Enhanced wave propagation control

Abstract

To provide a medical system.SOLUTION: In one embodiment, a medical system includes: a catheter to be inserted into a chamber of a heart, and including electrodes to capture electrical activity of tissue of the chamber over time; a display; and processing circuitry configured to compute propagation of a cardiac activation wave over an anatomical map of the chamber from a start time in a cardiac cycle to an end time in the cardiac cycle responsively to the captured electrical activity, render on the display a sub-region of the anatomical map, select a time-bounded portion of the propagation of the cardiac activation wave commencing at a time after the start time responsively to when the propagation commences to be rendered in the sub-region of the anatomical map, and render on the display the time-bound portion of the propagation of the cardiac activation wave on the sub-region of the anatomical map.SELECTED DRAWING: Figure 1

Description

Technical Field

[0001] The present invention relates to medical systems, and more particularly, but not exclusively, to catheter-based systems.

Background Art

[0002] A wide range of medical procedures involve placing a probe, such as a catheter, within a patient's body. To track such probes, location sensing systems have been developed. Magnetic location sensing is one of the known methods in the art. In magnetic location sensing, a magnetic field generator is typically placed at a known location outside the patient. Magnetic field sensors within the distal end of the probe generate electrical signals in response to these magnetic fields, and these signals are processed to determine the coordinate position of the distal end of the probe. These methods and systems are described in U.S. Patent Nos. 5,391,199, 6,690,963, 6,484,118, 6,239,724, 6,618,612, and 6,332,089, International Publication No. 1996 / 005768, and U.S. Patent Application Publication Nos. 2002 / 0065455, 2003 / 0120150, and 2004 / 0068178, the disclosures of which are hereby incorporated by reference in their entirety. Location may also be tracked using impedance or current-based systems.

[0003] One medical procedure in which these types of probes or catheters have proven to be extremely useful is in the treatment of cardiac arrhythmias. Cardiac arrhythmias, and particularly atrial fibrillation, persist as a common and dangerous medical condition, especially in the elderly population.

[0004] The diagnosis and treatment of cardiac arrhythmias involve mapping the electrical properties of cardiac tissue, particularly the endocardium and cardiac volume, and selectively ablating the cardiac tissue by applying energy. Such ablation can stop or modify unwanted electrical signals from propagating from one part of the heart to another. The ablation process destroys unwanted electrical pathways by forming non-conductive damaged areas. Various modes of energy delivery have been disclosed for the purpose of forming damaged areas, including the use of microwaves, lasers, and more commonly radiofrequency energy to create conduction blocks along the cardiac tissue walls. In a two-step procedure in which mapping is followed by ablation, electrical activity at each point in the heart is sensed and measured by advancing a catheter, usually containing one or more electrical sensors, into the heart and obtaining data at numerous points. These data are then used to select the target region of the endocardium to be ablated.

[0005] Electrode catheters have been commonly used in medical practice for many years. Electrode catheters are used to stimulate and map electrical activity within the heart and to ablate areas exhibiting abnormal electrical activity. During use, the electrode catheter is inserted into a major vein or artery, such as the femoral artery, and then guided into the target ventricle. A typical ablation procedure involves inserting a catheter with one or more electrodes at its distal end into the cardiac chamber. A reference electrode can be provided, typically taped to the patient's skin or by a second catheter positioned within or near the heart. A radio frequency (RF) current is applied to the tip electrode of the ablation catheter, causing the current to flow through the surrounding medium, i.e., blood and tissue, toward the reference electrode. The distribution of the current depends on the amount of electrode surface in contact with tissue, compared to blood, which has higher conductivity than tissue. Tissue heating occurs due to the electrical resistance of the tissue. When tissue is sufficiently heated, it causes cell destruction in the cardiac tissue, resulting in the formation of non-conductive damaged areas within the cardiac tissue.

[0006] Therefore, when an ablation catheter or other catheter is placed in the body, particularly near endocardial tissue, it is desirable that the distal tip of the catheter be in direct contact with the tissue. This contact can be confirmed, for example, by measuring the contact between the distal tip and body tissue. U.S. Patent Applications Publications 2007 / 0100332, 2009 / 0093806, and 2009 / 0138007 describe a method for sensing the contact pressure between the distal tip of a catheter and tissue in a body cavity using a force sensor embedded in the catheter. [Overview of the project] [Means for solving the problem]

[0007] According to one embodiment of the present disclosure, a medical system is provided, comprising: a catheter, which includes electrodes configured to be inserted into a ventricle of the heart and configured to capture the electrical activity of the tissue of the ventricle over time; a display; and a processing circuit, which is configured to calculate the propagation of cardiac activation waves across an anatomical map of the ventricle from the start time of the cardiac cycle to the end time of the cardiac cycle in response to the captured electrical activity; to render subregions of the anatomical map on the display; to select time-limited portions of the propagation of cardiac activation waves that begin at a time after the start time in response to the rendering of the propagation within the subregions of the anatomical map beginning; and to render time-limited portions of the propagation of cardiac activation waves on the subregions of the anatomical map on the display.

[0008] Furthermore, according to one embodiment of the present disclosure, the processing circuit is configured to select a time limit portion of the propagation of cardiac activation waves that terminates in a time prior to the termination time, in response to the completion of the rendering of the propagation of cardiac activation waves within a subregion of the anatomical map.

[0009] Furthermore, according to embodiments of the present disclosure, the processing circuit is configured to automatically repeat rendering of the time-limited portion of the propagation of cardiac activation waves on subregions of the anatomical map.

[0010] In addition, according to one embodiment of the present disclosure, the processing circuit is configured to render subregions of the anatomical map from viewpoints within the anatomical map.

[0011] Furthermore, according to one embodiment of the present disclosure, the processing circuit is configured to render a subregion of the anatomical map from a viewpoint within the anatomical map, the viewpoint remaining stationary during the rendering of the time-limited portion of the propagation of cardiac activation waves over the subregion of the anatomical map.

[0012] Furthermore, according to one embodiment of the present disclosure, the system includes a user interface for receiving user input for manipulating a virtual camera to change the rendered view of the anatomical map from within the anatomical map, and the processing circuit is configured to render subregions of the anatomical map in response to the user input.

[0013] Furthermore, according to one embodiment of the present disclosure, the processing circuit is configured to render a subregion of the anatomical map from a viewpoint outside the anatomical map.

[0014] In addition, according to one embodiment of the present disclosure, the system includes a user interface for receiving user input for the selection of subregions of an anatomical map, and the processing circuit is configured to render the subregions of the anatomical map in response to the user input.

[0015] Furthermore, according to one embodiment of the present disclosure, the system includes a user interface for receiving a user input of the rendering speed of the time-limited portion of the propagation of cardiac activation waves, and a processing circuit is configured to render the time-limited portion of the propagation of cardiac activation waves on a subregion of an anatomical map to a display in response to the user input of the speed.

[0016] Furthermore, according to one embodiment of the present disclosure, the system includes a user interface for receiving a user input of the width of a cardiac activation wave, and a processing circuit is configured to render to a display the time-limited portion of the propagation of the cardiac activation wave over a subregion of an anatomical map in response to the user input of the width of the cardiac activation wave.

[0017] Another embodiment of the present disclosure also provides a medical method comprising: calculating the propagation of cardiac activation waves across an anatomical map of the ventricles of the heart from the start time of the cardiac cycle to the end time of the cardiac cycle in response to the electrical activity of the ventricle tissue captured by electrodes of a catheter inserted into the ventricle; rendering subregions of the anatomical map on a display; selecting a time-limited portion of the propagation of cardiac activation waves that begins at a time after the start time in response to the start time when the propagation begins to be rendered within the subregions of the anatomical map; and rendering a time-limited portion of the propagation of cardiac activation waves on the subregions of the anatomical map on a display.

[0018] Furthermore, according to one embodiment of the present disclosure, the selection includes selecting a time-limited portion of the propagation of cardiac activation waves that terminates in a time prior to the termination time, in response to the completion of the rendering of the propagation of cardiac activation waves within a subregion of the anatomical map.

[0019] In addition, according to one embodiment of the present disclosure, the method includes automatically repeating the rendering of the time-limited portion of the propagation of cardiac activation waves on a subregion of an anatomical map.

[0020] Furthermore, according to one embodiment of the present disclosure, rendering a subregion includes rendering a subregion of an anatomical map from a viewpoint within the anatomical map.

[0021] Furthermore, according to one embodiment of the present disclosure, rendering a subregion includes rendering a subregion of an anatomical map from a viewpoint within the anatomical map, the viewpoint remaining stationary during the rendering of the time-limited portion of the propagation of cardiac activation waves over the subregion of the anatomical map.

[0022] Furthermore, according to one embodiment of the present disclosure, the method includes receiving user input for virtual camera operations that modify the rendered view of the anatomical map from within the anatomical map, and rendering a subregion, which includes rendering a subregion of the anatomical map in response to user input.

[0023] In addition, according to one embodiment of the present disclosure, rendering a subregion includes rendering a subregion of an anatomical map from a viewpoint outside the anatomical map.

[0024] Furthermore, according to one embodiment of the present disclosure, the method includes receiving user input for the selection of a subregion of an anatomical map, and rendering the subregion, which includes rendering the subregion of the anatomical map in response to the user input.

[0025] Furthermore, according to one embodiment of the present disclosure, the method includes receiving a user input of the rendering rate of the time-limited portion of the propagation of cardiac activation waves, and rendering a sub-region, which includes rendering the time-limited portion of the propagation of cardiac activation waves on a sub-region of an anatomical map in response to the user input of the rate.

[0026] Furthermore, according to one embodiment of the present disclosure, the method includes a user interface for receiving a user input of the width of a cardiac activation wave, and a processing circuit is configured to render to a display a time-limited portion of the propagation of the cardiac activation wave over a subregion of an anatomical map in response to the user input of the width of the cardiac activation wave.

[0027] Also, according to yet another embodiment of the present disclosure, there is provided a software product including a non - transient computer - readable medium storing program instructions, which, when read by a central processing unit (CPU), cause the CPU to calculate the propagation of cardiac activation waves across an anatomical map of a cardiac chamber in response to the electrical activity of the chamber tissue captured by electrodes of a catheter inserted into the chamber from the start time to the end time of the cardiac cycle, render a sub - region of the anatomical map on a display, select a time - limited portion of the propagation of the cardiac activation wave starting at a time after the start time in response to when the propagation begins to be rendered within the sub - region of the anatomical map, and render the time - limited portion of the propagation of the cardiac activation wave on the sub - region of the anatomical map on the display.

Brief Description of the Drawings

[0028] The present invention will be understood from the following detailed description in conjunction with the accompanying drawings. [Figure 1] It is a schematic diagram of a medical treatment system constructed and operating according to an exemplary embodiment of the present invention. [Figure 2] It is a schematic diagram of a catheter for use in the system of FIG. 1. [Figure 3] It is a schematic diagram showing the propagation of cardiac activation waves across an anatomical map generated by the system of FIG. 1. [Figure 4] It is a schematic diagram showing the propagation of the cardiac activation wave of FIG. 3 on a sub - region of the anatomical map. [Figure 5] It is a schematic diagram showing the rendering of a time - limited portion of the propagation of the cardiac activation wave on the inner sub - region of the anatomical map of FIG. 3. [Figure 6] It is a flowchart including steps in the operation method of the system of FIG. 1.

Modes for Carrying Out the Invention

[0029] General Introduction As mentioned above, in the two-step procedure of mapping followed by ablation, a catheter equipped with one or more electrodes is typically advanced into the heart, and data is obtained at numerous points, thereby sensing and measuring the electrical activity at each point within the heart. These data are then used to select the target area where ablation will be performed.

[0030] Mapping may be used to calculate the propagation of cardiac activation waves across the ventricles of the heart, from the start time of the cardiac cycle to the end time of the cardiac cycle, in response to captured electrical activity such as local activation time (LAT). The propagation of cardiac activation waves may be rendered on a display, typically in slow motion (or any preferred selected speed), across an anatomical map of the ventricles using colors and / or symbols. The propagation is then analyzed by a physician to determine whether and where to ablate the tissue of the ventricles of the heart.

[0031] A physician may view subregions of an anatomical map, for example, by zooming into or viewing a subregion of an anatomical map from inside the anatomical map (e.g., from the viewpoint of a virtual camera where only the subregion of the map can be viewed at any given time). Assuming that a selected subregion of the anatomical map is not present at the start of wave propagation, and the physician then performs cardiac activation wave propagation across the anatomical map of the ventricles of the heart, the physician will not see propagation over the selected and rendered subregion of the anatomical map until, after some delay, i.e., after "performing" across the unrendered portion of the map, the wave finally reaches the selected and rendered subregion of the anatomical map. In general, the above problem can be observed whenever the desired wave propagation range is smaller than the full wave propagation range. If wave propagation is performed in loop mode, the delay can be even greater, as the physician must wait while wave propagation is progressing across the unrendered portions of the anatomical map before and after the currently viewed selected and rendered subregion of the map, such as when wave propagation proceeds from start to finish and then repeats from the beginning. When wave propagation enters a selected rendered subregion, the wave propagation rapidly disappears until the next iteration of wave propagation after another delay. The visible delay of the wave in a selected subregion of the anatomical map can confuse physicians and waste valuable time during cardiac procedures, especially when physicians need to perform wave propagation repeatedly to determine whether and where to ablate cardiac ventricular tissue based on wave propagation.

[0032] Embodiments of the present invention solve the above problem by automatically calculating the earliest time (depending on the cardiac cycle time of wave propagation) at which a wave will reach a selected subregion of the anatomical map currently visible on the display. The rendering of wave propagation to the display then begins from the calculated earliest time in the cardiac cycle of wave propagation. Thus, when a physician performs wave propagation, the wave propagation is automatically rendered across the selected subregion currently visible with virtually no delay.

[0033] Similarly, the latest time (depending on the cardiac cycle time of wave propagation) for the wave to leave the currently visible subregion may be calculated, and the rendering of wave propagation may stop near that point. Thus, when wave propagation is performed by a physician, the rendering of the currently visible subregion may begin immediately until the wave propagation leaves the subregion, and may be repeatedly rendered to the subregion without any significant delay.

[0034] Embodiments of the present invention are useful regardless of whether a subregion of an anatomical map is viewed from a viewpoint within the anatomical map (e.g., a virtual camera) or from a viewpoint outside the anatomical map.

[0035] In some embodiments, the physician may select a subregion from outside the anatomical map by marking or pointing to a portion of the anatomical map. The selected subregion is then optionally enlarged, or otherwise highlighted or marked, providing the physician with better visibility of the subregion and rendering of wave propagation over the subregion.

[0036] In some embodiments, the virtual camera may be operated by a physician using a preferred user interface (e.g., a mouse, joystick, or other pointing device) to select a subregion of the anatomical map visible on the display.

[0037] In some embodiments, wave propagation rendering parameters, such as rendering speed and / or wavewidth, may be selected by the physician to enable the physician to better understand wave propagation in a given region. For example, if the physician selects a subregion associated with high-speed wave propagation, the physician may slow down the wave propagation to carefully visualize the wave propagation within the subregion. In some embodiments, the parameters may be automatically set according to any suitable parameters, such as the size of the selected region and / or the ratio of the size of the selected region to the size of the region in which the full wave propagation is originally calculated.

[0038] System Description Herein, we refer to Figure 1, a schematic diagram of a medical treatment system 20 constructed and operating according to an exemplary embodiment of the present invention. We also refer to Figure 2, a schematic diagram of a catheter 40 for use in the system 20 of Figure 1.

[0039] The medical procedure system 20 is used to determine the position of the catheter 40, which is shown in inset 25 of Figure 1 and in more detail in Figure 2. The catheter 40 includes a shaft 22 and a number of flexible arms 54 (only some are numbered for simplification) having proximal ends connected to the distal end of the shaft 22. The catheter 40 is configured to be inserted into a part of the living body (e.g., a chamber of the heart 26).

[0040] The catheter 40 includes a position sensor 53 disposed on the shaft 22 in a predetermined spatial relationship with respect to the proximal end of the flexible arm 54. The position sensor 53 may include a magnetic sensor 50 and / or at least one shaft electrode 52. The magnetic sensor 50 may include, but is not limited to, at least one coil, such as a biaxial coil array or a triaxial coil array, for providing positional data including rotation and orientation. The catheter 40 includes a plurality of electrodes 55 (only some are numbered in Figure 2 for simplification) disposed at respective locations along each of the flexible arms 54 and configured to capture the electrical activity of the tissues of the ventricles of the heart 26 over time at each location within the heart 26. Typically, the catheter 40 may be used to map the electrical activity within the heart 26 of a living organism using the electrodes 55, or to perform any other preferred function within a part of the body of a living organism.

[0041] The medical treatment system 20 may determine the position and orientation of the shaft 22 of the catheter 40 based on signals supplied by a magnetic sensor 50 and / or shaft electrodes 52 (proximal electrode 52a and distal electrode 52b) on both sides of the magnetic sensor 50 attached to the shaft 22. The proximal electrode 52a, distal electrode 52b, magnetic sensor 50 and at least some electrodes 55 are connected to various driver circuits in the console 24 via a catheter connector 35 by wires extending through the shaft 22. In some embodiments, at least two electrodes 55 of each of the flexible arms 54, shaft electrodes 52, and magnetic sensor 50 are connected to driver circuits in the console 24 via a catheter connector 35. In some embodiments, the distal electrode 52b and / or proximal electrode 52a may be omitted.

[0042] The diagram shown in Figure 2 has been selected purely for the purpose of clarifying the concept. Other configurations of the shaft electrode 52 and electrode 55 are also possible. The position sensor 53 may include further functions. For clarity, elements not relevant to the disclosed embodiments of the present invention, such as irrigation ports, have been omitted.

[0043] The physician 30 guides the catheter 40 to a target location within the patient's body (e.g., the heart 26) by manipulating the shaft 22 using a manipulator 32 near the proximal end of the catheter 40 and / or deflecting it from the sheath 23. The catheter 40 is inserted through the sheath 23 with its flexible arms 54 bundled together, and only after the catheter 40 has retracted from the sheath 23 can the flexible arms 54 unfold and regain their intended functional shape. By housing the flexible arms 54 together, the sheath 23 also plays a role in minimizing vascular trauma during its journey to the target location.

[0044] The console 24 includes a processing circuit 41, typically a general-purpose computer, and a suitable front-end and interface circuit 44 that generates signals at and / or receives signals from body surface electrodes 49 attached by wires extending through a cable 39 to the chest and back or any other suitable skin surface of the patient 28.

[0045] Console 24 further includes a magnetic sensing subsystem. The patient 28 is placed in a magnetic field generated by a pad containing at least one magnetic field emitter 42, which is driven by a unit 43 located in Console 24. The magnetic field emitter 42 is configured to transmit an alternating magnetic field to the region where a body part (e.g., heart 26) is located. The magnetic field generated by the magnetic field emitter 42 generates a directional signal in a magnetic sensor 50. The magnetic sensor 50 is configured to detect at least a portion of the emitted alternating magnetic field and to supply the directional signal as a corresponding electrical input to a processing circuit 41.

[0046] In some embodiments, the processing circuit 41 uses position signals received from the shaft electrode 52, magnetic sensor 50, and electrode 55 to estimate the position of the catheter 40 within an organ such as a ventricle. In some embodiments, the processing circuit 41 correlates the position signals received from electrodes 52 and 55 with previously acquired magnetic location calibration position signals to estimate the position of the catheter 40 within a ventricle. The position coordinates of the shaft electrode 52 and electrode 55 may be determined by the processing circuit 41 based, among other inputs, particularly the ratio of impedance or current distribution measured between electrodes 52, 55 and the body surface electrode 49. The console 24 drives a display 27 showing the distal end of the catheter 40 in an anatomical map of the heart 26.

[0047] Methods for position sensing using current distribution measurements and / or external magnetic fields have various medical applications, such as Biosense Webster. It is implemented in the Carto® system manufactured by Inc. (Irvine, California), and is detailed in U.S. Patents Nos. 5,391,199, 6,690,963, 6,484,118, 6,239,724, 6,618,612, 6,332,089, 7,756,576, 7,869,865, and 7,848,787, International Publication No. 96 / 05768, and U.S. Patent Application Publications 2002 / 0065455(A1), 2003 / 0120150(A1), and 2004 / 0068178(A1).

[0048] The Carto® 3 system applies an impedance-based position tracking method for Active Current Location (ACL). In some embodiments, the processing circuit 41 is configured to use the ACL method to create a mapping (e.g., a current-position matrix (CPM)) between the representation of electrical impedance and the position of the magnetic field radiator 42 within the magnetic coordinate frame. The processing circuit 41 estimates the positions of the shaft electrode 52 and electrode 55 by performing a lookup within the CPM.

[0049] The processing circuit 41 is typically programmed with software to perform the functions described herein. The software can be downloaded electronically to a computer, for example, over a network, or alternatively or additionally, it can be provided and / or stored on a non-temporary physical medium such as magnetic memory, optical memory, or electronic memory.

[0050] System 20 also includes a user interface 57 for receiving user inputs such as the selection of subregions of an anatomical map for display, the operation of a virtual camera used when viewing subregions of the anatomical map, the rendering speed of the wave propagation of cardiac activation waves, and / or the width of the cardiac activation waves being rendered. User interface 57 may include a keyboard and / or touchscreen, a foot pedal, and optionally a pointing device such as a mouse, stylus, and / or joystick.

[0051] Figure 1 shows only the elements relating to the technology of this disclosure for the sake of brevity and clarity. System 20 typically includes additional modules and elements that are intentionally omitted from Figure 1 and the corresponding description because they are not directly related to the technology disclosed.

[0052] The catheter 40 described above includes eight flexible arms 54, each having six electrodes 55. Instead of catheter 40, any suitable catheter may be used, such as a catheter having a varying number of flexible arms and / or multiple electrodes per arm, or various probe shapes, such as a balloon catheter or a lasso catheter, for example.

[0053] The medical procedure system 20 may also perform ablation of cardiac tissue using any suitable catheter and any suitable ablation method, such as using catheter 40 or a different catheter. The console 24 may include an RF signal generator 34 configured to generate RF power applied by one or more electrodes of a catheter connected to the console 24 and one or more body surface electrodes 49 for ablation of the myocardium of the heart 26. The console 24 may also include a pump (not shown) for pumping irrigation fluid into an irrigation channel at the distal end of the catheter performing the ablation. The catheter performing the ablation may also include a temperature sensor (not shown) used to measure the temperature of the myocardium during ablation and to adjust the ablation power and / or the irrigation rate of pumping the irrigation fluid according to the measured temperature.

[0054] Here, we refer to Figure 3, a schematic diagram showing the propagation of cardiac activation waves 60 across the anatomical map 62 generated by the system 20 in Figure 1. The processing circuit 41 is configured to calculate the propagation of cardiac activation waves 60 across the anatomical map 62 of the ventricles of the heart 26 in response to electrical activity captured by electrodes 55 (Figure 2) from the start time of the cardiac cycle to the end time of the cardiac cycle. The propagation begins at time T0 and continues until end time T7, as will be described in more detail with reference to Figure 5. Figure 3 shows the progression of cardiac activation waves 60 across the anatomical map 62 at times T1, T3, and T5. The cardiac activation waves 60 are represented by shaded portions moving across the anatomical map 62.

[0055] The anatomical map 62 may be generated using any preferred anatomical map generation method, for example, Fast Anatomical Mapping (FAM), which is described in U.S. Patent No. 10,918,310 by Cohen et al. In FAM, a smooth shell is generated over a three-dimensional (3D) cloud of data points, such as a cloud of calculated electrode positions of the electrodes 55. The propagation of the cardiac activation wave 60 may be calculated using any preferred method, for example, one or more of the methods disclosed in U.S. Patent Nos. 10,136,828, 6,226,542, 6,301,496, and 6,892,091, for example.

[0056] Figure 3 shows a square subregion 64 on an anatomical map 62. Subregion 64 is selected by the physician 30 and enlarged as shown in Figure 4. Figure 3 shows that at time T1, the cardiac activation wave 60 has not yet appeared in subregion 64. Figure 3 shows that at time T3, the cardiac activation wave 60 has already appeared in subregion 64 and its presence continues to grow until time T5.

[0057] Here, refer to Figure 4, a schematic diagram showing the propagation of cardiac activation waves 60 in Figure 3 over subregions 64 of the anatomical map 62 at times T2–T6.

[0058] The processing circuit 41 is configured to render subregions 64 of the anatomical map 62 of the ventricles of the heart 26 to the display 27. The processing circuit 41 is configured to select a time limit portion of the propagation of cardiac activation waves 60 that starts at a time after the cycle start time T0 (referred herein to as the "adjusted start time") (optionally, ends at a time before the cycle end time T7 (referred herein to as the "adjusted end time")) when the rendering of the propagation within the subregions 64 of the anatomical map 62 begins (and optionally, when the rendering of the propagation of cardiac activation waves 60 within the subregions 64 of the anatomical map 62 is completed). Thus, the processing circuit 41 is configured to calculate the adjusted start time and optionally the adjusted end time in order to render the propagation of cardiac activation waves 60 as the propagation is rendered within the subregions 64. Thus, the time limit portion is defined by the adjusted start time and optionally the adjusted end time. In the example in Figure 4, the time-limited portion has an adjusted start time T2 (compared to the original period start time T0) and an adjusted end time T6 (compared to the original period end time T7).

[0059] The processing circuit 41 is configured to render the time-limited portion of the propagation of the cardiac activation wave 60 over the subregion 64 of the anatomical map 62 on the display 27 by rendering the generated propagation of the cardiac activation wave 60 from a tuned start time (e.g., T2) to a tuned end time (e.g., T6). The time-limited portion of the propagation of the cardiac activation wave 60 may be repeatedly rendered in loop mode from a tuned start time (e.g., T2) to a tuned end time (e.g., T6), thereby allowing the physician 30 to carefully examine the wave propagation over the subregion 64.

[0060] The anatomical map 62 and subregions 64 shown in Figures 3 and 4 are typically viewed from an external viewpoint of the anatomical map 62. However, the subregions 64 may also be viewed from a viewpoint within the anatomical map 62 (e.g., a virtual camera), as will be explained in more detail with reference to Figure 5.

[0061] Here, refer to Figure 5, a schematic diagram showing a rendering of the time-limited portion of the propagation of cardiac activation waves 60 over sub-regions 64 within the anatomical map 62 in Figure 3.

[0062] The anatomical map 62 may be viewed from the viewpoint of the virtual camera 66 within the anatomical map 62, such that the field of view 68 of the virtual camera 66 is rendered on the display 27. The field of view 68 is drawn by two dotted lines 76. Figure 5 shows a cross-sectional view 72 of the anatomical map 62, in which the virtual camera 66 is positioned, and the inner wall 74 inside the anatomical map 62 is visible from the virtual camera 66. A portion of the inner wall 74 is shaded to indicate the portion of the inner wall 74 visible by the virtual camera 66, and corresponds to a sub-region 64 of the anatomical map 62. The left and right regions of the sub-region 64 can be viewed by moving the virtual camera 66 to the left and right, respectively.

[0063] Arrow 70 shows how the cardiac activation wave 60 propagates over the inner wall 74 of the anatomical map 62 from time T0 to time T7. It can be seen that the cardiac activation wave 60 enters subregion 64 at time T2 and exits subregion 64 at time T6. Therefore, if physician 30 chooses to perform the propagation of the cardiac activation wave 60 while subregion 64 is visible from the virtual camera 66, the propagation will be rendered from time T2 to time T6, rather than between times T0-T2 and T6-T7.

[0064] Here, refer to Figure 6, which is a flowchart 80 including the steps in the operation method of system 20 in Figure 1. See also Figure 5.

[0065] The processing circuit 41 is configured to generate an anatomical map 62 of the ventricles of the heart 26 and to render the anatomical map 62 or a portion thereof on the display 27. The processing circuit 41 is configured to calculate the propagation of cardiac activation waves 60 across the anatomical map 62 of the ventricles of the heart 26 (Figure 1) in response to electrical activity captured by electrodes 55 (Figure 2) from the start time of the cardiac cycle of the cardiac activation waves 60 to the end time of the cardiac cycle (block 82). The propagation of cardiac activation waves 60 can be calculated using any preferred method. In some embodiments, local excitation times (LATs) are identified from cardiac electrical activity signals (e.g., electrocardiogram (ECG) or intracardiac electrogram (IEGM)) and associated with their respective locations on the surface of the anatomical map 62. The propagation of cardiac activation waves 60 may then be calculated based on the LATs using a sliding window of LATs. For example, at time T0, LAT in the range of -200ms to -160ms is rendered on the anatomical map 62; at time T1, LAT in the range of -180ms to -140ms is rendered on the anatomical map 62; and at time T2, LAT in the range of -160ms to -120ms is rendered on the anatomical map 62. The LAT window continues to move until the complete period of the cardiac activation wave, cardiac activation wave 60, is rendered on the anatomical map 62. In this way, the cardiac activation wave 60 appears to move across the surface of the anatomical map 62. The width of the slide window, i.e., the range of LAT within the slide window, may be configurable. Color or shading may be used to indicate the LAT being rendered at any point in time during propagation. Different colors or shading may be used to indicate different LAT values. For example, LATs in the range of -200ms to -160ms can be rendered in red on the anatomical map 62, LATs in the range of -180ms to -140ms can be rendered in orange on the anatomical map 62, and LATs in the range of -160ms to -120ms can be rendered in yellow on the anatomical map 62.

[0066] In some embodiments, the user interface 57 is configured to receive user input for the selection of a sub-region 64 of the anatomical map 62 of the ventricles of the heart 26 (block 84). The sub-region 64 may be selected by the physician 30 from the surface of the anatomical map 62, for example, by selecting an area or point on the map 62 using a pointing device or touch-sensitive screen. The processing circuit 41 is configured to render the sub-region 64 of the anatomical map 62 in response to the user input (block 86). In some embodiments, the processing circuit 41 is configured to render the sub-region 64 of the anatomical map 62 from a viewpoint outside the anatomical map 62.

[0067] In some embodiments, the user interface 57 is configured to receive user input for manipulating a virtual camera 66 to change the rendered view of the anatomical map 62 from within the anatomical map 62 to a view of a sub-region 64 from within the anatomical map 62 (block 84). The processing circuit 41 is configured to render the sub-region 64 within the anatomical map 62 from a viewpoint within the anatomical map 62 (e.g., the virtual camera 66) to the display 27 in response to the user input for manipulating the virtual camera 66 (block 86).

[0068] The processing circuit 41 is configured to select a time limit portion of the propagation of the cardiac activation wave 60 that starts at a time after the period start time (e.g., T0) (e.g., adjusted start time T2) in response to when the propagation begins to be rendered within a subregion 64 of the anatomical map 62 (block 88). In some embodiments, the processing circuit 41 is configured to select a time limit portion of the propagation of the cardiac activation wave 60 that ends at a time before the period end time (e.g., T7) (e.g., adjusted end time T6) in response to when the propagation of the cardiac activation wave 60 has finished being rendered within a subregion 64 of the anatomical map 62.

[0069] The user interface 57 may be configured to receive user input regarding the rendering speed of the time-limited portion of the propagation of the cardiac activation wave 60 and / or the width of the cardiac activation wave 60 across subregions 64 of the anatomical map 62 (block 90). The time-limited portion may be rendered at real-time speed (i.e., the speed at which the cardiac activation wave 60 propagates over the ventricles of the heart 26), or at a speed slower or faster than real-time speed. The width of the cardiac activation wave 60 provides a measure of the LAT value that, at any given time, is contained within a sliding window of the propagation of the cardiac activation wave 60 across subregions 64 of the anatomical map 62. For example, if the selected width is 40 milliseconds, the range of LAT values ​​shown on the anatomical map 62 at any given time is within a width range of 40 milliseconds (ms) (e.g., -100ms to 60ms at time T2, or 10ms to 50ms at time T6, etc.), and the sliding window of LAT values ​​constantly shifts as the cardiac activation wave 60 propagates across the anatomical map 62, but has a stationary width of 40ms.

[0070] The processing circuit 41 is configured to render to the display 27 a time-limited portion of the propagation of cardiac activation waves 60 over a sub-region 64 of the anatomical map 62 (block 92). In other words, the processing circuit 41 is configured to render to the display 27 the propagation of cardiac activation waves 60 from a tuned start time (to a tuned end time). In some embodiments, the processing circuit 41 is configured to render the sub-region 64 of the anatomical map 62 from a viewpoint within the anatomical map 62 (e.g., a virtual camera 66). In some embodiments, the processing circuit 41 is configured to render the sub-region 64 of the anatomical map 62 from a viewpoint within the anatomical map 62 (e.g., a virtual camera 66), and the viewpoint (e.g., a virtual camera 66) remains stationary during the rendering of the time-limited portion of the propagation of cardiac activation waves 60 over the sub-region 64 of the anatomical map 62. In some embodiments, the processing circuit 41 is configured to render the sub-region 64 of the anatomical map 62 from a viewpoint outside the anatomical map 62.

[0071] In some embodiments, the processing circuit 41 is configured to render to the display 27 a time-limited portion of the propagation of cardiac activation waves 60 over subregions 64 of the anatomical map 62 in response to user input of the rendering speed in block 90. ​​In some embodiments, the processing circuit 41 is configured to render to the display 27 a time-limited portion of the propagation of cardiac activation waves 60 over subregions 64 of the anatomical map 62 in response to user input of the width of cardiac activation waves 60 in block 90.

[0072] The processing circuit 41 may be configured to automatically repeat rendering of the time-limited portion of the propagation of cardiac activation waves 60 on subregions 64 of the anatomical map 62 (block 94).

[0073] As used herein, the terms “about” or “approximately” for any number or range of numbers indicate a suitable dimensional tolerance that enables a part or set of components to function in accordance with its intended purpose as described herein. More specifically, “about” or “approximately” may refer to a range of values ​​within ±20% of the listed values; for example, “about 90%” may refer to a range of values ​​between 72% and 108%.

[0074] Various features of the present invention are described in the context of separate embodiments for clarity, but these may also be provided in combination in a single embodiment. Conversely, various features of the present invention described in the context of a single embodiment for brevity may be provided separately or in any preferred partial combination.

[0075] The embodiments described above are cited as examples, and the present invention is not limited to those specifically illustrated and described in the above specification. Rather, the scope of the present invention includes both combinations and partial combinations thereof of the various features described in the above specification, as well as variations and modifications thereof not disclosed in the prior art, which would be conceivable to those skilled in the art by reading the above description.

[0076] [Implementation Method] (1) A medical system for enhancing wave propagation, A catheter comprising electrodes configured to be inserted into a ventricle of the heart and configured to capture the electrical activity of the tissue in the ventricle over time, The display and A processing circuit, The propagation of cardiac activation waves across the anatomical map of the chamber is calculated in response to the captured electrical activity from the start time of the cardiac cycle to the end time of the cardiac cycle, Rendering a subregion of the anatomical map onto the display, Selecting a time-limiting portion of the propagation of the cardiac activation wave that begins at a time after the aforementioned start time in response to the start of rendering of the propagation within the subregion of the anatomical map, A system comprising: a processing circuit configured to render on a display the time-limited portion of the propagation of the cardiac activation wave on the subregion of the anatomical map. (2) The system according to Embodiment 1, wherein the processing circuit is configured to select the time-limited portion of the propagation of the cardiac activation wave that terminates in a time prior to the termination time in response to the completion of rendering the propagation of the cardiac activation wave within the subregion of the anatomical map. (3) The system according to Embodiment 2, wherein the processing circuit is configured to automatically repeat rendering of the time-limited portion of the propagation of the cardiac activation wave on the subregion of the anatomical map. (4) The system according to Embodiment 1, wherein the processing circuit is configured to render the sub-region of the anatomical map from a viewpoint within the anatomical map. (5) The system according to Embodiment 4, wherein the processing circuit is configured to render the subregion of the anatomical map from a viewpoint within the anatomical map, and the viewpoint remains stationary during the rendering of the time-limited portion of the propagation of the cardiac activation wave over the subregion of the anatomical map.

[0077] (6) The system according to Embodiment 4, further comprising a user interface for receiving user input for manipulating a virtual camera to change a rendered view of the anatomical map from within the anatomical map, wherein the processing circuit is configured to render the subregions of the anatomical map in response to the user input. (7) The system according to Embodiment 1, wherein the processing circuit is configured to render the sub-region of the anatomical map from a viewpoint outside the anatomical map. (8) The system according to Embodiment 7, further comprising a user interface for receiving user input for the selection of the subregions of the anatomical map, wherein the processing circuit is configured to render the subregions of the anatomical map in response to the user input. (9) The system according to Embodiment 1, further comprising a user interface for receiving user input of the rendering speed of the time-limited portion of the propagation of the cardiac activation wave, wherein the processing circuit is configured to render the time-limited portion of the propagation of the cardiac activation wave on the subregion of the anatomical map to the display in response to the user input of the speed. (10) The system according to Embodiment 1, further comprising a user interface for receiving a user input of the width of the cardiac activation wave, wherein the processing circuit is configured to render the time-limited portion of the propagation of the cardiac activation wave on the subregion of the anatomical map to the display in response to the user input of the width of the cardiac activation wave.

[0078] (11) A medical method for enhancing wave propagation control, The propagation of cardiac activation waves across the anatomical map of the cardiac ventricles is calculated in response to the electrical activity of the ventricle tissue captured by electrodes of a catheter inserted into the ventricle, from the start time of the cardiac cycle to the end time of the cardiac cycle. Rendering the subregions of the aforementioned anatomical map onto the display, Selecting a time-limiting portion of the propagation of the cardiac activation wave that begins at a time after the aforementioned start time in response to the start of rendering of the propagation within the subregion of the anatomical map, A method comprising rendering the time-limited portion of the propagation of the cardiac activation wave on the subregion of the anatomical map onto the display. (12) The method of Embodiment 11, wherein the selection is made in response to the completion of rendering the time-limited portion of the propagation of the cardiac activation wave which ends in a time prior to the end time. (13) The method of Embodiment 12, further comprising automatically repeating the rendering of the time-limited portion of the propagation of the cardiac activation wave on the subregion of the anatomical map. (14) The method according to Embodiment 11, wherein rendering the subregion includes rendering the subregion of the anatomical map from a viewpoint within the anatomical map. (15) The method of Embodiment 14, wherein rendering the subregion includes rendering the subregion of the anatomical map from a viewpoint within the anatomical map, the viewpoint being stationary during the rendering of the time-limited portion of the propagation of the cardiac activation wave over the subregion of the anatomical map.

[0079] (16) The method of Embodiment 14, further comprising receiving user input for virtual camera operation to change a rendered view of the anatomical map from within the anatomical map, and rendering the subregions, which includes rendering the subregions of the anatomical map in response to the user input. (17) The method according to Embodiment 11, wherein rendering the subregion includes rendering the subregion of the anatomical map from a viewpoint outside the anatomical map. (18) The method of Embodiment 17, further comprising receiving user input for selection of the subregion of the anatomical map, and rendering the subregion, which includes rendering the subregion of the anatomical map in response to the user input. (19) The method of Embodiment 11, further comprising receiving a user input of the rendering speed of the time-limited portion of the propagation of the cardiac activation wave, wherein rendering the subregion includes rendering the time-limited portion of the propagation of the cardiac activation wave on the subregion of the anatomical map in response to the user input of the speed. (20) The method according to Embodiment 11, further comprising a user interface for receiving a user input of the width of the cardiac activation wave, wherein the processing circuit is configured to render the time-limited portion of the propagation of the cardiac activation wave on the subregion of the anatomical map to the display in response to the user input of the width of the cardiac activation wave.

[0080] (21) A software product including a non-temporary computer-readable medium in which program instructions are stored, wherein when the instructions are read by a central processing unit (CPU), the CPU The propagation of cardiac activation waves across the anatomical map of the cardiac ventricles is calculated in response to the electrical activity of the ventricle tissue captured by electrodes of a catheter inserted into the ventricle, from the start time of the cardiac cycle to the end time of the cardiac cycle. Rendering the subregions of the aforementioned anatomical map onto the display, Selecting a time-limiting portion of the propagation of the cardiac activation wave that begins at a time after the aforementioned start time in response to the start of rendering of the propagation within the subregion of the anatomical map, A software product that causes the display to render the time-limited portion of the propagation of the cardiac activation wave on the subregion of the anatomical map.

Claims

1. A medical system for enhancing wave propagation, A catheter comprising electrodes configured to be inserted into a ventricle of the heart and configured to capture the electrical activity of the tissue in the ventricle over time, The display and A processing circuit, The propagation of cardiac activation waves across the anatomical map of the chamber is calculated in response to the captured electrical activity from the start time of the cardiac cycle to the end time of the cardiac cycle, Rendering a subregion of the anatomical map onto the display, Selecting a time-limiting portion of the propagation of the cardiac activation wave that begins at a time after the aforementioned start time in response to the start of rendering of the propagation within the subregion of the anatomical map, A system comprising: a processing circuit configured to render on a display the time-limited portion of the propagation of the cardiac activation wave on the subregion of the anatomical map.

2. The system according to claim 1, wherein the processing circuit is configured to select the time-limited portion of the propagation of the cardiac activation wave that terminates at a time prior to the termination time, in response to the completion of rendering the propagation of the cardiac activation wave within the subregion of the anatomical map.

3. The system according to claim 2, wherein the processing circuit is configured to automatically repeat rendering of the time-limited portion of the propagation of the cardiac activation wave on the sub-region of the anatomical map.

4. The system according to claim 1, wherein the processing circuit is configured to render the sub-region of the anatomical map from a viewpoint within the anatomical map.

5. The system according to claim 4, wherein the viewpoint remains stationary during the rendering of the time-limited portion of the propagation of the cardiac activation wave over the subregion of the anatomical map.

6. The system according to claim 4, further comprising a user interface for receiving user input for manipulating a virtual camera to change a rendered view of the anatomical map from within the anatomical map, wherein the processing circuit is configured to render the sub-regions of the anatomical map in response to the user input.

7. The system according to claim 1, wherein the processing circuit is configured to render the sub-region of the anatomical map from a viewpoint outside the anatomical map.

8. The system according to claim 7, further comprising a user interface for receiving user input for the selection of the subregions of the anatomical map, wherein the processing circuit is configured to render the subregions of the anatomical map in response to the user input.

9. The system according to claim 1, further comprising a user interface for receiving user input of the rendering speed of the time-limited portion of the propagation of the cardiac activation wave, wherein the processing circuit is configured to render the time-limited portion of the propagation of the cardiac activation wave on the subregion of the anatomical map to the display in response to the user input of the speed.

10. The system according to claim 1, further comprising a user interface for receiving a user input of the temporal width of the cardiac activation wave, wherein the processing circuit is configured to render the time-limited portion of the propagation of the cardiac activation wave on the subregion of the anatomical map to the display in response to the user input of the temporal width of the cardiac activation wave.

11. A method for operating a processing circuit for enhancing wave propagation control, The processing circuit calculates the propagation of cardiac activation waves across an anatomical map of the cardiac ventricles in response to the electrical activity of the tissue in the ventricles captured by electrodes of a catheter inserted into the ventricles, from the start time of the cardiac cycle to the end time of the cardiac cycle. The processing circuit renders a subregion of the anatomical map on a display, The processing circuit selects a time-limiting portion of the propagation of the cardiac activation wave that begins at a time after the start time, in response to the start of the propagation being rendered within the subregion of the anatomical map. A method of operating the processing circuit, comprising rendering the time-limited portion of the propagation of the cardiac activation wave on the subregion of the anatomical map to the display.

12. A method of operating the processing circuit according to claim 11, wherein the processing circuit selects the time-limited portion of the propagation of the cardiac activation wave that terminates in a time prior to the termination time, in response to the completion of rendering the propagation of the cardiac activation wave within the subregion of the anatomical map.

13. A method of operating the processing circuit according to claim 12, further comprising the processing circuit automatically repeating the rendering of the time-limited portion of the propagation of the cardiac activation wave on the subregion of the anatomical map.

14. The method of operating the processing circuit according to claim 11, wherein the rendering of the sub-region by the processing circuit includes the rendering of the sub-region of the anatomical map from a viewpoint within the anatomical map.

15. The method of operating the processing circuit according to claim 14, wherein the viewpoint remains stationary during the rendering of the time-limited portion of the propagation of the cardiac activation wave over the subregion of the anatomical map.

16. A method of operating a processing circuit according to claim 14, comprising a user interface for receiving user input for operating a virtual camera to change a rendered view of the anatomical map from within the anatomical map, wherein the processing circuit rendering the sub-regions includes the processing circuit rendering the sub-regions of the anatomical map in response to the user input.

17. The method of operating the processing circuit according to claim 11, wherein the rendering of the sub-region by the processing circuit includes the rendering of the sub-region of the anatomical map from a viewpoint outside the anatomical map.

18. A method of operating a processing circuit according to claim 17, comprising a user interface for receiving user input for the selection of the subregion of the anatomical map, wherein the rendering of the subregion by the processing circuit includes the rendering of the subregion of the anatomical map in response to the user input.

19. A method of operating a processing circuit according to claim 11, comprising a user interface for receiving a user input of the rendering speed of the time-limited portion of the propagation of the cardiac activation wave, wherein the rendering of the sub-region by the processing circuit includes the processing circuit rendering the time-limited portion of the propagation of the cardiac activation wave on the sub-region of the anatomical map in response to the user input of the speed.

20. A method of operating a processing circuit according to claim 11, comprising a user interface for receiving a user input of the temporal width of the cardiac activation wave, wherein the processing circuit is configured to render the time-limited portion of the propagation of the cardiac activation wave on the subregion of the anatomical map to the display in response to the user input of the temporal width of the cardiac activation wave.

21. A software product including a non-temporary computer-readable medium in which program instructions are stored, wherein when the program instructions are read by a central processing unit (CPU), the CPU... The propagation of cardiac activation waves across the anatomical map of the cardiac ventricles is calculated in response to the electrical activity of the ventricle tissue captured by electrodes of a catheter inserted into the ventricle, from the start time of the cardiac cycle to the end time of the cardiac cycle. Rendering the subregions of the aforementioned anatomical map onto the display, Selecting a time-limiting portion of the propagation of the cardiac activation wave that begins at a time after the aforementioned start time in response to the start of rendering of the propagation within the subregion of the anatomical map, A software product that causes the display to render the time-limited portion of the propagation of the cardiac activation wave on the subregion of the anatomical map.

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