Visual guidance for positioning the distal tip of a medical probe - Patents.com

Abstract

To provide visual feedback to aid in guiding a distal end of a medical probe to a location in a body cavity requiring medical treatment.SOLUTION: A method includes receiving, from electrodes positioned within a heart, first signals from at least three of the electrodes indicating electrical activity in tissue with which the at least three of the electrodes engage, and second signals indicating locations of the at least three electrodes. The second signals are processed to compute the locations of the at least three electrodes and to determine a geometric center of the locations. Based on the signals, an electroanatomical map is generated for an area of the tissue including the geometric center, and an arrhythmia focus is determined in the map. A circle is presented and, within the circle, a region of the map is presented including the geometric center and the focus such that the geometric center on the map aligns with a center of the circle, the region within the circle indicating a spatial relationship between the geometric center and the focus.SELECTED DRAWING: Figure 1

Description

[Technical field]

[0001] (CROSS REFERENCE TO RELATED APPLICATIONS) This application claims the benefit of U.S. Provisional Patent Application No. 62 / 875,770, filed July 18, 2019, and is incorporated herein by reference.

[0002] FIELD OF THEINVENTION The present invention relates generally to medical imaging, and more particularly to providing visual feedback to assist in guiding the distal tip of a medical probe to a location within a body cavity requiring treatment. [Background technology]

[0003] Some medical procedures, such as mapping cavities of a body organ (e.g., the heart), are performed by inserting a medical probe into the cavity. In some configurations, the medical probe includes a distal segment that includes multiple electrodes capable of measuring physiological properties, such as local surface potentials, at a location on the heart.

[0004] Examples of medical probes that include multiple electrodes include balloon catheters and basket catheters. In some configurations, these medical probes deliver radio frequency (RF) current to ablate tissue in contact with the distal end of the probe to provide a therapeutic result.

[0005] U. Chmiel et al., U.S. Patent No. 8,577,450, describes a graphic interface for a multi-spine probe. The graphic interface includes a circle, the center of the circle representing the location of the distal end of the body of the catheter, and the radius of the circle representing the orientation of the location attached to the distal end of the catheter.

[0006] U. Afonso et al., U.S. Patent Application Publication No. 2013 / 0274582, describes a method for diagnosing arrhythmias and guiding catheter therapy, which includes creating a representation of a catheter having a spiral-shaped distal end that contains multiple electrodes, that can be overlaid on a map, model, or image of tissue.

[0007] U. Swanson et al., U.S. Patent No. 5,722,402, describes a method for guiding a movable electrode element in a multiple electrode structure, which includes using different color shades to present a normalized distribution of voltages detected by electrodes of a basket catheter.

[0008] U. Strommer et al., U.S. Patent Application Publication No. 2013 / 0184569, describes a method for generating an electrophysiological map of the heart, which includes generating a regional activation time map of the heart by superimposing a representation of the position of the distal tip of a catheter on a marked image.

[0009] MacAdam et al., U.S. Patent No. 8,224,432, describes a method for rapid 3D mapping using multiple electrode location data, which involves applying color coding to maps depicting variations in activation time, or any other parameter that is mapped according to a color scale.

[0010] U. Rosenberg et al., U.S. Patent No. 8,326,419, describes a method for treatment optimization by multidimensional mapping. The method includes generating an electromechanical delay map by subtracting local electrical actuation times from corresponding local mechanical actuation times, and rendering at least the electromechanical delay map on a display. The method may also include rendering the electromechanical delay map in color, where the color scale quantitatively identifies the electromechanical delay values ​​(e.g., via open or filled contours).

[0011] The documents incorporated by reference into this patent application are to be considered part of this application, except that if any term is defined in these incorporated documents in a manner that contradicts the definition given herein, either expressly or impliedly, then only the definition given herein shall be considered.

[0012] The above discussion is provided as a general overview of the related art in the art and is not to be construed as an admission that any information contained in this discussion constitutes prior art to the present patent application. Summary of the Invention [Means for solving the problem]

[0013] According to an embodiment of the present invention, a method is provided, comprising: receiving, from an intracardiac catheter having a distal end including a plurality of electrodes within a subject's heart, a first signal from at least three of the electrodes in response to electrical activity of myocardial tissue in contact with at least three of the electrodes; receiving a second signal indicative of location coordinates of each of the at least three electrodes within the heart; processing the second signal to calculate location coordinates of each of the at least three electrodes and determine a geometric center of the respective location coordinates; generating an electro-anatomical map for a region of the myocardial tissue including the determined geometric center based on the first and second signals; determining, within the map, a focus of arrhythmia within the region of the myocardial tissue; presenting, on a display, a circle; presenting, within the circle, a region of the map including the geometric center and the focus of arrhythmia and aligning the geometric center on the map with the center of the circle, wherein the region of the map presented within the circle indicates a spatial relationship between the geometric center and the focus of arrhythmia.

[0014] In some embodiments, the electrical activity includes local activation time values. In an additional embodiment, presenting the regions of the map at the arrhythmia foci includes plotting the local activation time values ​​versus their respective locations.

[0015] In one embodiment, the arrhythmia comprises a rotor having at least one focus.In one embodiment, the arrhythmia comprises focal.

[0016] In a further embodiment, presenting a region of the map that includes the geometric center includes presenting an icon within the circle at a location corresponding to the location of the arrhythmia focus relative to the geometric center. In another embodiment, presenting the circle and the region of the map includes overlaying the circle on the electroanatomical map. In a supplementary embodiment, the method also includes presenting within the circle a pathway of the arrhythmia from the arrhythmia focus.

[0017] In one embodiment, the intracardiac catheter comprises a balloon catheter, hi another embodiment, the intracardiac catheter comprises a basket catheter.

[0018] In an additional embodiment, generating the electroanatomical map may include presenting the map on a display at a first resolution, in which presenting the region may include presenting the region at a second resolution that is higher than the first resolution.

[0019] According to an embodiment of the invention, an apparatus is provided comprising: an intracardiac catheter configured to be inserted into a heart chamber; a plurality of electrodes attached to a distal end of the intracardiac catheter; a display; and a processor configured to: receive from the intracardiac catheter inserted into a given heart chamber first signals from at least three of the electrodes in response to electrical activity of myocardial tissue contacting the at least three of the electrodes; receive second signals indicative of location coordinates of each of the at least three electrodes in the heart; process the second signals to calculate location coordinates of each of the at least three electrodes and determine a geometric center of the respective location coordinates; generate an electro-anatomical map for a region of the myocardial tissue including the determined geometric center based on the first and second signals; determine within the map a focus of arrhythmia within the region of the myocardial tissue; present on the display a circle; present within the circle a region of the map including the geometric center and the focus of arrhythmia; and align the geometric center on the map with the center of the circle, wherein the region of the map presented within the circle indicates a spatial relationship between the geometric center and the focus of arrhythmia.

[0020] According to an embodiment of the present invention, there is further provided a computer software product operating in conjunction with an intracardiac catheter having a distal end including a plurality of electrodes, the product including a non-transitory computer readable medium having stored thereon program instructions which, when read by a computer, cause the computer to receive, from an intracardiac catheter positioned within a subject's heart, first signals from at least three of the electrodes in response to electrical activity of myocardial tissue contacting at least three of the electrodes, receive second signals indicative of location coordinates of each of the at least three electrodes within the heart, process the second signals to calculate location coordinates of each of the at least three electrodes and determine a geometric center of the respective location coordinates, generate an electro-anatomical map for a region of the myocardial tissue including the determined geometric center based on the first and second signals, determine within the map a focus of arrhythmia within the region of the myocardial tissue, present on a display a circle, present within the circle a region of the map including the geometric center and the focus of arrhythmia, align the geometric center on the map with the center of the circle, the region of the map presented within the circle indicating a spatial relationship between the geometric center and the focus of arrhythmia. [Brief description of the drawings]

[0021] The present disclosure is herein described, by way of example only, with reference to the accompanying drawings. [Figure 1] 1 is a schematic, pictorial diagram of a medical system including a basket catheter with a distal end, in accordance with an embodiment of the present invention; [Diagram 2] FIG. 2 is a schematic, pictorial diagram of a distal end of a basket catheter including electrodes attached to splines of the catheter, in accordance with an embodiment of the present invention. [Diagram 3] 1 is a flow diagram that generally illustrates a method for providing visual feedback to a medical professional for guiding a distal end of a balloon catheter, in accordance with an embodiment of the present invention. [Figure 4] 1 is a schematic, pictorial illustration of electrodes engaging myocardial tissue of a heart during a medical procedure, in accordance with an embodiment of the present invention. [Diagram 5]FIG. 2 is a schematic, pictorial diagram illustrating the presentation of an electroanatomical map on a display according to a first embodiment of the present invention; [Figure 6] FIG. 11 is a schematic, pictorial illustration of presenting an electroanatomical map on a display, according to a second embodiment of the present invention; [Figure 7A] 1 is a schematic, pictorial illustration of a visual indicator that may be presented on a display to assist a medical professional in positioning a distal end of a medical probe in an area of ​​tissue requiring treatment, in accordance with an embodiment of the present invention. [Figure 7B] 1 is a schematic, pictorial illustration of a visual indicator that may be presented on a display to assist a medical professional in positioning a distal end of a medical probe in an area of ​​tissue requiring treatment, in accordance with an embodiment of the present invention. [Figure 8A] 1 is a schematic, pictorial illustration of a visual indicator that may be presented on a display to assist a medical professional in positioning a distal end of a medical probe in an area of ​​tissue requiring treatment, in accordance with an embodiment of the present invention. [Figure 8B] 1 is a schematic, pictorial illustration of a visual indicator that may be presented on a display to assist a medical professional in positioning a distal end of a medical probe in an area of ​​tissue requiring treatment, in accordance with an embodiment of the present invention. [Figure 9A] 1 is a schematic, pictorial illustration of a visual indicator that may be presented on a display to assist a medical professional in positioning a distal end of a medical probe in an area of ​​tissue requiring treatment, in accordance with an embodiment of the present invention. [Figure 9B] 1 is a schematic, pictorial illustration of a visual indicator that may be presented on a display to assist a medical professional in positioning a distal end of a medical probe in an area of ​​tissue requiring treatment, in accordance with an embodiment of the present invention. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0022] When using a medical probe having multiple electrodes (e.g., a basket catheter or a balloon catheter), it may be difficult to precisely position the electrodes relative to a desired location. For example, during a medical procedure, a medical professional may wish to position a particular electrode of the catheter on or near a focal source of arrhythmia in myocardial tissue. However, there may be instances during a procedure when the electrode and / or portions of the tissue are not directly visible to the medical professional. In these instances, even if the location of the electrode can be determined and the tissue can be viewed using a camera, it may still be difficult for the medical professional to precisely position the electrode at the desired location.

[0023] An embodiment of the present invention provides a method and system for guiding a distal end of a medical probe towards a treatment location. As described below, first and second signals are received from an intracardiac catheter positioned within a subject's heart and having a distal end including a plurality of electrodes. In an embodiment of the present invention, the first signal is received from at least three electrodes in response to electrical activity of myocardial tissue contacted by the at least three electrodes, and the second signal is indicative of location coordinates of each of the at least three electrodes within the heart.

[0024] The second signal is processed to calculate location coordinates for each of the at least three electrodes and to determine a geometric center of each location coordinate. An electro-anatomical map is generated for a region of the myocardial tissue containing the determined geometric center based on the first signal and the second signal, and arrhythmia foci in the region of the myocardial tissue are determined in the map.

[0025] To provide positioning guidance to the medical professional, a circle is presented on the display within which a region of the map containing the geometric center and the arrhythmia focus is presented such that the geometric center (of the electrode location coordinates) on the map is aligned with the center of the circle. In an embodiment of the invention, the region of the map presented within the circle indicates the spatial relationship between the geometric center and the arrhythmia focus.

[0026] In some embodiments, a system implementing an embodiment of the present invention can present the spatial relationship as a circular bull's-eye, with the bull's-eye indicating the location of the arrhythmia focus relative to the electrode. The location of the bull's-eye within the circle can be used to confirm that the electrode is in close proximity to or in contact with the desired area. If the electrode is close to (but not in contact with) the desired area, the medical professional can use the image (e.g., the bull's-eye) as a visual guide to reposition the distal end of the medical probe to move the electrode to the desired location.

[0027] System Description FIG. 1 is a schematic pictorial view of a medical system 20 including a medical probe 22 and a control console 24, and FIG. 2 is a schematic pictorial view of a distal end 26 of the medical probe, according to an embodiment of the present invention. The medical system 20 may be based, for example, on the CARTO® system manufactured by Biosense Webster Inc., 33 Technology Drive, Irvine, CA 92618 USA. In the embodiment described below, the medical probe 22 may be used for diagnostic or therapeutic procedures such as mapping electrical potentials of a heart 28 of a patient 30 (also referred to herein as a subject). Alternatively, the medical probe 22 may be used, mutatis mutandis, for other therapeutic and / or diagnostic purposes in the heart or other body organs.

[0028] The probe 22 comprises an insertion tube 32 and a handle 34 coupled to a proximal end of the insertion tube. During a medical procedure, a medical professional 36 may insert the probe 22 through the vascular system of a patient 30 such that a distal end 26 of the medical probe enters a heart chamber 28. Once the distal end 26 enters the heart chamber 28, the medical professional 36 may deploy an electrode assembly 38 attached to the distal end 26, and the medical professional may manipulate the handle 34 to position the splines of the electrode assembly such that the electrodes on the splines engage myocardial tissue at a desired location or locations. In an embodiment of the invention, the electrode assembly 38 may include a basket-shaped electrode assembly attached to a basket catheter (as described in the description below with reference to FIG. 2) or a balloon electrode assembly attached to a balloon catheter.

[0029] 1, the control console 24 is connected via a cable 40 to body surface electrodes, which typically comprise adhesive skin patches 42 attached to the patient 30. The control console 24 includes a processor 44 that, in conjunction with a current tracking module 46, determines location coordinates of the distal end 26 within the heart 28 based on impedance and / or current measured between the adhesive patch 42 and electrodes 48 (FIG. 2) that are attached to splines of the electrode assembly 38. In addition to being used as location sensors during a medical procedure, the electrodes 48 may perform other tasks, such as measuring electrical activity of the heart 28.

[0030] As mentioned above, in conjunction with the current tracking module 46, the processor 44 may determine location coordinates of the distal end 26 within the heart 28 based on the impedance and / or current measured between the adhesive skin patch 42 and the electrodes 48. Such determination is typically after a calibration process has been performed that relates the impedance or current to known locations of the distal end. In embodiments of the invention, the electrodes 48 may also be configured to apply signals to tissue within the heart 28 and / or measure certain physiological properties (e.g., local surface potentials) at locations within the heart.

[0031] The processor 44 may include a real-time noise reduction circuit 50, typically configured as a field programmable gate array (FPGA), followed by an analog-to-digital (A / D) signal conversion integrated circuit 52. The processor may pass signals from the A / D circuit 52 to another processor and / or may be programmed to determine the location coordinates referred to above.

[0032] 1 uses impedance or current based sensing to measure the location of the distal end 26, although other location tracking techniques may be used (e.g., techniques using magnetic based sensors). Impedance and current based location tracking techniques are described, for example, in U.S. Patent Nos. 5,983,126, 6,456,864, and 5,944,022. The location sensing methods described herein above are implemented in the CARTO® system mentioned above and are described in detail in the above-cited patents.

[0033] The control console 24 also includes an input / output (I / O) communication interface 54 that allows the control console to transfer signals from the electrodes 48 and the adhesive skin patch 42. Based on signals received from the electrodes 48 and / or the adhesive skin patch 42, the processor 44 can generate an electroanatomical map 56 that indicates the location of the distal end 26 within the patient's body. During a procedure, the processor 44 can present the map 56 to the medical professional 36 on a display 58 and store data representing the electroanatomical map in a memory 60. The memory 60 may comprise any suitable volatile and / or non-volatile memory, such as a random access memory or a hard disk drive. In some embodiments, the medical professional 36 can manipulate the map 56 using one or more input devices 62. In an alternative embodiment, the display 58 may comprise a touch screen that may be configured to receive input from the medical professional 36 in addition to presenting the map 56.

[0034] In the example shown in FIG. 2, the electrode assembly 38 is configured as a basket-shaped electrode assembly having a number of splines 70 connected at their proximal and distal ends. The basket-shaped electrode assembly 38 has an expanded configuration in which the splines 70 bend radially outward and a folded configuration in which the splines are disposed generally along the axis of the insertion tube 32. In some embodiments, the distance between the proximal and distal ends of the basket-shaped electrode assembly 38 can be shortened, such as by moving the puller wire 72 proximally, to bend the splines 70 outward into the expanded configuration. During a medical procedure, the basket-shaped electrode assembly 38 can be adopted in the expanded configuration when unconstrained, such as by being advanced out of a lumen 74 at the distal end 26.

[0035] Each given spline 70 includes one or more electrodes 48. In addition to using the electrodes 48 to determine the location of the basket-shaped electrode assembly 38, the electrodes can also be used to measure physiological properties such as local surface potentials at their respective locations on the myocardial tissue 110. In further embodiments, the electrodes 48 can be configured to deliver ablation power (e.g., radio frequency energy) to the myocardial tissue.

[0036] Figure 3 is a flow diagram that generally illustrates a method of providing visual feedback to a medical professional 36 for guiding a balloon 38 within a heart 28, according to an embodiment of the present invention, and Figure 4 is a schematic pictorial illustration of an electrode 48 engaging myocardial tissue 110 of a heart during a medical procedure, according to an embodiment of the present invention. Although the steps of the flow diagram are described using a medical probe 22 that includes an electrode 48 mounted on a basket-shaped electrode assembly 38, it is considered within the spirit and scope of the present invention to use any other type of medical probe, e.g., a balloon catheter, that includes multiple electrodes that can simultaneously measure physiological characteristics at respective locations of the myocardial tissue 110.

[0037] At an insertion step 80, the medical professional 36 inserts the distal end 26 of the medical probe 22 into the ventricle 28 of the heart. Once the distal end 26 is inserted into the chamber, the medical professional 36 can deploy the balloon 38 from the lumen 72 and inflate the balloon using the embodiments described above.

[0038] In a positioning step 82, the medical professional 36 manipulates the handle 34 so that the electrode 48 at the distal end 26 engages an area 112 on the myocardial tissue 110 having the arrhythmia.

[0039] In a first receiving step 84, the processor 44 receives first signals from the at least three electrodes 48 responsive to electrical activity in the myocardial tissue engaged by the electrodes. In some embodiments, the electrical activity is indicative of local activation times within the myocardial tissue.

[0040] In a second receiving step 86, the processor receives a second signal indicative of the respective locations of the electrodes engaging the myocardial tissue. In the configuration shown in Figure 1, the processor 44 receives the second signal from the body surface electrodes in the adhesive skin patch 42 in response to the current delivered by the processor to the electrodes 48.

[0041] In a calculation step 88, the processor 44 processes the received second signal to calculate the locations of each of the electrodes engaging the myocardial tissue 110, and in a determination step 90, the processor determines the geometric center 114 of the calculated locations on the myocardial tissue.

[0042] In a generating step 92, the processor 44 generates an electroanatomical map 56 based on the received first and second signals for the region 112, and in an identifying step 94, the processor identifies arrhythmia foci in the electroanatomical map. Arrhythmias may be identified using local activation times (LAT) of myocardial tissue, and the processor may identify specific arrhythmia foci using the tissue LAT. For example, the processor may identify focal arrhythmia foci as regions of arrhythmic tissue having the lowest LAT, and rotor foci as regions of arrhythmic tissue around which the LAT values ​​rotate. Implementations of this embodiment that use other methods for the processor 44 to identify arrhythmia foci are also considered to be within the scope of the present invention.

[0043] In a first presentation step 96, the processor 44 presents a circle on the display 58, and in a second presentation step 98, the processor presents within the circle the geometric center and the region of the electroanatomical map containing the arrhythmia focus such that the geometric center of the electroanatomical map is aligned with the center of the circle.

[0044] As presented in Figures 5-9 described herein below, regions of the map presented within circles indicate the spatial relationship between the geometric center and the arrhythmia foci. In some embodiments, processor 44 can present the spatial relationship by plotting local activation time values ​​versus their respective locations.

[0045] FIG. 5 is a schematic pictorial diagram of an electroanatomical map 56 presented on a display 58, according to a first embodiment of the invention. In the first embodiment of the invention, the processor 44 presents the electroanatomical map 56 in a first window 120 and a circle 122 in a second window 124 on the display 58. The circle 122 corresponds to a region of the electroanatomical map 56 such that a center 126 of the circle 122 is aligned with a geometric center 128 of the arrhythmia 130. In some embodiments, the processor 44 may present a visual indicator 132 (e.g., an icon) that corresponds to a location of the arrhythmia focus 136 and indicates a spatial relationship between the geometric center 128 and the arrhythmia focus. In an embodiment of the invention, the processor 44 may present the spatial relationship as a "bull's eye" that indicates a distance 134 between the visual indicator 132 (corresponding to the focus 136) and the circle center 126 (corresponding to the geometric center 128).

[0046] In an embodiment of the invention, the processor 44 may present the map 56 at a first resolution and present a circle 122 including an area on the myocardial tissue having an arrhythmia at a second resolution that is greater than the first resolution. Presenting the area on the myocardial tissue having an arrhythmia at a higher resolution (and thus presenting the area having the arrhythmia in greater detail) may assist the medical professional 36 in positioning the electrodes 48 at appropriate locations to treat the arrhythmia 130.

[0047] 6 is a schematic, pictorial illustration of an electroanatomical map 56 presented on a display 58, in accordance with a second embodiment of the present invention. In the second embodiment of the present invention, processor 44 presents electroanatomical map 56 on display 58 and superimposes circle 122 and visual indicator 132 onto electroanatomical map 56 such that circle center 126 is aligned with geometric center 128 and visual indicator 132 is aligned with arrhythmia focus 136.

[0048] In a third embodiment, the processor 44 may combine the first and second embodiments described above by presenting a circle 122 and a visual indicator 132 in the window 124, presenting an electro-anatomical map 56 in the window 120, and superimposing the circle and the visual indicator on the electro-anatomical map.

[0049] 5 (and FIGS. 6-9), the geometric center 128 is very close to the lesion 136, and the processor 44 presents the visual indicator 132 within the circle 122. However, if the geometric center 128 is not close to the lesion 136, the processor 44 may present the visual indicator 132 outside of the circle 122.

[0050] Returning to the flow diagram, at decision step 100, if the medical professional 36 observes that the ablation focus is not at the center of the circle (e.g., as shown in Figures 5, 6, 7A, 8A, and 9A), then the medical professional repositions the distal end 26 at repositioning step 102 and the method continues at step 84. If the medical professional 36 observes that the ablation focus is at the center of the circle (e.g., as shown in Figures 7B, 8B, and 9B), the method ends. In some cases, the medical professional can command the control console 24 to deliver ablation power (e.g., radio frequency energy) to the electrodes 48 to ablate a region of myocardial tissue containing the arrhythmia.

[0051] Figures 7A and 7B, collectively also referred to herein as Figure 7, are schematic pictorial illustrations of circle 122 and visual indicator 132 of arrhythmia 130, including focal arrhythmia, in accordance with an embodiment of the present invention. In Figure 7A, visual indicator 132 is not aligned with circle center 126, thereby indicating that geometric center 128 is not aligned with focus 136. In Figure 7B, visual indicator 132 is aligned (i.e., overlaps) with circle center 126, thereby indicating that geometric center 128 is aligned with focus 136.

[0052] 8A and 8B, also collectively referred to herein as FIG. 8, are schematic pictorial illustrations of a circle 122 and visual indicator 132 of an arrhythmia 130, including a rotor arrhythmia having a single focus 136, in accordance with an embodiment of the present invention. In the example presented in FIG. 8A and 8B, an arrow 140 indicates the path of the arrhythmia from the focus 136 in the myocardial tissue 110. In FIG. 8A, the visual indicator 132 is not aligned with the circle center 126, thereby indicating that the geometric center 128 is not aligned with the focus 136. In FIG. 8B, the visual indicator 132 is aligned (i.e., overlaps) with the circle center 126, thereby indicating that the geometric center 128 is aligned with the focus 136.

[0053] 9A and 9B, also collectively referred to herein as FIG. 9, are schematic pictorial illustrations of a circle 122 and visual indicator 132 of an arrhythmia 130, including a rotor arrhythmia having two foci 136, in accordance with an embodiment of the present invention. In the example presented in FIG. 9A and 9B, arrows 150 and 152 indicate the path of the arrhythmia from the foci 136 in the myocardial tissue 110. In FIG. 9A, the visual indicator 132 is not aligned with the circle center 126, thereby indicating that the geometric center 128 is not aligned with the foci 136. In FIG. 9B, the visual indicator 132 is aligned (i.e., overlaps) with the circle center 126, thereby indicating that the geometric center 128 is aligned with the foci 136.

[0054] Although the description with reference to Figures 5, 6, 7, 8, and 9 describes the processor 44 presenting a circle 122 on the display 58, it is believed to be within the spirit and scope of the present invention to show any type of oval that corresponds to a region of the map 56.

[0055] It will be understood that the embodiments described above are given by way of example, and that the present invention is not limited to what has been particularly shown and described above. Rather, the scope of the present invention includes both combinations and subcombinations of the various features as 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.

[0056] [Embodiment] (1) A method comprising: receiving, from an intracardiac catheter having a distal end including a plurality of electrodes within a subject's heart, a first signal from at least three of the electrodes in response to electrical activity of myocardial tissue in contact with the at least three of the electrodes; receiving a second signal indicative of location coordinates of each of the at least three electrodes within the heart; processing the second signal to calculate location coordinates of each of the at least three electrodes and to determine a geometric center of the respective location coordinates; generating an electroanatomical map for a region of the myocardial tissue that includes the determined geometric center based on the first signal and the second signal; determining within said map a focus of arrhythmias within said region of said myocardial tissue; presenting a circle on a display; presenting within the circle a region of the map including the geometric center and the focus of the arrhythmia and aligning the geometric center on the map with the center of the circle, wherein the region of the map presented within the circle indicates a spatial relationship between the geometric center and the focus of the arrhythmia. (2) The method of embodiment 1, wherein the electrical activity includes a local activation time value. (3) The method of embodiment 2, wherein presenting the region of the map containing the focus of the arrhythmia includes plotting the local activation time values ​​against their respective locations. (4) The method of embodiment 1, wherein the arrhythmia comprises a rotor having at least one focus. (5) The method of embodiment 1, wherein the arrhythmia includes focal arrhythmia.

[0057] (6) The method of embodiment 1, wherein presenting the region of the map that includes the geometric center includes presenting an icon within the circle at a position corresponding to the location of the focus of the arrhythmia relative to the geometric center. (7) The method of embodiment 1, wherein presenting the circle and the region of the map includes overlaying the circle on the electroanatomical map. (8) The method of embodiment 1, further comprising presenting within the circle a path of the arrhythmia from the focus of the arrhythmia. (9) The method of embodiment 1, wherein the intracardiac catheter comprises a balloon catheter. (10) The method of embodiment 1, wherein the intracardiac catheter comprises a basket catheter.

[0058] (11) The method of embodiment 1, wherein generating the electroanatomical map includes presenting the map on the display at a first resolution and presenting the region includes presenting the region at a second resolution higher than the first resolution. (12) An apparatus comprising: an intracardiac catheter configured to be inserted into a chamber of the heart; a plurality of electrodes attached to a distal end of the intracardiac catheter; A display and 1. A processor comprising: receiving, from the intracardiac catheter inserted into a given heart chamber, first signals from at least three of the electrodes in response to electrical activity of myocardial tissue in contact with the at least three of the electrodes; receiving a second signal indicative of location coordinates of each of the at least three electrodes within the heart; processing the second signal to calculate location coordinates of each of the at least three electrodes and to determine a geometric center of the respective location coordinates; generating an electroanatomical map for a region of the myocardial tissue that includes the determined geometric center based on the first signal and the second signal; determining within said map a focus of arrhythmia within said region of said myocardial tissue; presenting a circle on the display; presenting within the circle an area of ​​the map that includes the geometric center and the focus of the arrhythmia, and aligning the geometric center on the map with the center of the circle; and a processor configured to: determine a region of the map presented within the circle, the region of the map indicating a spatial relationship between the geometric center and the focus of the arrhythmia. (13) The device of embodiment 12, wherein the electrical activity comprises a local activation time value. (14) The device of embodiment 13, wherein the processor is configured to present the regions of the map according to the foci of the arrhythmia including plotting the local activation time values ​​against their respective locations. (15) The device of embodiment 12, wherein the arrhythmia comprises a rotor having at least one focus.

[0059] (16) The device of embodiment 12, wherein the arrhythmia includes focal arrhythmia. (17) The device of embodiment 12, wherein the processor is configured to present the region of the map including the geometric center by presenting an icon within the circle at a position corresponding to a location of the focus of the arrhythmia relative to the geometric center. (18) The apparatus of claim 12, wherein the processor is configured to present the circle and the region of the map by overlaying the circle on the electroanatomical map. (19) The device of embodiment 12, wherein the processor is further configured to present within the circle a path of the arrhythmia from the focus of the arrhythmia. (20) The apparatus of embodiment 12, wherein the intracardiac catheter comprises a balloon catheter.

[0060] (21) The apparatus of embodiment 12, wherein the intracardiac catheter comprises a basket catheter. (22) The device of embodiment 12, wherein the processor is configured to generate the electroanatomical map by presenting the map on the display at a first resolution, and the processor is configured to present the region by presenting the region at a second resolution that is higher than the first resolution. (23) A computer software product operating in conjunction with an intracardiac catheter having a distal end including a plurality of electrodes, the product including a non-transitory computer-readable medium having stored thereon program instructions which, when read by a computer, cause the computer to: receiving, from the intracardiac catheter positioned within a subject's heart, first signals from at least three of the electrodes in response to electrical activity of myocardial tissue in contact with the at least three of the electrodes; receiving a second signal indicative of location coordinates of each of the at least three electrodes within the heart; processing the second signal to calculate location coordinates of each of the at least three electrodes and to determine a geometric center of each of the location coordinates; generating an electroanatomical map for a region of the myocardial tissue that includes the determined geometric center based on the first signal and the second signal; determining within said map a focus of arrhythmia within said region of said myocardial tissue; A circle is presented on the display. a region of the map including the geometric center and the focus of the arrhythmia presented within the circle, the geometric center on the map being aligned with the center of the circle, and the region of the map presented within the circle indicating a spatial relationship between the geometric center and the focus of the arrhythmia.

Claims

1. A method of operating an apparatus comprising an intracardiac catheter, a plurality of electrodes attached to a distal end of the intracardiac catheter, a display, and a processor, comprising: receiving, from the intracardiac catheter, first signals from at least three of the plurality of electrodes in response to electrical activity of myocardial tissue in contact with the at least three of the plurality of electrodes; receiving, by the processor, a second signal indicative of a location coordinate of each of the at least three electrodes in response to the current delivered to each of the at least three electrodes; the processor processes the second signal to calculate location coordinates of each of the at least three electrodes and to determine a geometric center of the respective location coordinates; generating, based on the first signal and the second signal, an electroanatomical map for a region of the myocardial tissue that includes the determined geometric center; the processor determining, within the map, foci of arrhythmia within the region of the myocardial tissue; the processor presenting, on the display, a circle; The method includes: the processor presenting, within the circle, a region of the map including the geometric center and the focus of the arrhythmia and aligning the geometric center on the map with the center of the circle, wherein the region of the map presented within the circle indicates a spatial relationship between the geometric center and the focus of the arrhythmia.

2. The method of claim 1 , wherein the electrical activity comprises local activation time values.

3. The method of claim 2 , wherein presenting the regions of the map containing the foci of the arrhythmia comprises plotting the local activation time values ​​against their respective locations.

4. The method of claim 1 , wherein the arrhythmia comprises a rotor arrhythmia having at least one focus.

5. The method of claim 1 , wherein the arrhythmia comprises a focal arrhythmia.

6. 2. The method of claim 1, wherein presenting the region of the map that includes the geometric center comprises presenting an icon within the circle at a position corresponding to a location of the focus of the arrhythmia relative to the geometric center.

7. The method of claim 1 , wherein presenting the circle and the region of the map comprises overlaying the circle on the electroanatomical map.

8. The method of claim 1, further comprising the processor presenting within the circle a path of the arrhythmia from the focus of the arrhythmia.

9. The method of claim 1 , wherein the intracardiac catheter comprises a balloon catheter.

10. The method of claim 1 , wherein the intracardiac catheter comprises a basket catheter.

11. 2. The method of claim 1 , wherein generating the electroanatomical map comprises presenting the map on the display at a first resolution, and presenting the regions comprises presenting the regions at a second resolution that is higher than the first resolution.

12. An apparatus comprising: an intracardiac catheter configured to be inserted into a chamber of the heart; a plurality of electrodes attached to a distal end of the intracardiac catheter; A display and 1. A processor comprising: receiving, from the intracardiac catheter inserted into a given heart chamber, first signals from at least three of the plurality of electrodes in response to electrical activity of myocardial tissue contacting the at least three of the plurality of electrodes; receiving a second signal indicative of location coordinates of each of the at least three electrodes within the heart in response to the current delivered to each of the at least three electrodes; processing the second signal to calculate location coordinates of each of the at least three electrodes and to determine a geometric center of the respective location coordinates; generating an electro-anatomical map for a region of the myocardial tissue that includes the determined geometric center based on the first signal and the second signal; determining within said map a focus of arrhythmia within said region of said myocardial tissue; presenting a circle on the display; presenting within the circle an area of ​​the map that includes the geometric center and the focus of the arrhythmia, and aligning the geometric center on the map with the center of the circle; and a processor configured to: determine a region of the map presented within the circle, the region of the map indicating a spatial relationship between the geometric center and the focus of the arrhythmia.

13. The apparatus of claim 12 , wherein the electrical activity comprises a local activation time value.

14. 14. The apparatus of claim 13, wherein the processor is configured to present the regions of the map according to the foci of the arrhythmia including plotting the local activation time values ​​versus their respective locations.

15. The apparatus of claim 12 , wherein the arrhythmia comprises a rotor arrhythmia having at least one focus.

16. The device of claim 12 , wherein the arrhythmia comprises a focal arrhythmia.

17. 13. The apparatus of claim 12, wherein the processor is configured to present the region of the map that includes the geometric center by presenting an icon within the circle at a position corresponding to a location of the focus of the arrhythmia relative to the geometric center.

18. The apparatus of claim 12 , wherein the processor is configured to present the circle and the region of the map by overlaying the circle on the electro-anatomical map.

19. 13. The apparatus of claim 12, wherein the processor is further configured to present, within the circle, a path of the arrhythmia from the focus of the arrhythmia.

20. The apparatus of claim 12 , wherein the intracardiac catheter comprises a balloon catheter.

21. The apparatus of claim 12 , wherein the intracardiac catheter comprises a basket catheter.

22. 13. The apparatus of claim 12, wherein the processor is configured to generate the electroanatomical map by presenting the map on the display at a first resolution, and the processor is configured to present the regions by presenting the regions at a second resolution that is higher than the first resolution.

23. 1. A computer software product operating in conjunction with an intracardiac catheter having a distal end including a plurality of electrodes, the computer software product including a non-transitory computer readable medium having stored thereon program instructions that, when read by a computer, cause the computer to: receiving, from the intracardiac catheter positioned within a subject's heart, first signals from at least three of the plurality of electrodes in response to electrical activity of myocardial tissue in contact with the at least three of the plurality of electrodes; receiving a second signal indicative of location coordinates of each of the at least three electrodes within the heart in response to the current delivered to each of the at least three electrodes; processing the second signal to calculate location coordinates of each of the at least three electrodes and to determine a geometric center of each of the location coordinates; generating an electroanatomical map for a region of the myocardial tissue that includes the determined geometric center based on the first signal and the second signal; determining within said map a focus of arrhythmia within said region of said myocardial tissue; A circle is presented on the display. a region of the map including the geometric center and the focus of the arrhythmia presented within the circle, the geometric center on the map being aligned with the center of the circle, and the region of the map presented within the circle indicating a spatial relationship between the geometric center and the focus of the arrhythmia.

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