified portion of the anatomical map the value(s) of the electrical property in the corresponding portion of the arrhythmia map.

[0054] For further details, reference is now made to FIG. 4, which is a flow diagram of an algorithm 64 for constructing a hybrid electro-anatomical map, according to some embodiments of the present disclosure.

[0055] Algorithm 64 begins with a portion selection step 66 in which the processor selects multiple representative portions of the arrhythmia electroanatomical map. For example, the processor may select all portions of the map associated with electrical property values ​​acquired by one of electrodes 25 (FIG. 1), as opposed to portions of the map associated with interpolated values. Alternatively, for example, the processor may select all portions of the map, including portions associated with interpolated values.

[0056] Following portion selection step 66, the processor checks, in a check step 67, whether there is at least one ultrasound sequence that includes both rhythm and arrhythmia images (as described above with reference to FIG. 3) that has not yet been selected. If not, the processor aborts construction of the hybrid electro-anatomical map. Otherwise, in a sequence selection step 68, the processor selects an ultrasound sequence that has not yet been selected.

[0057] Next, the processor identifies arrhythmia images within the selected sequence that are suitable for initiating tracking, in an image identification step 70. Exemplary criteria for identifying such images are described above with reference to arrhythmia image 48a' of FIG.

[0058] The processor then identifies any anatomical parts represented by the respective representative portions of the arrhythmia map in the identified "start" arrhythmia image in an anatomical part identification step 72. The processor then tracks the identified anatomical parts through the sequence in a tracking step 74 until it reaches an "end" rhythm image, which may be identified as described above with reference to rhythm image 48r' of FIG.

[0059] Next, the processor checks whether there are any representative portions that have not yet been grasped in a check step 76. If there are, the processor returns to check step 67. If not, the processor identifies portions of the rhythm anatomical map that correspond to the tracked anatomical portions in an identification step 78. The processor then associates values ​​of electrical properties, such as LAT, in the representative portions of the arrhythmia map with the identified corresponding portions of the anatomical map, respectively, in an association step 80.

[0060] Next, in an interpolation step 81, the processor interpolates the values ​​of the electrical properties on the rhythm anatomical map. (If the representative portion includes the entire arrhythmia map, relatively little or no interpolation may be required.) Finally, in an annotation step 82, the processor annotates the rhythm anatomical map to indicate the values ​​of the electrical properties. [Example]

[0061] The following examples relate to various non-exhaustive ways in which the teachings herein may be combined or applied. It should be understood that the following examples are not intended to limit the scope of any claims that may be presented at any time in this application or any subsequent application related to this application. No disclaimer is intended. The following examples are provided merely for illustrative purposes. It is contemplated that the various teachings herein may be configured and applied in many other ways. It is also contemplated that certain features referred to in the following examples may be omitted in some variations. Accordingly, none of the aspects or features referred to below should be considered critical unless later expressly indicated as such by the inventors or their successors. If a claim presented in this application or a subsequent application related to this application includes additional features other than those referred to below, those additional features should not be considered added for any reasons of patentability.

[0062] Example 1 The system (20) includes a display (27) and one or more processors (39, 41) configured to cooperatively execute a process that includes acquiring an electro-anatomical map (55a) mapping a portion of a heart (26) of a subject (28) while the heart is experiencing an arrhythmia. The process further includes acquiring a sequence (46) of images (48) of the heart acquired by an ultrasound probe (21), the sequence including one or more arrhythmia images (48a) acquired while the heart is experiencing the arrhythmia and one or more rhythm images (48r) acquired while the heart is in sinus rhythm, the ultrasound probe including a sensor (52) that outputs a signal indicative of the position and orientation of the probe in a coordinate system of the electro-anatomical map during acquisition of the sequence of images. The processor further includes identifying an anatomical portion (54) represented by a particular portion (42a) of the electro-anatomical map in one of the arrhythmia images based on the signal. The process further includes identifying the anatomical part in at least one of the rhythmic images by tracking the anatomical part through the sequence of images, and displaying an output on a display (27) in response to identifying the anatomical part in at least one of the rhythmic images.

[0063] Example 2 2. The system of claim 1, wherein the output includes at least one of the rhythm images having overlaid markers marking the anatomical portion.

[0064] Example 3 The electroanatomical map is an arrhythmia electroanatomical map (55a); The process further includes acquiring a rhythmic electroanatomical map (55r) mapping a portion of the heart (26) in a coordinate system while the heart is in sinus rhythm; To view the output, identifying, in response to identifying an anatomical portion (54) in at least one of the rhythm images (48r), a portion (42r) of the rhythm electro-anatomical map corresponding to the particular portion (42a) of the arrhythmia electro-anatomical map by representing the anatomical portion (54) based on the signal; and displaying the rhythmic electroanatomical map with a marker overlaid on the identified portion of the rhythmic electroanatomical map.

[0065] Example 4 The electroanatomical map is an arrhythmia electroanatomical map (55a); the particular portion (42a) is one of a plurality of representative portions of the arrhythmia electroanatomical map; the anatomical portion (54) is one of a plurality of anatomical portions each represented by a representative portion; The sequence (46) is one of one or more sequences, the process includes tracking each of the anatomical parts through a respective one of the sequences; To view the output, constructing a hybrid electro-anatomical map, in which an anatomical map representing a portion of the heart during sinus rhythm is annotated to indicate respective values ​​of electrical properties in the anatomical portion during arrhythmia; and displaying a hybrid electroanatomical map.

[0066] Example 5 5. The system of any one of Examples 1 to 4, wherein the anatomical portion comprises an arrhythmia focus.

[0067] Example 6 The system (20) of any one of Examples 1 to 5, wherein the arrhythmia comprises premature ventricular contractions (PVCs).

[0068] Example 7 7. The system of any one of Examples 1 to 6, wherein the arrhythmia image is acquired before the rhythm image.

[0069] Example 8 7. The system according to any one of the preceding embodiments, wherein the arrhythmia image is acquired after the rhythm image.

[0070] Example 9 9. The system (20) of any one of Examples 1 to 8, wherein the process further comprises receiving input from a user indicating a particular portion (42a) of the electroanatomical map (55a).

[0071] Example 10 The method includes acquiring an electro-anatomical map (55a) mapping a portion of a heart (26) of a subject (28) while the heart is experiencing an arrhythmia. The method further includes acquiring a sequence (46) of images (48) of the heart acquired by an ultrasound probe (21), the sequence including one or more arrhythmia images (48a) acquired while the heart is experiencing the arrhythmia and one or more rhythm images (48r) acquired while the heart is in sinus rhythm, the ultrasound probe including a sensor (52) that outputs a signal indicative of a position and orientation of the probe in a coordinate system of the electro-anatomical map during acquisition of the sequence of images. The method further includes identifying an anatomical portion (54) represented by a particular portion (42a) of the electro-anatomical map in one of the arrhythmia images based on the signal. The method further includes identifying the anatomical portion in at least one of the rhythm images by tracking the anatomical portion through the sequence of images and displaying an output in response to identifying the anatomical portion in at least one of the rhythm images.

[0072] Example 11 11. The method of example 10, wherein the output includes at least one of the rhythm images (48r) having overlaid markers marking the anatomical portion (54).

[0073] Example 12 The electroanatomical map is an arrhythmia electroanatomical map (55a); The method further includes acquiring a rhythmic electroanatomical map (55r) mapping portions of the heart (26) in a coordinate system while the heart is in sinus rhythm; To view the output, identifying a portion (42r) of the rhythm electro-anatomical map corresponding to the particular portion (42a) of the arrhythmia electro-anatomical map by representing the anatomical portion (54) based on the signal in response to identifying the anatomical portion (54) in at least one of the rhythm images (48r); and displaying the rhythmic electroanatomical map with a marker (44) overlaid on the identified portion of the rhythmic electroanatomical map.

[0074] Example 13 The electroanatomical map is an arrhythmia electroanatomical map (55a); the particular portion (42a) is one of a plurality of representative portions of the arrhythmia electroanatomical map; the anatomical portion (54) is one of a plurality of anatomical portions each represented by a representative portion; The sequence (46) is one of one or more sequences, The method includes tracking each of the anatomical parts through a respective one of the sequences; To view the output, constructing a hybrid electro-anatomical map, in which an anatomical map representing a portion of the heart during sinus rhythm is annotated to indicate respective values ​​of electrical properties in the anatomical portion during arrhythmia; and displaying a hybrid electroanatomical map.

[0075] Example 14 The method of any one of Examples 10 to 13, wherein the anatomical portion (54) comprises an arrhythmia focus.

[0076] Example 15 The method of any one of Examples 10 to 14, wherein the arrhythmia comprises premature ventricular contractions (PVCs).

[0077] Example 16 The method according to any one of Examples 10 to 15, wherein the arrhythmia image is acquired before the rhythm image.

[0078] Example 17 The method according to any one of Examples 10 to 15, wherein the arrhythmia image is acquired after the rhythm image.

[0079] Example 18 18. The method of any one of Examples 10-17, further comprising receiving input from a user indicating a particular portion of the electroanatomical map.

[0080] Example 19 The computer software product includes a tangible, non-transitory computer-readable medium having stored thereon program instructions. When read by a processor, the instructions cause the processor to acquire an electro-anatomical map (55a) mapping a portion of a heart (26) of a subject (28) while the heart is experiencing an arrhythmia. The instructions further cause the processor to acquire a sequence (46) of images (48) of the heart acquired by an ultrasound probe (21), the sequence including one or more arrhythmia images (48a) acquired while the heart is experiencing the arrhythmia and one or more rhythm images (48r) acquired while the heart is in sinus rhythm, the ultrasound probe including a sensor (52) that outputs signals indicative of the position and orientation of the probe in a coordinate system of the electro-anatomical map during acquisition of the sequence of images. The instructions further cause the processor to identify, based on the signals, an anatomical portion (54) represented by a particular portion (42a) of the electro-anatomical map in one of the arrhythmia images. The instructions further cause the processor to track the anatomical part through the sequence of images to identify the anatomical part in at least one of the rhythmic images, and to display an output in response to identifying the anatomical part in at least one of the rhythmic images.

[0081] Example 20 The electroanatomical map is an arrhythmia electroanatomical map, The instructions further cause the processor to acquire a rhythmic electroanatomical map mapping portions of the heart in a coordinate system while the heart is in sinus rhythm; The command is, identifying, based on the signal, a portion of the rhythm electro-anatomical map corresponding to the portion of the arrhythmia electro-anatomical map by representing the anatomical portion in at least one of the rhythm images in response to identifying the anatomical portion in at least one of the rhythm images; and displaying the rhythmic electroanatomical map with markers overlaid on the identified portions of the rhythmic electroanatomical map.

[0082] Those skilled in the art will understand that the present disclosure is not limited to what is specifically shown and described above in this specification. Rather, the scope of the present disclosure includes combinations and subcombinations of the various features described hereinabove, as well as variations and modifications of features not found in the prior art that would occur to one skilled in the art upon reading the above description. Documents incorporated by reference into this patent application are to be considered an integral part of this application, provided that, to the extent that any term in these incorporated documents is defined in a manner that contradicts a definition expressly or implicitly made herein, only the definition herein shall be considered.

[0083] [Embodiment] (1) A system comprising: The display and one or more processors configured to cooperatively execute a process, said process comprising: obtaining an electroanatomical map mapping a portion of a subject's heart while the heart is experiencing an arrhythmia; acquiring a sequence of images of the heart acquired by an ultrasound probe, the sequence including one or more arrhythmia images acquired while the heart is experiencing the arrhythmia and one or more rhythm images acquired while the heart is in sinus rhythm; the ultrasound probe including a sensor that outputs signals indicative of the position and orientation of the probe in a coordinate system of the electroanatomical map during the acquisition of the sequence of images; Identifying, based on the signal, an anatomical portion in one of the arrhythmia images that is represented by a particular portion of the electroanatomical map; identifying the anatomical portion in at least one of the rhythmic images by tracking the anatomical portion through the sequence of images; and displaying an output on the display in response to identifying the anatomical portion in the at least one of the rhythm images. (2) The system of embodiment 1, wherein the output includes at least one of the rhythm images having an overlaid marker marking the anatomical part. (3) the electroanatomical map is an arrhythmia electroanatomical map; the process further includes acquiring a rhythmic electroanatomical map mapping the portion of the heart in the coordinate system while the heart is in sinus rhythm; Displaying the output includes: identifying a portion of the rhythm electro-anatomical map corresponding to the particular portion of the arrhythmia electro-anatomical map by representing the anatomical portion based on the signal in response to identifying the anatomical portion in the at least one of the rhythm images; and displaying the rhythmic electroanatomical map with a marker overlaid on the identified portion of the rhythmic electroanatomical map. (4) the electroanatomical map is an arrhythmia electroanatomical map; the particular portion is one of a plurality of representative portions of the arrhythmia electroanatomical map; the anatomical portion is one of a plurality of anatomical portions each represented by the representative portion; the sequence is one of one or more sequences; the process includes tracking each of the anatomical parts through a respective one of the sequences; Displaying the output includes: constructing a hybrid electro-anatomical map, wherein an anatomical map representing the portion of the heart during sinus rhythm is annotated to indicate respective values ​​of electrical properties in the anatomical portion during the arrhythmia; and displaying the hybrid electro-anatomical map. (5) The system described in embodiment 1, wherein the anatomical portion includes the focus of the arrhythmia.

[0084] (6) The system described in embodiment 1, wherein the arrhythmia includes a premature ventricular contraction (PVC). (7) The system described in embodiment 1, wherein the arrhythmia image is acquired before the rhythm image. (8) The system described in embodiment 1, wherein the arrhythmia image is acquired after the rhythm image. (9) The system of embodiment 1, wherein the process further includes receiving input from a user indicating the particular portion of the electroanatomical map. (10) A method comprising: obtaining an electroanatomical map mapping a portion of a subject's heart while the heart is experiencing an arrhythmia; acquiring a sequence of images of the heart acquired by an ultrasound probe, the sequence including one or more arrhythmia images acquired while the heart is experiencing the arrhythmia and one or more rhythm images acquired while the heart is in sinus rhythm; the ultrasound probe including a sensor that outputs signals indicative of the position and orientation of the probe in a coordinate system of the electroanatomical map during the acquisition of the sequence of images; Identifying, based on the signal, an anatomical portion in one of the arrhythmia images that is represented by a particular portion of the electroanatomical map; identifying the anatomical portion in at least one of the rhythmic images by tracking the anatomical portion through the sequence of images; and displaying an output in response to identifying the anatomical portion in the at least one of the rhythm images.

[0085] (11) The method of embodiment 10, wherein the output includes the at least one of the rhythm images having an overlaid marker marking the anatomical portion. (12) The electroanatomical map is an arrhythmia electroanatomical map; The method further includes acquiring a rhythmic electroanatomical map mapping the portion of the heart in the coordinate system while the heart is in sinus rhythm; Displaying the output includes: identifying a portion of the rhythm electro-anatomical map corresponding to the particular portion of the arrhythmia electro-anatomical map by representing the anatomical portion based on the signal in response to identifying the anatomical portion in the at least one of the rhythm images; and displaying the rhythmic electroanatomical map with a marker overlaid on the identified portion of the rhythmic electroanatomical map. (13) The electroanatomical map is an arrhythmia electroanatomical map; the particular portion is one of a plurality of representative portions of the arrhythmia electroanatomical map; the anatomical portion is one of a plurality of anatomical portions each represented by the representative portion; the sequence is one of one or more sequences; the method includes tracking each of the anatomical parts through a respective one of the sequences; Displaying the output includes: constructing a hybrid electro-anatomical map, wherein an anatomical map representing the portion of the heart during sinus rhythm is annotated to indicate respective values ​​of electrical properties in the anatomical portion during the arrhythmia; and displaying the hybrid electro-anatomical map. (14) The method of embodiment 10, wherein the anatomical portion includes the focus of the arrhythmia. (15) The method of embodiment 10, wherein the arrhythmia comprises a premature ventricular contraction (PVC).

[0086] (16) The method of embodiment 10, wherein the arrhythmia image is acquired before the rhythm image. (17) The method of embodiment 10, wherein the arrhythmia image is acquired after the rhythm image. (18) The method of embodiment 10, further comprising receiving input from a user indicating the particular portion of the electroanatomical map. (19) A computer software product including a tangible, non-transitory computer-readable medium having stored thereon program instructions, the program instructions, when read by a processor, causing the processor to: obtaining an electroanatomical map mapping a portion of a subject's heart while the heart is experiencing an arrhythmia; acquiring a sequence of images of the heart acquired by an ultrasound probe, the sequence including one or more arrhythmia images acquired while the heart is experiencing the arrhythmia and one or more rhythm images acquired while the heart is in sinus rhythm; the ultrasound probe including a sensor that outputs signals indicative of the position and orientation of the probe in a coordinate system of the electroanatomical map during the acquisition of the sequence of images; Identifying, based on the signal, an anatomical portion in one of the arrhythmia images that is represented by a particular portion of the electroanatomical map; identifying the anatomical portion in at least one of the rhythmic images by tracking the anatomical portion through the sequence of images; and displaying an output in response to identifying the anatomical portion in the at least one of the rhythm images. (20) The electroanatomical map is an arrhythmia electroanatomical map; The instructions further cause the processor to acquire a rhythmic electroanatomical map mapping the portion of the heart in the coordinate system while the heart is in sinus rhythm; The instruction: identifying, in response to identifying the anatomical portion in the at least one of the rhythm images, a portion of the rhythm electro-anatomical map corresponding to the portion of the arrhythmia electro-anatomical map by representing the anatomical portion based on the signal; and displaying the rhythmic electroanatomical map with markers overlaid on the identified portions of the rhythmic electroanatomical map.

Claims

1. 1. A system comprising: The display and one or more processors configured to cooperatively execute a process, said process comprising: obtaining an electroanatomical map mapping a portion of a subject's heart while the heart is experiencing an arrhythmia; acquiring a sequence of images of the heart acquired by an ultrasound probe, the sequence including one or more arrhythmia images acquired while the heart is experiencing the arrhythmia and one or more rhythm images acquired while the heart is in sinus rhythm; the ultrasound probe including a sensor that outputs signals indicative of the position and orientation of the probe in a coordinate system of the electroanatomical map during the acquisition of the sequence of images; Identifying, based on the signal, an anatomical portion in one of the arrhythmia images that is represented by a particular portion of the electroanatomical map; identifying the anatomical portion in at least one of the rhythm images by tracking the anatomical portion through the sequence of images; and displaying an output on the display in response to identifying the anatomical portion in the at least one of the rhythm images.

2. The system of claim 1 , wherein the output includes the at least one of the rhythm images with an overlaid marker marking the anatomical portion.

3. the electroanatomical map is an arrhythmia electroanatomical map; the process further includes acquiring a rhythmic electroanatomical map mapping the portion of the heart in the coordinate system while the heart is in sinus rhythm; Displaying the output includes: and in response to identifying the anatomical portion in the at least one of the rhythm images, identifying a portion of the rhythm electro-anatomical map corresponding to the particular portion of the arrhythmia electro-anatomical map by representing the anatomical portion based on the signal. and displaying the rhythmic electroanatomical map with a marker overlaid on the identified portion of the rhythmic electroanatomical map.

4. the electroanatomical map is an arrhythmia electroanatomical map; the particular portion is one of a plurality of representative portions of the arrhythmia electroanatomical map; the anatomical portion is one of a plurality of anatomical portions each represented by the representative portion; the sequence is one of one or more sequences; the process includes tracking each of the anatomical parts through a respective one of the sequences; Displaying the output includes: constructing a hybrid electro-anatomical map, wherein an anatomical map representing the portion of the heart during sinus rhythm is annotated to indicate respective values ​​of electrical properties in the anatomical portion during the arrhythmia; and displaying the hybrid electro-anatomical map.

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

6. The system of claim 1 , wherein the arrhythmia comprises a premature ventricular contraction (PVC).

7. The system of claim 1 , wherein the arrhythmia image is acquired before the rhythm image.

8. The system of claim 1 , wherein the arrhythmia image is acquired after the rhythm image.

9. The system of claim 1 , wherein the process further comprises receiving input from a user indicating the particular portion of the electroanatomical map.

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

11. The method of claim 10 , wherein the output includes the at least one of the rhythm images with an overlaid marker marking the anatomical portion.

12. the electroanatomical map is an arrhythmia electroanatomical map; The method further includes acquiring a rhythmic electroanatomical map mapping the portion of the heart in the coordinate system while the heart is in sinus rhythm; Displaying the output includes: and in response to identifying the anatomical portion in the at least one of the rhythm images, identifying a portion of the rhythm electro-anatomical map corresponding to the particular portion of the arrhythmia electro-anatomical map by representing the anatomical portion based on the signal. and displaying the rhythmic electroanatomical map with a marker overlaid on the identified portion of the rhythmic electroanatomical map.

13. the electroanatomical map is an arrhythmia electroanatomical map; the particular portion is one of a plurality of representative portions of the arrhythmia electroanatomical map; the anatomical portion is one of a plurality of anatomical portions each represented by the representative portion; the sequence is one of one or more sequences; the method includes tracking each of the anatomical parts through a respective one of the sequences; Displaying the output includes: constructing a hybrid electro-anatomical map, wherein an anatomical map representing the portion of the heart during sinus rhythm is annotated to indicate respective values ​​of electrical properties in the anatomical portion during the arrhythmia; and displaying the hybrid electro-anatomical map.

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

15. 11. The method of claim 10, wherein the arrhythmia comprises a premature ventricular contraction (PVC).

16. The method of claim 10 , wherein the arrhythmia image is acquired before the rhythm image.

17. The method of claim 10 , wherein the arrhythmia image is acquired after the rhythm image.

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

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

20. the electroanatomical map is an arrhythmia electroanatomical map; The instructions further cause the processor to acquire a rhythmic electroanatomical map mapping the portion of the heart in the coordinate system while the heart is in sinus rhythm; The instruction: identifying, in response to identifying the anatomical portion in the at least one of the rhythm images, a portion of the rhythm electro-anatomical map corresponding to the portion of the arrhythmia electro-anatomical map by representing the anatomical portion based on the signal; and displaying the rhythmic electroanatomical map with markers overlaid on the identified portions of the rhythmic electroanatomical map.

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