Systems and methods for cardiac ventricular visualization

Abstract

To provide systems, methods, apparatuses and programs for improved cardiac chamber visualization.SOLUTION: A system and method for visualizing a cardiac structure of interest includes at least one imaging device that obtains image data of a cardiac structure of interest from within the cardiac structure, and a processor comprising a memory. The processor is configured to: receive and store model data of the cardiac structure of interest; determine at least one location for positioning the at least one imaging device within the cardiac structure of interest to obtain image data of the cardiac structure of interest; receive the image data from the at least one imaging device positioned at the at least one determined location within the cardiac structure of interest; and generate a 3D electrophysiological map of the cardiac structure of interest from within the electrophysiological map.SELECTED DRAWING: Figure 1

Description

[Technical Field]

[0001] The present invention relates to a system, method, device, and program for improved cardiac ventricular visualization. [Background technology]

[0002] Visualization of cardiac structures is important for monitoring and diagnosing cardiac health and performing certain cardiac procedures. For example, cardiac arrhythmias, such as atrial or ventricular fibrillation, ventricular tachycardia, and atrial flutter, are potentially significant causes of morbidity and mortality. Treatment of such cardiac conditions often requires obtaining detailed mapping of cardiac tissue, chambers, veins, arteries, and / or electrical pathways to aid in identifying problem areas, such as scar tissue, arrhythmia sources (e.g., electrical rotors), and healthy areas. As a prerequisite for performing cardiac procedures, such as catheter ablation, the source of the cardiac arrhythmia must be precisely localized within the heart chambers. Such localization can be performed via electrophysiological studies to generate electrophysiological (EP) cardiac maps, in which 3D mapping data can be displayed on a monitor.

[0003] Viewing ablation targets or sites is currently cumbersome in current EP cardiac maps, which are viewed from outside the heart chamber or cardiac region of interest, and require tedious steps of rotating and zooming the EP map to view ablation sites, such as within the pulmonary veins, from multiple perspectives.

[0004] It would be advantageous for a physician, such as a cardiologist, to be able to view potential sites for ablation in a single view without having to rotate and zoom the EP cardiac map. Additionally, it would be advantageous for a physician to view the EP cardiac map from inside a cardiac chamber to provide a more complete visualization of a cardiac site targeted for ablation, such as within a pulmonary vein, in a single view. Summary of the Invention [Means for solving the problem]

[0005] Disclosed herein are systems, methods, devices, and programs for improved cardiac ventricular visualization.

[0006] According to one aspect, the subject matter disclosed herein relates to a system for visualizing a cardiac structure of interest. The system includes at least one imaging device configured to acquire image data of the cardiac structure of interest from within the cardiac structure, and a processor configured to receive and store model data of the cardiac structure of interest, determine at least one location within the cardiac structure of interest for positioning the at least one imaging device to acquire the image data of the cardiac structure of interest, receive image data from the at least one imaging device positioned at the determined at least one location within the cardiac structure of interest, and generate a 3D electrophysiological map from within an electrophysiological map of the cardiac structure of interest based on the received image data.

[0007] According to another aspect, the subject matter disclosed herein relates to a method for visualizing a cardiac structure of interest, the method including acquiring model data of the cardiac structure of interest, determining at least one location for positioning at least one imaging device within the cardiac structure of interest to acquire image data of the cardiac structure of interest, positioning the at least one imaging device at the determined at least one location within the cardiac structure of interest, generating image data of the cardiac structure of interest from the determined at least one location within the cardiac structure of interest, and generating a 3D electrophysiological map from an electrophysiological map of the cardiac structure of interest based on the generated image data.

[0008] According to yet another aspect, the subject matter disclosed herein relates to a non-transitory computer-readable recording medium storing program instructions for visualizing a cardiac structure of interest by causing a computer to perform the following steps: acquiring model data of the cardiac structure of interest; determining at least one location for positioning at least one imaging device within the cardiac structure of interest to acquire image data of the cardiac structure of interest; positioning the at least one imaging device at the determined at least one location within the cardiac structure of interest; generating image data of the cardiac structure of interest from the determined at least one location within the cardiac structure of interest; and generating a 3D electrophysiological map from an electrophysiological map of the cardiac structure of interest based on the generated image data. [Brief explanation of the drawings]

[0009] A more detailed understanding may be had from the following description, given by way of example in conjunction with the accompanying drawings, in which like reference numerals indicate similar elements and in which: [Figure 1] FIG. 1 is a block diagram depicting an exemplary computing environment of a system for improved cardiac visualization, according to a disclosed embodiment of the present application. [Figure 2] 1 illustrates an exemplary electrophysiological (EP) mapping system capable of implementing one or more features of the disclosed subject matter, according to disclosed embodiments of the present application. [Figure 3A] FIG. 1 shows a conventional view of an EP map of the left atrium showing the pulmonary veins as viewed from outside the heart chamber or outside the EP map. [Figure 3B] FIG. 1 shows a conventional view of an EP map of the left atrium showing the pulmonary veins as viewed from outside the heart chamber or outside the EP map. [Figure 4] 1 shows a conventional EP map of the left atrium showing locations identified for ablation. [Figure 5] FIG. 1 is a flow diagram illustrating an exemplary process for generating an EP map of a chamber or cardiac region of interest from within a utilized EP map, according to one disclosed embodiment of the present application. [Figure 6A] 10A-10C illustrate exemplary EP maps of the left atrium showing full visualization of delineated pulmonary veins from within each EP map, according to one disclosed embodiment of the present application. [Figure 6B] 10A-10C illustrate exemplary EP maps of the left atrium showing full visualization of delineated pulmonary veins from within each EP map, according to one disclosed embodiment of the present application. [Figure 6C] 6B illustrates the EP map of FIG. 6A showing a complete view of the identified locations for ablation around the depicted pulmonary veins as viewed from within the EP map, according to one disclosed embodiment of the present application. [Figure 7] FIG. 10 is a flow diagram illustrating an exemplary process for generating an EP map of a chamber or cardiac region of interest from within an EP map, according to another disclosed embodiment of the present application. [Figure 8] 3 shows an exemplary skeletal axis displayed on 3D model data of the left atrium 310, according to one disclosed embodiment of the present application. [Figure 9A] 1 illustrates an imaging device positioned in the left atrium to obtain a view of the right superior pulmonary vein (RSPV) and right inferior pulmonary vein (RIPV) from inside the ventricle, according to one disclosed embodiment of the present application. [Figure 9B] 9B shows images of the RSPV and RIPV from inside the ventricle obtained from the imaging device shown in FIG. 9A. [Figure 10A] 1 illustrates an imaging device positioned within the left atrium to obtain a view of the left superior pulmonary vein (LSPV), left inferior pulmonary vein (LIPV), and left atrial appendage (LAA) from inside the ventricle, according to one disclosed embodiment of the present application. [Figure 10B] 10B shows images of the LSPV, LIPV, and LAA from inside the ventricle obtained from the imaging device shown in FIG. 10A. [Figure 11A] 1 illustrates an imaging device positioned in the left atrium to obtain a view of the LIPV from inside the LIPV, according to one disclosed embodiment of the present application. [Figure 11B] 11B shows an image of the LIPV from inside the LIPV, obtained from the imaging device shown in FIG. 11A. DETAILED DESCRIPTION OF THE INVENTION

[0010] Disclosed herein are methods, devices, systems, and programs for improved ventricular visualization.

[0011] Cardiac arrhythmias, including atrial arrhythmias, can be multiwavelet reentrant, characterized by multiple asynchronous loops of electrical impulses that scatter, often self-propagating, around the atria. Alternatively, or in addition to multiwavelet reentrant, cardiac arrhythmias can also have a local origin, such as when isolated regions of atrial tissue are autonomously excited in a rapid, repetitive manner. Patients with cardiac arrhythmias can be treated with catheter ablation.

[0012] Catheter ablation-based therapy may involve mapping cardiac tissue, particularly the endocardium, cardiac volumes, selective cardiac chambers, and pulmonary veins, and selectively ablating the cardiac tissue through the application of energy. Cardiac mapping, such as creating electrophysiological (EP) maps (voltage maps) of the electrical potential of wave propagation along cardiac tissue, or maps of arrival times to points where various tissues are located (local time activation (LAT) maps), can be used to detect local dysfunction of cardiac tissue. Ablation, such as ablation based on EP cardiac mapping, can stop or modify the propagation of unwanted electrical signals from one part of the heart to another.

[0013] Ablation techniques disrupt unwanted electrical pathways by creating non-conducting lesions. Various energy delivery modalities have been previously disclosed for creating lesions, including the use of microwave, laser, and more commonly, radiofrequency energy to create conduction blocks along cardiac tissue walls. In a two-stage procedure, EP mapping followed by ablation, electrical activity at each point within the heart is typically sensed and measured by advancing a catheter containing one or more electrical sensors (or electrodes) into the heart and acquiring data at multiple points. These data are then used to select a target region of the endocardium where ablation will be performed.

[0014] Cardiac ablation and other cardiac electrophysiology procedures are becoming increasingly complex as physicians treat challenging conditions such as atrial fibrillation and ventricular tachycardia. Treatment of complex arrhythmias can now rely on the use of three-dimensional (3D) electrophysiological (EP) mapping systems to reconstruct the anatomical structure of the cardiac chamber of interest. For example, cardiologists rely on the CARTO® 3 3D mapping system, manufactured by Biosense Webster, Inc. (Diamond Bar, Calif.), to analyze cardiac tissue and determine ablation points for the treatment of a wide range of cardiac conditions. 3D EP maps can provide multiple pieces of information about the electrophysiological properties of cardiac tissue, describing the anatomical and functional substrates of these challenging arrhythmias.

[0015] Electrode catheters have been commonly used in medical practice for many years. They are used to stimulate and map electrical activity within the heart and to ablate sites of abnormal electrical activity. In use, an electrode catheter is inserted into a major vein or artery, such as the femoral artery, and then guided into a target heart chamber. A typical ablation procedure involves inserting a catheter with at least one electrode at its distal end into a heart chamber. A reference electrode is typically provided by a second catheter taped to the patient's skin or positioned within or near the heart. When RF (radio frequency) current is applied to the tip electrode of the ablation catheter, current flows through the medium surrounding the tip electrode (i.e., blood and tissue) toward the reference electrode. The distribution of the current depends on the amount of electrode surface in contact with the tissue compared to blood, which has a higher electrical conductivity than tissue. Tissue heating occurs due to the electrical resistance of the tissue. Sufficient tissue heating can cause cell destruction in the cardiac tissue, resulting in lesions within the non-conductive cardiac tissue.

[0016] In one embodiment, EP cardiac mapping can be implemented by sensing electrical properties of cardiac tissue, e.g., local activation time (LAT), as a function of precise location within the heart. The corresponding data can be acquired using one or more catheters advanced into the heart using catheters having electrical and location sensors at their distal tips. By way of example, location and electrical activity can initially be measured at about 10 to about 20 points on the inner surface of the heart. These data points can generally be sufficient to generate a preliminary reconstruction or map of the cardiac surface with satisfactory quality. This preliminary map can be combined with data acquired at additional points to generate a more comprehensive map of the cardiac electrical activity. In clinical settings, it is not uncommon to collect data at 100 or more sites to generate a detailed, comprehensive map of the cardiac chamber's electrical activity. The detailed map can then serve as a basis for making decisions regarding therapeutic action, e.g., tissue ablation, to alter the propagation of the cardiac electrical activity and restore normal cardiac rhythm.

[0017] 1 is a block diagram depicting a computing environment of an exemplary system 100 for improved cardiac visualization in accordance with the subject matter of the present application. In the example shown in FIG. 1, system 100 comprises a biometric device 102 associated with a patient 104, a local computing device 106, optionally a remote computing system 108, a first network 110, and a second network 120. In one embodiment, system 100 can be used with an EP mapping system.

[0018] According to one embodiment, the monitoring and processing unit 102 may be a device internal to the patient's body (e.g., subcutaneously implantable). The biometric device 102 may be inserted into the patient via any applicable method, including surgical insertion via a vein or artery, an endoscopic procedure, or a laparoscopic procedure. According to one embodiment, the biometric device 102 may also include a catheter with one or more electrodes or probes, or an imaging device. According to one embodiment, the biometric device 102 may include both components internal to the patient and components external to the patient.

[0019] A single biometric device 102 is shown in Figure 1. However, one or more monitoring and processing devices 102 may be used to acquire patient biometric data (e.g., electrical signals, image data, or other biometric data) and receive at least a portion of the patient biometric data representing the acquired patient biometric indicators. Each biometric device 102 may process data including its own acquired patient biometric indicators as well as data received from one or more other monitoring and processing devices 102.

[0020] 1, network 110 is an example of a short-range network (e.g., a local area network (LAN) or a personal area network (PAN)). Information may be transmitted over short-range network 110 between monitoring and processing equipment 102 and local computing device 106 using any one of a variety of short-range wireless communication protocols, such as Bluetooth, Wi-Fi, Zigbee, Z-Wave, near field communication (NFC), Ultraband, Zigbee, or infrared (IR).

[0021] Network 120 may be a wired network, a wireless network, or may include one or more wired and wireless networks. For example, network 120 may be a long-range network (e.g., a wide area network (WAN), the Internet, or a cellular network). Information may be transmitted over network 120 using any one of a variety of long-range wireless communication protocols (e.g., TCP / IP, HTTP, 3G, 4G / LTE, or 5G / New Radio).

[0022] The patient biometric device 102 may include a patient biometric sensor 112, a processor 114, a memory 118, and a transmitter-receiver (i.e., transceiver) 122. The patient biometric device 102 may continuously or periodically monitor, store, process, and communicate any number of various patient biometric indicators over the network 110. Examples of patient biometric indicators include, but are not limited to, electrical signals and imaging signals. The patient biometric indicators may be monitored and communicated to treat any number of various disorders, such as cardiovascular disease (e.g., arrhythmia, cardiomyopathies, and coronary artery disease).

[0023] The patient biometric sensor 112 may include, for example, one or more sensors configured to sense a type of biometric patient biometric indicator. For example, the patient biometric sensor 112 may include electrodes configured to acquire electrical signals (e.g., cardiac signals) or image signals.

[0024] The transceiver 122 may include a separate transmitter and receiver, or alternatively, the transceiver 122 may include a transmitter and receiver integrated into a single device.

[0025] The processor 114 may be configured to store patient data, such as patient biometric data acquired by the patient biometric sensor 112, in the memory 118 and to communicate the patient data over the network 110 via the transmitter of the transceiver 122. Data from one or more other biometric devices 102 may also be received by the receiver of the transceiver 122.

[0026] The local computing device 106 of the system 100 may be configured to communicate with the patient biometric device 102 and act as a gateway to the remote computing system 108 via the second network 120. The local computing device 106 may be, for example, a smartphone, smartwatch, tablet, or other portable smart device configured to communicate with other devices via the network 120. Alternatively, the local computing device 106 may be a fixed or stand-alone device, such as, for example, a fixed base station including modem and / or router capabilities, a desktop or laptop computer using an executable program to communicate information between the processing unit 102 and the remote computing system 108 via a wireless module in a PC, or a USB dongle. Patient biometric indicators may be communicated between the local computing device 106 and the patient biometric device 102 via a short-range wireless network 110, such as a local area network (LAN) (e.g., a personal area network (PAN)), using short-range wireless technology standards (e.g., Bluetooth, Wi-Fi, ZigBee, Z-Wave, and other short-range wireless standards). In some embodiments, the local computing device 106 may also be configured to display the acquired patient electrical signals and information related to the acquired patient electrical signals, as described in more detail below.

[0027] In some embodiments, the remote computing system 108 may be configured to receive at least one of the monitored patient's biometric indicators and information associated with the monitored patient over the network 120, which is a long-range network. For example, if the local computing device 106 is a cellular phone, the network 120 may be a wireless cellular network, and information may be communicated between the local computing device 106 and the remote computing system 108 via a wireless technology standard, such as any of the wireless technologies described above. As described in more detail below, the remote computing system 108 may be configured to provide (e.g., visually display and / or audibly provide) at least one of the patient's biometric indicators and associated information to a medical professional (e.g., a physician).

[0028] In one embodiment, the remote computing system 108 can be incorporated into a public cloud computing platform (such as Amazon Web Services or Microsoft Azure), a hybrid cloud computing platform (such as HP Enterprise OneSphere), or a private cloud computing platform. In one embodiment, the remote computing system 108 can include one or more processors that perform various functions, including, but not limited to, analyzing monitored patient biometric indicators and providing alerts, additional information, or instructions according to physician-determined or algorithm-driven thresholds and parameters. The remote computing system 108 can be used to provide a dashboard of patient information to medical personnel, such that such information can enable medical personnel to identify and prioritize patients with more significant needs than others.

[0029] FIG. 2 is a diagram of an exemplary EP mapping system 200 capable of implementing one or more features of the disclosed subject matter. EP mapping system 200 may include one or more biometric devices 220 (shown in inset 225), such as catheter 240 (shown in inset 245), or imaging device 241, such as an image sensor or camera (shown in inset 246). Alternatively, biometric device 220 may be a catheter including an imaging device and, optionally, an ablation device and an illumination device. Biometric device 220 may be biometric device 120 depicted in FIG. 1. Biometric device 220 may be configured to acquire biometric data, such as imaging signals or electronic signals. Those skilled in the art will recognize that catheter 240 and imaging device 241 may be of any shape and may include one or more elements (e.g., electrodes or sensors) used to implement the embodiments disclosed herein. The EP mapping system 200 includes a probe 221 having one or more shafts 222 that can be navigated by a physician 230 into a body part, such as a heart 226, of a patient 228 reclining on a table 229. According to various embodiments, multiple probes 221 can be provided; however, for simplicity, a single probe 221 is described in this example. However, it will be understood that the probe 221 can represent multiple probes. As shown in FIG. 2 , the physician 230 can insert the probe 221 through the sheath 223 while manipulating the shaft 222 at the distal end of the probe 221 using a manipulator near the proximal end of the invasive device and / or deflection from the sheath 223. As shown in inset 225, a biometric device 220 can be attached to the distal end of the probe 221. The biometric device 220 can be inserted through the sheath 223 to acquire biometric data of the heart 226. For example, the catheter 240 may include at least one ablation electrode 247 and a catheter needle.

[0030] According to one embodiment, catheter 240 can be configured to ablate a tissue region in a chamber of heart 226. Inset 245 shows an enlarged view of catheter 240 inside a chamber of heart 226. As shown, catheter 240 can include at least one ablation electrode 247 coupled to the body of the catheter. According to other embodiments, multiple elements can be connected via splines that define the shape of catheter 240. One or more other elements (not shown) can be provided and can be any element configured to perform ablation or acquire biometric data, such as an electrode, a transducer, or one or more other elements.

[0031] According to another embodiment, imaging device 241 may be configured to acquire image data, such as image data 235, from outside heart 226 or within a ventricle. Inset 246 shows a close-up of imaging device 241 inside a ventricle of heart 226. One skilled in the art will recognize that multiple imaging devices 241 can be utilized to acquire images of heart 226 from multiple positions or angles. One skilled in the art will recognize that imaging device 241 can be any camera or image sensor capable of converting optical images into electronic signals. In some embodiments, the imaging device can be a miniature CMOS image sensor with a lens or a CCD camera or other image sensor capable of converting optical images into electronic signals.

[0032] According to embodiments disclosed herein, the biometric data may also include one or more of LAT, electrical activity, topology, bipolar mapping, dominant frequency, impedance, etc. The local activation time may be the time point of a threshold activation corresponding to local activation, calculated based on a normalized initial onset. The electrical activity may be any applicable electrical signal that can be measured based on one or more thresholds and sensed and / or enhanced based on signal-to-noise ratio and / or other filters. The topology may correspond to the physical structure of a body part or a portion of a body part, or may correspond to changes in the physical structure for different portions of the body part or for different body parts. The dominant frequency may be a frequency or range of frequencies prevalent in a portion of a body part, and may differ in different portions of the same body part. For example, the dominant frequency of the pulmonary veins of a heart may be different from the dominant frequency of the right atrium of the same heart. The impedance may be a resistance measurement in a given region of a body part.

[0033] 2, the probe 221 may be connected to a console 224. The console 224 may include a processor 244, such as a general-purpose computer with suitable front-end and interface circuitry 238, for transmitting signals to and receiving signals from the biometric device 220, as well as for controlling other components of the EP mapping system 200. In some embodiments, the processor 244 may be further configured to receive biometric data, such as electrical activity, and determine whether a given tissue region conducts electricity. According to one embodiment, the processor may be external to the console 224, for example, located in a catheter, an external device, a mobile device, a cloud-based device, or may be a stand-alone processor.

[0034] As noted above, the processor 244 may include a general-purpose computer, which can be programmed with software to perform the functions described herein. The software may be downloaded in electronic form to the general-purpose computer, for example, over a network, or alternatively or additionally, may be provided and / or stored on a non-transitory tangible medium, such as magnetic, optical, or electronic memory. The exemplary configuration shown in FIG. 2 may be modified to implement embodiments disclosed herein. Embodiments of the present disclosure may be similarly applied using other system components and configurations. Additionally, the EP mapping system 200 may include additional components, such as elements for sensing electrical activity, wired or wireless connectors, processing and display devices, etc.

[0035] According to one embodiment, the display 227 connected to a processor (e.g., processor 244) may be located at a remote location, such as a separate hospital, or within a separate healthcare provider network. Additionally, the EP mapping system 200 may be part of a surgical system configured to obtain anatomical and electrical measurements of a patient's organs, such as the heart, and to perform cardiac ablation procedures. One example of such a surgical system is the Carto® system sold by Biosense Webster.

[0036] EP mapping system 200 can also, and optionally, acquire biometric data, such as anatomical measurements of the patient's heart, using ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), or other medical imaging techniques known in the art. EP mapping system 200 can acquire electrical measurements using catheter 240, imaging device 241, body surface electrodes 243, or other sensors that measure electrical properties of the heart. The biometric data, including the anatomical and electrical measurements, may then be stored in memory 242 of EP mapping system 200, as shown in FIG. 2 . The biometric data may be transmitted from memory 242 to processor 244. Alternatively, or additionally, the biometric data may be transmitted using network 262 to server 260, which may be local or remote.

[0037] Network 262 may be any network or system commonly known in the art, such as an intranet, a local area network (LAN), a wide area network (WAN), a metropolitan area network (MAN), a direct connection or series of connections, a cellular telephone network, or any other network or medium capable of facilitating communication between EP mapping system 200 and server 260. Network 262 may be wired, wireless, or a combination thereof. Wired connections may be implemented using Ethernet, Universal Serial Bus (USB), RJ-11, or any other wired connection commonly known in the art. Wireless connections may be implemented using Wi-Fi, WiMAX, Bluetooth, infrared, cellular networks, satellite, or any other wireless connection method commonly known in the art. Additionally, several networks may operate alone or in communication with each other to facilitate communication within network 262.

[0038] In some cases, server 260 may be implemented as a physical server. In other cases, server 262 may be implemented as a virtual server, a public cloud computing provider (e.g., Amazon Web Services (AWS)).

[0039] Processor 244 may include real-time noise reduction circuitry, typically configured as a field programmable gate array (FPGA), followed by an analog-to-digital (A / D) ECG (electrocardiograph) or EMG (electromyogram) signal conversion integrated circuit. Processor 244 may communicate signals from the A / D ECG or EMG circuitry to another processor and / or may be programmed to perform one or more functions disclosed herein.

[0040] The control console 224 may also include an input / output (I / O) communication interface that allows the control console to communicate signals to and / or from the biometric device 220 .

[0041] During a procedure, processor 244 facilitates presentation of body part renderings 235 to physician 230 on display 227 and may store data representing body part renderings 235 in memory 242. Memory 242 may comprise any suitable volatile and / or non-volatile memory, such as random access memory or a hard disk drive. In some embodiments, medical professional 230 may be able to manipulate body part renderings 235 using one or more input devices, such as a touchpad, a mouse, a keyboard, a gesture recognizer, or the like. For example, the input device may be used to change the position of catheter 240 so that renderings 235 are updated. In an alternative embodiment, display 227 may include a touchscreen, which may be configured to receive input from medical professional 230 in addition to presenting body part renderings 235.

[0042] Current EP mapping systems generate EP maps of the heart viewed from outside the heart chambers, requiring tedious steps of rotating and zooming the map from multiple views to view ablation sites, such as within the pulmonary veins. For example, Figures 3A and 3B show a conventional view of an EP map 300 of the left atrium 310 of the heart, showing the pulmonary veins as viewed from outside the heart chambers or outside the EP map 300. More specifically, Figures 3A and 3B show the right superior pulmonary vein (RSPV) 320, the right inferior pulmonary vein (RIPV) 330, the left superior pulmonary vein (LSPV) 340, the left inferior pulmonary vein (LIPV) 350, and the left atrial appendage (LAA) 360 as viewed from outside the left atrium 310.

[0043] Conventional EP maps showing the heart chambers have several drawbacks. For example, the visualization can simulate an orthographic camera, where elements at different depths appear the same. This makes it difficult to determine how close a catheter, such as an ablation catheter, is to the EP map surface. For example, a catheter can be close to the anterior or posterior surface of the EP map and visually appear the same. Conventional EP mapping systems have attempted to compensate for this visual ambiguity by providing a catheter distance projection to aid in understanding the catheter's depth.

[0044] Another drawback with conventional EP maps is that veins may obscure one another. For example, as shown in FIG. 3A, a portion of the RIPV 330 is obscured by the RSPV 320, and a portion of the LIPV 350 is obscured by the LSPV 340. To view the various veins with such conventional EP mapping systems, the map 300 must be rotated to view the obscured portions.

[0045] Yet another drawback with conventional EP maps is that viewing the map from outside the chamber while the catheter is inside the map obscures the position of the catheter relative to the veins. Additionally, during an ablation procedure, areas identified for ablation around the veins cannot be viewed in a single view. For example, FIG. 4 shows an illustration of an EP map 400 of the left atrium 310 of a heart, showing locations 410 identified for ablation around the LSPV 340 and LIPV 350 viewed from outside the heart chamber or outside the EP map. As shown in FIG. 4, all of the locations 410 identified for ablation cannot be observed in a single view, requiring rotation of the EP map 400 to view the obscured locations 410 for ablation.

[0046] In one embodiment, the present subject matter is directed to utilizing positioning algorithms to determine locations within cardiac structures for positioning one or more imaging devices, such as imaging device 241 (FIG. 2), or to obtain an image view of a cardiac chamber for generating a 3D EP map of the entire cardiac chamber or region of interest from within the cardiac chamber or region of interest without the need for a physician to rotate and zoom the EP map to view the entire cardiac chamber or region of interest. In one embodiment, the present subject matter utilizes an imaging device, such as a perspective camera, to provide improved 3D depth of the EP map compared to a conventional orthogonal camera view.

[0047] In one embodiment, the present subject matter can be used to generate a view of the entire cardiac chamber from within a cardiac chamber or EP map. In yet another embodiment, the present subject matter can be used to generate a view of a cardiac region of interest, such as, but not limited to, a pulmonary vein, an appendage, or a venous branch. In yet another embodiment, the present subject matter can be used during a cardiac procedure, such as, but not limited to, an ablation procedure, to view locations identified for ablation from within an EP map in a single view.

[0048] In one embodiment, the present subject matter is directed to a system, such as EP mapping system 200, or a method, for visualizing a cardiac structure of interest. The system preferably includes at least one imaging device, such as imaging device 241, that acquires image data, such as image data 235 of the cardiac structure of interest, from within the cardiac structure, and a processor, such as processor 244, including a memory, such as memory 242. The processor is configured to receive and store model data of the cardiac structure of interest, determine at least one location for positioning the at least one imaging device within the cardiac structure of interest to acquire the image data of the cardiac structure of interest, receive image data from the at least one imaging device positioned at the determined at least one location within the cardiac structure of interest, and generate a 3D electrophysiological map from within the electrophysiological map of the cardiac structure of interest based on the received image data.

[0049] 3D Museum Monitoring Algorithm In one embodiment, the subject matter of this application utilizes the "museum surveillance problem" to identify optimal areas within a cardiac chamber for placing an imaging device, such as imaging device 241, to generate a three-dimensional (3D) view of the entire cardiac chamber or region of interest from within a cardiac chamber or EP map.

[0050] The "museum surveillance problem" is a well-known problem in the field of computational geometry and is readily understood by those skilled in the art. For example, the "museum surveillance problem" traditionally involves placing the minimum number of guards (i.e., cameras) in a two-dimensional (2D) closed polygonal museum surveillance so that the guards can see the entire area of ​​the polygon. In other words, every location in the museum can be seen by at least one guard. The field of computational geometry utilizes algorithms to solve the problem. For example, for a simple polygon with n vertices, the minimum number of guards to see every point inside the polygon is (n / 3) guards.

[0051] Two-dimensional (2D) and three-dimensional (3D) "art gallery surveillance problems," as well as algorithms for solving 2D and 3D art gallery surveillance problems, are well known and described in the art. See, for example, O'Rourke, Joseph, "Art Gallery Theorems And Algorithms," New York, Oxford University Press, Inc. (1987); Csizmadia et al., "Note On Art Gallery Problem," Computational Geometry, Vol. 10, pp. 47-55 (1998); and Marzal, Jefri, "The Three-Dimensional Art Gallery Problem And Its Solutions," Murdoch University School of Information Technology (2012), the contents of which are incorporated herein by reference as if fully set forth. In one embodiment, the subject matter of the present application utilizes the 3D art gallery surveillance problem to determine the location of the minimum number of imaging devices, such as imaging device 241, to be positioned within a cardiac chamber to generate a 3D view of the entire cardiac chamber or region of interest. According to the subject matter of the present application, any known or approximate algorithm described in the literature for solving the 3D museum surveillance problem can be utilized.

[0052] In one embodiment, a 3D museum surveillance algorithm is utilized to determine the locations of a minimum number of imaging devices or imaging fields within the EP map to create a complete visualization of the chamber or cardiac location of interest. Images acquired from the minimum number of imaging device locations or fields of view are combined to generate an EP map with a single view of the entire chamber or cardiac region of interest, so that the physician does not need to rotate and zoom the EP map to view the entire chamber or ablation site.

[0053] According to one embodiment, the present application utilizes an imaging device, such as imaging device 241 used with EP mapping system 200 as described above with respect to FIG. 2, to generate a view of the interior of a chamber or cardiac region of interest. As discussed above, one or more imaging devices 241 can be positioned within the chamber via probe 221 or shaft 222. Imaging device 241 is used to acquire image data of the chamber or cardiac region of interest and can be in communication with a processor or computing device, such as processor 114 and computing devices 106 and 108 as described with reference to FIG. 1, or processor 244 and server 260 as described with reference to FIG. 2, to generate an EP map having a view of the chamber or cardiac region of interest from within the chamber or EP map.

[0054] FIG. 5 is an exemplary embodiment of a method or process 500 for generating an EP map of a chamber or cardiac region of interest from within an EP map utilizing the 3D museum surveillance algorithms described herein.

[0055] In step 510, a processing device, such as processor 244, and a memory, such as memory 242, associated with EP mapping system 200 (FIG. 2) preferably receive and store model data associated with the chamber or cardiac region of interest. The model data may be acquired by an imaging system, such as, but not limited to, magnetic resonance imaging (MRI), computed tomography (CT), X-ray imaging, rotational angiography, ultrasound imaging, three-dimensional ultrasound imaging, three-dimensional mapping, an intracardiac probe having an imaging device, or any other means for three-dimensional imaging. The model data may be acquired in real time from previously generated model data of the patient's heart or from a database of cardiac model data.

[0056] In step 520, the processing device preferably utilizes the 3D art gallery surveillance algorithm described above to process the model data associated with the ventricle or cardiac region of interest to determine locations within the ventricle or cardiac region of interest for positioning a minimum number of imaging devices or acquiring a minimum number of image fields, and generate an EP map with full visualization of the ventricle or cardiac location of interest from within the EP map. For example, and without limitation, the 3D art gallery surveillance algorithm utilized herein may be "The Fixed-Point Guard Placement Algorithm," by Marzal, Jefri, "The Three-Dimensional Art Gallery Problem And Its Solutions," Murdoch University School of Information Technology (2012), which is incorporated by reference as if fully set forth.

[0057] In step 530, at least one probe including at least one imaging device, such as probe 221 and imaging device 241 described above with respect to Figure 2, is preferably inserted into the chamber or cardiac region of interest at the determined location to acquire image data of the chamber or cardiac region of interest at the determined location. For example, but not by way of limitation, the imaging device may have a positioning sensor to assist in positioning the imaging device at the determined location.

[0058] Alternatively, in step 520, the processing device can utilize a 3D museum monitoring algorithm to suggest locations within the chamber or cardiac region of interest for positioning an imaging device or acquiring image data, and the physician or technician can select a preferred location for generating an EP map in step 530.

[0059] In step 540, the acquired image data is preferably communicated to a processing device, such as processor 244, to generate a 3D EP map of the chamber or cardiac region of interest from within the EP map with full visualization of the chamber or cardiac location of interest. The imaging device may transmit the image data to the processing device via wired or wireless transmission means as described above.

[0060] In step 550, the generated 3D EP map may optionally be displayed on a display, such as display 227 (FIG. 2).

[0061] 6A, 6B, and 6C show exemplary EP maps 610 and 620, respectively, of the left atrium 310 generated according to process 500. FIG. 6A shows an exemplary view of the left atrium 310 showing full visualization of the LSPV 340, LIPV 350, and LAA 360 from within the EP map 610. FIG. 6B shows an exemplary view of the left atrium 310 showing full visualization of the RSPV 320 and RIPV 330 from within the EP map 620. FIG. 6C shows the EP map 610 of FIG. 6A showing a complete view of the locations 630 identified for ablation around the LSPV 340 and LIPV 350 as viewed from within the EP map 610. As shown in FIG. 6C, all of the locations 630 identified for ablation around the LSPV 340 and LIPV 350 can be viewed without having to rotate the EP map 610. In comparison, a conventional EP map 400 outside the heart chamber depicted in FIG. 4 and described above requires rotation of the map 400 to view all of the locations 410 identified for ablation around the LSPV 340 and LIPV 350.

[0062] Skeleton Axis Algorithm In another embodiment, the subject matter of the present application utilizes a skeletal axis algorithm to generate a skeletal axis of a ventricle or cardiac region of interest, identify optimal regions within the ventricle for placing an imaging device, such as imaging device 241, and generate a three-dimensional (3D) view of the cardiac region of interest from within the ventricle or EP map.

[0063] FIG. 7 is an exemplary embodiment of a process 700 for generating an EP map of a cardiac region of interest from within an EP map utilizing the skeletal axis algorithm described herein.

[0064] In step 710, a processing device, such as processor 244 and memory 242, associated with EP mapping system 200 (FIG. 2) preferably receives and stores model data associated with the chamber or cardiac region of interest. The model data may be acquired by an imaging system, such as, but not limited to, magnetic resonance imaging (MRI), computed tomography (CT), X-ray imaging, rotational angiography, ultrasound imaging, three-dimensional ultrasound imaging, three-dimensional mapping, an intracardiac probe having an imaging device, or any other means for three-dimensional imaging. The model data may be acquired in real time from previously generated model data of the patient's heart or from a database of cardiac model data.

[0065] In step 720, the processing device preferably generates skeletal axes or topographical skeletons of the ventricle or cardiac region of interest by known methods and algorithms for creating skeletal axes of a triangular mesh. An exemplary method for creating skeletal axes includes generating a surface mesh within the 3D model data, such as a polygonal or triangular mesh, according to known methods for graphic modeling. The surface mesh is then folded to generate central or major axes along the interior of the structure and any extending branches, such as, but not limited to, veins, arteries, and appendages. Those skilled in the art will recognize that other methods or algorithms for generating skeletal axes can be utilized within the scope of this application, such as those described in Tagliasacchi et al., "Mean Curvature Skeletons," Computer Graphics Forum (Proceedings of the Symposium on Geometry Processing), 31(5):1735-1744 (2012), the contents of which are incorporated herein by reference.

[0066] Figure 8 illustrates an exemplary embodiment of a skeletal axis 805 displayed on the 3D model data 800 of the left atrium 310 according to step 720 of Figure 7. The skeletal axis 805 includes a main axis 810 and five branch axes, including an RSPV axis 820, an RIPV axis 830, an LSPV axis 840, an LIPV axis 850, and an LAA 860 axis.

[0067] In step 730, at least one probe, including at least one imaging device such as probe 221 and imaging device 241 described above with respect to Figure 2, is inserted into the chamber or cardiac region of interest at the location of interest, preferably along the generated skeletal axis, to acquire image data of the cardiac location of interest. For example, the location of interest may be along a vein or adjacent to a venous branch, the entire region may be visible, and may be determined by a physician, such as a cardiologist.

[0068] 9A shows an exemplary embodiment of an imaging device 910 positioned within the left atrium 310 along the major axis 810 of the skeletal axis 805 adjacent the bifurcation junction of the RSPV axis 820 and the RIPV axis 830 to obtain a view of the RSPV 320 and the RIPV 330 from inside the ventricle. FIG. 9B shows an image of the RSPV 320 and the RIPV 330 from inside the ventricle obtained from the imaging device 910 shown in FIG.

[0069] Figure 10A shows an exemplary embodiment of an imaging device 910 positioned within the left atrium 310 along the major axis 810 of the skeletal axis 805 adjacent the bifurcation junction of the LSPV axis 840, the LIPV axis 850, and the LAA axis 860 to obtain a view of the LSPV 840, the LIPV 850, and the LAA 860 from inside the ventricle. Figure 10B shows an image of the LSPV 840, the LIPV 850, and the LAA 860 from inside the ventricle obtained from the imaging device 910 shown in Figure 10A.

[0070] Figure 11A shows an exemplary embodiment of an imaging device 910 positioned within the left atrium 310 along the LIPV axis 850 of the skeletal axis 805 to obtain a view of the LIPV 350 from within the LIPV 350. Figure 11B shows an image of the LIPV 850 from within the LIPV obtained from the imaging device 910 shown in Figure 11A.

[0071] In step 740, the acquired image data is preferably communicated to a processing device, such as processor 244, to generate a 3D EP map of the chamber or cardiac region of interest from within the EP map with full visualization of the cardiac location of interest.

[0072] In step 750, the generated 3D EP map may optionally be displayed on a display such as display 227 (FIG. 2).

[0073] While Figures 5 and 7 relate to an exemplary process for identifying optimal regions for placing an imaging device, such as imaging device 241, within a ventricle to generate a three-dimensional (3D) view of the ventricle or cardiac region of interest from within an EP map using the EP mapping system 200 described herein, those skilled in the art will readily appreciate that the disclosed process is not limited and can be applied to visualize other cardiac structures or body organs.

[0074] The subject matter disclosed herein for improved cardiac visualization provides a more comprehensive view of a chamber or cardiac region of interest to aid in cardiac procedures, such as ablation procedures, compared to conventional techniques. For example, the improved cardiac visualization systems, methods, and techniques disclosed herein reduce or eliminate obscuring geometry when viewing EP maps, and reduce or avoid the tedious and time-consuming steps of rotating and zooming EP maps to visualize the entire cardiac region of interest.

[0075] In one embodiment of the subject matter disclosed herein, a physician or technician can choose a method for generating a 3D EP map of a ventricle or cardiac region of interest from within an EP map utilizing the 3D museum surveillance algorithm or the skeletal axis algorithm disclosed herein. For example, without limitation, if having a minimum number of fields to see the entire ventricle is an important factor, a museum surveillance algorithm may be selected. However, if viewing the entire cardiac region of interest for ablation is an important factor, a skeletal algorithm may be selected.

[0076] It should be understood that many variations are possible based on the disclosure herein. While features and elements are described above in particular combinations, each feature or element may be used alone without the other features and elements, or in various combinations with other features and elements, with or without the other features and elements. Similarly, although process steps are described above in a particular order, the steps may be performed in any other desired order.

[0077] The methods, processes and / or flowcharts provided herein may be implemented in a computer program, software, or firmware embodied in a non-transitory computer-readable storage medium for execution by a general-purpose computer or processor. Examples of non-transitory computer-readable storage media include ROM, random access memory (RAM), registers, cache memory, semiconductor memory devices, magnetic media such as internal hard disks and removable disks, magneto-optical media, and optical media such as CD-ROM disks and digital versatile disks (DVDs).

[0078] Certain terminology is used in this description merely for convenience and is not limiting. The words "right," "left," "top," "bottom," "front," and "back" designate directions in the drawings to which reference is made. The words "a" and "one," when used in the claims and corresponding portions of this specification, are defined to include one or more of the referenced items, unless otherwise specified. This terminology includes the words specifically mentioned above, derivatives thereof, and words of similar import. The phrase "at least one" followed by a list of two or more items, such as "A, B, or C," means any individual one of A, B, or C, and any combination thereof.

[0079] Further exemplary embodiments of the present specification may be formed by adding to an embodiment one or more elements from any one or more other embodiments of the present specification and / or by substituting one or more elements from an embodiment with one or more elements from one or more other embodiments of the present specification.

[0080] It is understood, therefore, that the disclosed subject matter is not limited to the particular embodiments disclosed, but is intended to encompass all modifications that are within the spirit and scope of the present invention as defined by the appended claims, the above description, and / or as illustrated in the accompanying drawings.

[0081] [Embodiment] (1) A system for visualizing a cardiac structure of interest, comprising: at least one imaging device for acquiring image data of the cardiac structure of interest from within the cardiac structure of interest; A processor comprising a memory, receiving and storing model data of the cardiac structure of interest; determining at least one location for positioning the at least one imaging device within the cardiac structure of interest to acquire image data of the cardiac structure of interest; receiving the image data from the at least one imaging device positioned at the determined at least one location within the cardiac structure of interest; and generating, based on the received image data, a 3D electrophysiological map of the cardiac structure of interest that is viewable within the 3D electrophysiological map. (2) The system of embodiment 1, further comprising a display for displaying the generated 3D electrophysiological map of the cardiac structure of interest. (3) The system described in embodiment 1, wherein the cardiac structure of interest is a ventricle. (4) The system described in embodiment 1, wherein the cardiac structure of interest is at least one vein or at least one vein branch. (5) The system described in embodiment 1, wherein the generated 3D electrophysiological map provides complete visualization of the cardiac structure of interest in a single field of view.

[0082] (6) The system of embodiment 1, wherein the processor determines the at least one location for positioning the at least one imaging device within the cardiac structure of interest based on a 3D art gallery algorithm that determines the minimum number of locations within the cardiac structure of interest to obtain complete visualization of the cardiac structure of interest. (7) The system of embodiment 6, wherein an imaging device is positioned at each of the minimum number of locations within the cardiac structure of interest to acquire image data at each determined location. (8) The system of embodiment 1, wherein the processor determines the at least one location for positioning the at least one imaging device within the cardiac structure of interest based on a skeletal axis algorithm that generates a skeletal axis of the model data of the cardiac structure of interest. (9) The system of embodiment 8, wherein the at least one location for positioning the at least one imaging device is a location along the skeletal axis. (10) The system described in embodiment 1, wherein the at least one imaging device is an intracardiac probe.

[0083] (11) A method for visualizing a cardiac structure of interest, comprising: obtaining model data of a cardiac structure of interest; determining at least one location for positioning at least one imaging device within the cardiac structure of interest to acquire image data of the cardiac structure of interest; positioning the at least one imaging device at the determined at least one location within the cardiac structure of interest; generating image data of the cardiac structure of interest from the determined at least one location within the cardiac structure of interest; generating a 3D electrophysiological map viewable from within the 3D electrophysiological map of the cardiac structure of interest based on the generated image data. (12) The method of embodiment 11, further comprising displaying the generated 3D electrophysiological map of the cardiac structure of interest on a display. (13) The method of embodiment 11, wherein the cardiac structure of interest is a ventricle. (14) The method of embodiment 11, wherein the cardiac structure of interest is at least one vein or at least one venous branch. (15) The method of embodiment 11, wherein the generated 3D electrophysiological map provides complete visualization of the cardiac structure of interest in a single field of view.

[0084] (16) The method of embodiment 11, wherein determining the at least one location for positioning the at least one imaging device within the cardiac structure of interest further includes providing a processor that utilizes a 3D museum surveillance algorithm to determine a minimum number of locations within the cardiac structure of interest to obtain complete visualization of the cardiac structure of interest. (17) The method of embodiment 16, further comprising positioning an imaging device at each of the minimum number of locations within the cardiac structure of interest to acquire image data at each determined location. (18) The method of embodiment 11, wherein determining the at least one location for positioning the at least one imaging device within the cardiac structure of interest further includes providing a processor that utilizes a skeletal axis algorithm to generate a skeletal axis of the model data of the cardiac structure of interest. (19) The method of embodiment 18, wherein the at least one imaging device is positioned at a location along the skeletal axis. (20) A non-transitory computer-readable recording medium, obtaining model data of a cardiac structure of interest; determining at least one location for positioning at least one imaging device within the cardiac structure of interest to acquire image data of the cardiac structure of interest; positioning the at least one imaging device at the determined at least one location within the cardiac structure of interest; generating image data of the cardiac structure of interest from the determined at least one location within the cardiac structure of interest; and generating a 3D electrophysiological map of the cardiac structure of interest based on the generated image data, the 3D electrophysiological map being viewable within the 3D electrophysiological map of the cardiac structure of interest.

Claims

1. 1. A system for visualizing a cardiac structure of interest, comprising: at least one imaging device for acquiring image data of the cardiac structure of interest from within the cardiac structure of interest; A processor comprising a memory, receiving and storing model data of the cardiac structure of interest; determining at least one location for positioning the at least one imaging device within the cardiac structure of interest to acquire image data of the cardiac structure of interest; receiving the image data from the at least one imaging device positioned at the determined at least one location within the cardiac structure of interest; generating a 3D electrophysiological map of the cardiac structure of interest based on the received image data, the 3D electrophysiological map being viewable within the 3D electrophysiological map of the cardiac structure of interest; The system, wherein the processor determines the at least one location for positioning the at least one imaging device within the cardiac structure of interest based on a 3D museum surveillance algorithm that determines a minimum number of locations within the cardiac structure of interest to obtain complete visualization of the cardiac structure of interest.

2. The system of claim 1 , further comprising a display for displaying the generated 3D electrophysiological map of the cardiac structure of interest.

3. The system of claim 1 , wherein the cardiac structure of interest is a ventricle.

4. The system of claim 1 , wherein the cardiac structure of interest is at least one vein or at least one vein branch.

5. The system of claim 1 , wherein the generated 3D electrophysiological map provides a complete visualization of the cardiac structure of interest in a single field of view.

6. The system described in claim 1, wherein the at least one imaging device is positioned at each of the minimum number of locations within the cardiac structure of interest to acquire image data at each determined location.

7. 2. The system of claim 1, wherein the processor determines the at least one location for positioning the at least one imaging device within the cardiac structure of interest based on a skeletal axis algorithm that generates skeletal axes of the model data of the cardiac structure of interest.

8. The system of claim 7 , wherein the at least one location for positioning the at least one imaging device is a location along the skeletal axis.

9. The system of claim 1 , wherein the at least one imaging device is an intracardiac probe.

10. A non-transitory computer-readable recording medium, comprising: obtaining model data of a cardiac structure of interest; determining at least one location for positioning at least one imaging device within the cardiac structure of interest to acquire image data of the cardiac structure of interest; positioning the at least one imaging device at the determined at least one location within the cardiac structure of interest; generating image data of the cardiac structure of interest from the determined at least one location within the cardiac structure of interest; generating a 3D electrophysiological map viewable within the 3D electrophysiological map of the cardiac structure of interest based on the generated image data; determining at least one location for positioning the at least one imaging device within the cardiac structure of interest based on a 3D museum surveillance algorithm that determines a minimum number of locations within the cardiac structure of interest to obtain a complete visualization of the cardiac structure of interest; 1. A non-transitory computer-readable storage medium storing program instructions for visualizing a cardiac structure of interest by performing:

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