Automated anatomical feature recognition and map segmentation

Abstract

To provide a medical system.SOLUTION: In one embodiment, a medical system includes: a catheter configured to be inserted into a heart of a living subject, and including electrodes configured to capture electrical activity of the heart at respective positions in the heart; a display; and processing circuitry configured to receive position signals from the catheter, and, in response to the position signals, compute the respective positions of the electrodes, generate an anatomical map responsively to respective ones of the computed positions, find an anatomical feature of the heart and a position of the anatomical feature responsively to the respective positions of, and electrical activity captured by, respective ones of the electrodes, automatically segment the anatomical map responsively to the found position of the anatomical feature, and render the anatomical map on the display.SELECTED DRAWING: Figure 1

Description

Technical Field

[0001] The present invention relates to a medical system, and particularly, but not exclusively, to a catheter-based system. Background Art

[0002] A wide range of medical procedures involve placing a probe such as a catheter into a patient's body. Position sensing systems have been developed to track such probes. Magnetic position sensing is one of the methods known in the art. In magnetic position sensing, magnetic field generators are typically placed at known locations external to the patient. A magnetic field sensor within the distal end of the probe generates 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. WO 1996 / 005768, and U.S. Patent Application Publication Nos. 2002 / 0065455, 2003 / 0120150, and 2004 / 0068178, the disclosures of which are incorporated herein by reference in their entireties. Position may also be tracked using impedance- or current-based systems.

[0003] One medical procedure in which these types of probes or catheters have proven extremely useful is in the treatment of cardiac arrhythmias. Cardiac arrhythmias, and particularly atrial fibrillation, remain common and dangerous medical conditions, 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 that involves mapping followed by ablation, a catheter containing one or more electrical sensors is typically advanced into the heart, and electrical activity at each point within the heart is sensed and measured by obtaining data at multiple 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. They 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 cardiac chamber. 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 tissue's electrical resistance. When tissue is sufficiently heated, it causes cell destruction in 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 the 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 configured to be inserted into the heart of a living organism, and including electrodes configured to capture the electrical activity of the heart at each of its locations within the heart; a display; and a processing circuit configured to receive position signals from the catheter, calculate the position of each of the electrodes in response to the position signals, generate an anatomical map in response to each of the calculated positions, find anatomical features of the heart and the locations of the anatomical features in response to the position of each of the electrodes and the electrical activity captured by each of the electrodes, automatically segment the anatomical map in response to the locations where the anatomical features are found, and render the anatomical map on the display.

[0008] Furthermore, according to one embodiment of the present disclosure, the processing circuit is configured to automatically segment the anatomical map in response to the location where an anatomical feature is found, leaving holes in the anatomical map in place of the anatomical feature.

[0009] Furthermore, according to one embodiment of the present disclosure, the anatomical feature is a heart valve, the anatomical map includes a map of the atria, and the processing circuit is configured to automatically segment the anatomical map, leaving holes in the anatomical map in place of the heart valve.

[0010] In addition, according to one embodiment of the present disclosure, the processing circuit is configured to calculate the local excitation time of each electrical activity captured by the electrodes, and to locate the anatomical features of the heart and the locations of the anatomical features in response to the respective positions of the electrodes and the calculated local excitation times of the electrical activity captured by each electrode.

[0011] Furthermore, according to one embodiment of the present disclosure, the processing circuit is configured to automatically segment the anatomical map in response to the location where an anatomical feature is found, leaving holes in the anatomical map in place of the anatomical feature.

[0012] Furthermore, according to one embodiment of the present disclosure, some of the local excitation times represent atrial electrical activity, some of the local excitation times represent ventricular electrical activity, and the processing circuit is configured to find cardiac anatomical features in response to each local excitation time representing ventricular electrical activity.

[0013] Furthermore, according to one embodiment of the present disclosure, the anatomical feature is a heart valve, the anatomical map includes a map of the atria, and the processing circuit is configured to automatically segment the anatomical map, leaving holes in the anatomical map in place of the heart valve.

[0014] In addition, according to one embodiment of the present disclosure, the catheter includes a shaft and a plurality of flexible arms, each having a proximal end connected to the distal end of the shaft, with electrodes disposed at their respective positions along each of the flexible arms.

[0015] Another embodiment of the present disclosure also provides a method for receiving position signals from a catheter inserted into the heart of a living organism, wherein the catheter includes electrodes for capturing the electrical activity of the heart at each of its locations within the heart; calculating the respective positions of the electrodes in response to the position signals; generating an anatomical map in response to each of the calculated positions; finding anatomical features of the heart and the locations of the anatomical features in response to the respective positions of the electrodes and the electrical activity captured by each of the electrodes; automatically segmenting the anatomical map in response to the locations where the anatomical features are found; and rendering the anatomical map on a display.

[0016] Furthermore, according to one embodiment of the present disclosure, automatic segmentation includes segmenting the anatomical map in response to the location where anatomical features are found, leaving holes in the anatomical map instead of the anatomical features.

[0017] Furthermore, according to one embodiment of the present disclosure, the anatomical feature is a heart valve, the anatomical map includes a map of the atria, and the automatic segmentation includes segmenting the anatomical map, leaving holes in the anatomical map in place of the heart valve.

[0018] Furthermore, according to embodiments of the present disclosure, the method further includes calculating the local excitation time of each of the electrical activity captured by the electrodes, finding the anatomical features of the heart and the locations of the anatomical features in response to the respective locations of the electrodes and the calculated local excitation times of the electrical activity captured by each of the electrodes.

[0019] In addition, according to one embodiment of the present disclosure, automatic segmentation includes segmenting the anatomical map in response to the location where anatomical features are found, leaving holes in the anatomical map instead of the anatomical features.

[0020] Furthermore, according to one embodiment of the present disclosure, finding that some of the local excitation times represent atrial electrical activity, and some of the local excitation times represent ventricular electrical activity, involves finding cardiac anatomical features in response to each local excitation time representing ventricular electrical activity.

[0021] Furthermore, according to one embodiment of the present disclosure, the anatomical feature is a heart valve, the anatomical map includes a map of the atria, and the automatic segmentation includes segmenting the anatomical map, leaving holes in the anatomical map in place of the heart valve.

[0022] Furthermore, according to one embodiment of the present disclosure, the catheter includes a shaft and a plurality of flexible arms, each having a proximal end connected to the distal end of the shaft, wherein electrodes are disposed at their respective positions along each of the flexible arms.

[0023] A further embodiment of the present disclosure also provides a software product comprising a non-temporary computer-readable medium on which program instructions are stored, wherein when the instructions are read by a central processing unit (CPU), the CPU is instructed to receive position signals from a catheter inserted into the heart of a living organism, wherein the catheter includes electrodes for capturing the electrical activity of the heart at each of its locations within the heart; to calculate the position of each of the electrodes in response to the position signals; to generate an anatomical map in response to each of the calculated positions; to find anatomical features of the heart and the locations of the anatomical features in response to the position of each of the electrodes and the electrical activity captured by each of the electrodes; to automatically segment the anatomical map in response to the locations where the anatomical features are found; and to render the anatomical map on a display. [Brief explanation of the drawing]

[0024] This invention will be understood from the following detailed description, along with the drawings. [Figure 1]1 is a schematic diagram of a medical procedure system constructed and operating in accordance with an exemplary embodiment of the present invention. [Figure 2] Fig. 1 is a schematic diagram of a catheter for use in the system of Fig. 1. [Figure 3] Fig. 2 is a schematic diagram of an anatomical map and the catheter of Fig. 2. [Figure 4] Fig. 3 is a schematic diagram of electrical activity signals captured via electrodes of the catheter of Fig. 2 and body surface electrodes at the position shown in Fig. 3. [Figure 5] Fig. 4 is a schematic diagram of an electrical activity signal and an associated local activation time thereof. [Figure 6] Fig. 5 is a schematic diagram of calculated electrode positions for use in the system of Fig. 1. [Figure 7] Fig. 6 is a schematic diagram of a first anatomical map based on some of the electrode positions of Fig. 6. [Figure 8] Fig. 7 is a schematic diagram of a second anatomical map based on some of the electrode positions of Fig. 6. [Figure 9] Fig. 8 is a flowchart including steps in a method of operating the system of Fig. 1. DETAILED DESCRIPTION OF EMBODIMENTS OF THE INVENTION

[0025] General Introduction As mentioned above, in a two-step procedure of mapping followed by ablation, a catheter including one or more electrodes is typically advanced into the heart, and data is acquired at a number of points to sense and measure electrical activity at each point within the heart. These data are then used to select a target region where ablation is to be performed.

[0026] When creating anatomical structures of either the ventricle or atrium, mapping catheters often pass through valves during mapping, resulting in undesirable additions to the reconstruction. Physicians can manually identify the valve's location and edit the anatomical structure to remove the valve from the mapped anatomical reconstruction. One solution to enable such a process is for the physician to determine if the catheter has entered a valve by examining the captured intracardiac signal to see if the signal indicates it is within the ventricle or atrium. The physician then knows whether the catheter is positioned within the valve and whether the anatomical structure is cropped accordingly. This process is essential for the accuracy of LAT coloring of the map or other electroanatomical mapping processes, ensuring that the electroanatomical mapping extends beyond the valve to the atrium or ventricle. Manual intervention is cumbersome and can be inaccurate for the operator. For example, with multi-electrode catheters such as Pentaray® (commercially available from Biosense Webster Inc. (Irvine, CA)), some electrodes of the multi-electrode catheter may be within the valve while others are not, making it difficult for the physician to accurately identify the valve or another anatomical feature.

[0027] Embodiments of the present invention solve the above problem by automatically segmenting an anatomical map, which includes automatically finding anatomical features such as valves and excluding (or cropping) those anatomical features from the anatomical map. Segmentation typically involves excluding (or cropping) anatomical features from the map, leaving holes in the map at the locations of the anatomical features, rather than assuming that the anatomical features do not exist at all. For example, a valve would be excluded (or cropped) from the atrium map, leaving holes in the atrium map in place of the excluded valve.

[0028] For example, when mapping with a Pentaray catheter (which includes multiple flexible arms or splines), the catheter moves around, and at some point during mapping, some of the Pentaray arms may be in the atria and some may be in the valves toward the ventricles (or vice versa). Electrodes on the arms in the atria capture signals indicating atrial activity (e.g., intracardiac electrograms (IEGMs)), and electrodes on the arms in the valves capture signals indicating ventricular activity (e.g., IEGMs). The captured signals are analyzed to identify ventricular activity. This may be done by comparing the timing of the signals (e.g., local excitation time of the signals) with the timing of body surface (BS) lead activation, or by any other suitable technique. In addition, the current position of each catheter electrode may be calculated using position tracking techniques. For example, position tracking based on magnetic tracking, impedance between the catheter electrode and the body surface electrode, or a combination of magnetic tracking and impedance tracking may be used. Therefore, electrodes exhibiting ventricular activity may be identified as being located within the ventricle (e.g., within the valve), and their calculated locations (while exhibiting ventricular activity) may be used to automatically and accurately segment the map (e.g., crop the valve from the map).

[0029] In some embodiments, electrodes exhibiting ventricular activity provide a point cloud in 3D space. These locations may then be used to locate boundary structures in 3D, which are then segmented, for example, excluded (or cropped) from anatomical structures.

[0030] The above may be used to find any suitable anatomical features based on distinguishing the electrical activity between different parts of the heart. For example, in some embodiments, valves may be excluded from the ventricular map.

[0031] Segmenting an anatomical map may include indicating anatomical features as distinct features on the anatomical map (for example, by using surfaces of different colors and / or different levels of transparency and / or dotted lines to represent anatomical features), or excluding anatomical features from the anatomical map (e.g., cropping).

[0032] System Description Referring now to Figure 1, Figure 1 is a schematic diagram of a medical treatment system 20 constructed and operating according to one embodiment of the present invention. Also refer to Figure 2, which is a schematic diagram of a catheter 40 for use in the system 20 of Figure 1.

[0033] The medical procedure system 20, shown in inset 25 of Figure 1 and shown in more detail in Figure 2, is used to determine the position of the catheter 40. The catheter 40 includes a shaft 22 and flexible arms 54 (only some are labeled with reference numerals 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., the heart 26).

[0034] 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 at least one coil, such as a biaxial or triaxial coil array, for example, but not limited to, to provide positional and orientational data including rotation (roll). The catheter 40 includes a plurality of electrodes 55 (only some are reference-labeled in Figure 2 for simplification), disposed at their respective positions along each of the flexible arms 54 and configured to capture the electrical activity of the heart 26 at their respective positions 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.

[0035] The medical treatment system 20 can 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) 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.

[0036] 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 the irrigation port, have been omitted.

[0037] 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.

[0038] 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.

[0039] 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 radiator 42, which is driven by a unit 43 located within Console 24. The magnetic field radiator 42 is configured to transmit an alternating magnetic field to the region where a part of the body (e.g., the heart 26) is located. The magnetic field generated by the magnetic field radiator 42 generates a directional signal in a magnetic sensor 50. The magnetic sensor 50 is configured to detect at least a portion of the transmitted alternating magnetic field and to supply the directional signal as a corresponding electrical input to a processing circuit 41.

[0040] 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 cardiac chamber. In some embodiments, the processing circuit 41 correlates the position signals received from electrodes 52 and 55 with previously acquired magnetic position calibration position signals to estimate the position of the catheter 40 within a cardiac chamber. 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 indicating the distal end of the catheter 40 within the heart 26.

[0041] Methods for position detection 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).

[0042] 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 a 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.

[0043] 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, provided and / or stored on a non-temporary physical medium such as magnetic memory, optical memory, or electronic memory.

[0044] 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.

[0045] The catheter 40 described above includes eight flexible arms 54, each having six electrodes 55. Instead of catheter 40, any suitable catheter can be used, for example, a catheter with a varying number of flexible arms and / or multiple electrodes per arm, or various probe shapes, such as a balloon probe or a lasso catheter.

[0046] The medical procedure system 20 may also perform ablation of cardiac tissue using any suitable catheter, such as catheter 40 or a different catheter, and any suitable ablation method. 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 of the body surface electrodes 49 for ablation of the myocardium of the heart 26. The console 24 may also include a pump (not shown) for delivering irrigation fluid to an irrigation channel at the distal end of the catheter performing the ablation. The catheter performing the ablation may further 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.

[0047] Here, we refer to Figure 3, which is a schematic diagram of the anatomical map 36 and the representation 38 of the catheter 40 in Figure 2. Figure 3 shows that most of the flexible arms 54 of the catheter 40 (labeled A, B, D-H) are in the atria of the heart 26, but one of the flexible arms 54 (labeled arm C) is in the valve toward the ventricle. For simplicity, the example in Figure 3 shows that only one of the flexible arms 54 (arm C) is in the valve, and all of arm C (the electrode) is in the valve. In other scenarios, part of one of the flexible arms 54, or two or more (or parts thereof) of the flexible arms 54, may be in the valve or other anatomical feature selected to be excluded from the anatomical map 36. The anatomical map 36 shown in Figure 3 is of one of the atria. In some embodiments, the anatomical map 36 may be of one of the ventricles or any other preferred body part.

[0048] Here, we refer to Figure 4, which is a schematic diagram of the window of interest 64 (e.g., one heart cycle) of electrical activity signals 60, 62 captured via the electrodes 55 of the catheter 40 (Figure 2) and the body surface electrodes 49 (Figure 1) at the position shown in Figure 3. Figure 4 shows the electrocardiogram (ECG) 60 captured by the body surface electrodes 49 and the intracardiac electrogram (IEGM) 62 captured by the electrodes 55 of the catheter 40. In Figure 4, the IEGM 62 is regular according to the flexible arms 54 of the catheter 40 (i.e., arms A to H) and according to the order of each electrode 55 of the flexible arms 54. The groups of IEGM 62 are labeled A to H according to the corresponding reference numerals of the flexible arms 54, as shown in Figure 3.

[0049] Figure 3 shows that the electrocardiogram 60 captured by the body surface electrodes 49 exhibits both atrial activity (block 66) and ventricular activity (block 68). The electrodes 55 on arms A and B show very little electrical activity, which may indicate that the electrodes 55 on arms A and B are not in contact with the tissue of the heart 26, or are in insufficient contact with the tissue. The electrodes 55 on arms D to H show atrial activity (block 70), while the electrode 55 on arm C shows ventricular activity (block 72).

[0050] The difference between atrial and ventricular activity observed in IEGM62 can be represented by the respective time values ​​of the respective local excitation times of each IEGM62 within the window of interest64. Generally, ventricular activity occurs later than atrial activity within the window of interest64.

[0051] Here, we refer to Figure 5, a schematic diagram of an electrical activity signal 74 and its associated local excitation time 76. The electrical activity signal 74 is one example of IEGM62 in Figure 4. The local excitation time 76 of the electrical activity signal 74 may be calculated by any preferred method, for example, by calculating the maximum negative slope of the electrical activity signal 74 (for example, based on distinguishing the signals) and setting the local excitation time 76 to be equal to the time of the calculated maximum negative slope. A method for determining reference annotation time from a multichannel electrocardiogram (ECG) signal is described in U.S. Patent No. 9,259,165 by Rubinstein et al. The precise time annotation of intracardiac ECG signals is described in U.S. Patent Application Publication No. 2013 / 0123652 by Rubinstein.

[0052] Here, we refer to Figure 6, a schematic diagram of the calculated electrode positions for use in the system 20 of Figure 1. Figure 6 shows the electrode positions 78 in one of the atria of the heart 26 and the electrode positions 80 in the valves of the heart 26 calculated for the electrodes 55 of the catheter 40 over time. Positions 78, 80 can be calculated using any suitable position tracking method, for example, using magnetic-based tracking, distribution of current or impedance measurements, or any suitable combination thereof. Thus, moving the catheter 40 around or within the lumen of the heart 26 generates a 3D cloud of the calculated positions 78, 80 over time, which can then be used to generate an anatomical map of the heart 26, as will be described in more detail below.

[0053] Here, we refer to Figure 7, a schematic diagram of a first anatomical map 82 based on some of the electrode positions in Figure 6. The anatomical map 82 can be generated using any preferred anatomical map generation method, e.g., Fast Anatomical Mapping (FAM), which is described in U.S. Patent No. 10,918,310 by Cohen et al. FAM generates a smooth shell around a three-dimensional (3D) cloud of data points. The anatomical map 82 can be generated by generating a smooth shell around the calculated electrode positions 78 (Figure 6) of the atria, while ignoring the electrode positions 80 of the valves. In this way, the anatomical map 82 provides a closed shell describing the atria, ignoring the valves and positioning the shell surface so that the valve inlets are within the atria. While the anatomical map 82 may be useful in many scenarios, ignoring the valve openings is inaccurate in other scenarios where electroanatomical maps, such as LAT maps, are generated based on the shell surface of the anatomical map 82. In such cases, the LAT map will show inaccurate propagation, as it represents the propagation of electrical activity waves across the atrial opening to the valves.

[0054] Here, we refer to Figure 8, which is a schematic diagram of a second anatomical map 84 based on some of the electrode positions 78,80 in Figure 6. The anatomical map 84 is generated by creating a smooth shell 86 around the electrode positions 78 in the atrium, taking into account the electrode positions 80 in the valve, so that the openings 88 corresponding to the valve openings from the atrium are left within the smooth shell 86. In such a case, the LAT map would show the propagation of electrical activity waves across the surface of the atrium, without crossing the openings to the valve.

[0055] Referring now to Figure 9, this is a flowchart 100 that includes the steps in the operation method of system 20 in Figure 1. Similarly, refer to Figures 1 and 2.

[0056] The catheter 40 is moved around the heart 26 or cardiac chambers, and the processing circuit 41 is configured to receive position signals from the catheter 40 as the catheter 40 moves around the heart 26 or cardiac chambers (block 102). Position signals may be received by the processing circuit 41 from electrodes 55 and / or from magnetic sensors 50 and / or directly from electrodes 52 via shaft 22. Additionally or alternatively, position signals may be received by the processing circuit 41 from body surface electrodes 49 that receive signals from electrodes 52, 55. In response to receiving position signals, the processing circuit 41 is configured to calculate the respective positions 78, 80 (Figure 6) of electrodes 55 (as the catheter 40 moves around the heart 26 over time) using any preferred position tracking method (block 104).

[0057] The processing circuit 41 is configured to calculate the local excitation time (LAT) for each electrical activity captured by the electrodes 55 at various positions in the catheter 40 over time (block 106). The LAT can be calculated using any preferred method, for example, by calculating the maximum negative slope of each IEGM 62 (Figure 4). In some cases, for example, the diagram provided in Figure 4 shows that some of the local excitation times represent atrial electrical activity, and some of the local excitation times represent ventricular electrical activity.

[0058] The processing circuit 41 is configured to generate an anatomical map 36 (Figure 3) in response to the calculated positions 78 and 80, respectively (block 108). For example, the anatomical map may be generated using Fast Anatomical Mapping (FAM), as described in U.S. Patent No. 10,918,310 by Cohen et al. Any suitable method for generating an anatomical map may be used.

[0059] The processing circuit 41 is configured to find (block 110) the anatomical features of the heart 26 (e.g., parts of the heart such as heart valves) and the locations of the found anatomical features in response to the electrical activity captured by each position 80 of the electrodes 50 and each of the electrodes 55 at various positions in the catheter 40 over time. For example, the electrical activity captured by at least some of the electrodes 55 (at various points in time) may indicate the electrical activity of an anatomical feature, e.g., ventricular activity, and each electrode position associated with this electrical activity (e.g., ventricular electrical activity) indicates the location of the found anatomical feature (e.g., valve). In some embodiments, the processing circuit 41 is configured to find the anatomical features of the heart (e.g., parts of the heart such as heart valves) and the locations of the anatomical features in response to the calculated local excitation time (e.g., indicating atrial-ventricular electrical activity) of the electrical activity captured by each position 55 and each of the electrodes 55 at various positions in the catheter 40 over time. In some embodiments, the processing circuit 41 is configured to locate anatomical features of the heart (e.g., heart valves) in response to each local excitation time that indicates electrical activity of the ventricles.

[0060] The processing circuit 41 is configured to automatically segment the anatomical map 36 (block 112) in response to the location where anatomical features are found. The processing circuit 41 is configured to automatically segment the anatomical map 36 by either indicating the anatomical features as distinct features on the anatomical map 36 (for example, by using surfaces of different colors and / or different levels of transparency and / or dotted lines to indicate the anatomical features) or by excluding the anatomical features from the anatomical map 36 (e.g., by cropping).

[0061] In some embodiments, the processing circuit 41 is configured to automatically segment the anatomical map 36 in response to the location where an anatomical feature is found, leaving a hole (e.g., an opening 88 in Figure 8) in the anatomical map 36 at the location of the anatomical feature. In some embodiments, if the found anatomical feature is a heart valve and the anatomical map 36 includes a map of the atrium, the processing circuit 41 is configured to automatically segment the anatomical map 36 in such a way that it leaves a hole in the anatomical map of the atrium instead of the heart valve. The processing circuit 41 is configured to render the anatomical map to the display 27 (block 114).

[0062] 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%.

[0063] 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.

[0064] 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.

[0065] [Implementation Method] (1) A medical system for automated anatomical feature identification and map segmentation, A catheter configured to be inserted into the heart of a living organism, comprising electrodes configured to capture the electrical activity of the heart at various locations within the heart, The display and A processing circuit, The system receives a position signal from the catheter and calculates the respective positions of the electrodes in response to the position signal. To generate an anatomical map in response to each of the calculated locations, The anatomical features of the heart and the location of those anatomical features are located in response to the respective positions of the electrodes and the electrical activity captured by each of the electrodes. The anatomical map is automatically segmented in response to the location where the anatomical features are found. A medical system comprising a processing circuit configured to render the anatomical map on the display. (2) The system according to Embodiment 1, wherein the processing circuit is configured to automatically segment the anatomical map in response to the found location of the anatomical feature, leaving a hole in the anatomical map in place of the anatomical feature. (3) The system according to Embodiment 2, wherein the anatomical feature is a heart valve, the anatomical map includes a map of the atria, and the processing circuit is configured to automatically segment the anatomical map, leaving holes in the anatomical map in place of the heart valve. (4) The processing circuit To calculate the local excitation time of each of the electrical activities captured by the electrodes, The system according to Embodiment 1, configured to locate the anatomical features of the heart and the locations of the anatomical features in response to the respective locations of the electrodes and the calculated local excitation time of the electrical activity captured by each of the electrodes. (5) The system according to Embodiment 4, wherein the processing circuit is configured to automatically segment the anatomical map in response to the found location of the anatomical feature, leaving a hole in the anatomical map in place of the anatomical feature.

[0066] (6) Some of the respective local excitation times show atrial electrical activity, and some of the respective local excitation times show ventricular electrical activity, The system according to Embodiment 4, wherein the processing circuit is configured to locate the anatomical features of the heart in response to each of the local excitation times indicating ventricular electrical activity. (7) The system according to Embodiment 6, wherein the anatomical feature is a heart valve, the anatomical map includes a map of the atria, and the processing circuit is configured to automatically segment the anatomical map, leaving holes in the anatomical map in place of the heart valve. (8) The catheter includes a shaft and a plurality of flexible arms, each having a proximal end connected to the distal end of the shaft, The system according to embodiment 1, wherein the electrodes are arranged at their respective positions along each of the flexible arms. (9) A medical method for automated anatomical feature identification and map segmentation, Receiving position signals from a catheter inserted into the heart of a living organism, wherein the catheter includes electrodes for capturing the electrical activity of the heart at each location within the heart. In response to the position signal, the respective positions of the electrodes are calculated, To generate an anatomical map in response to each of the calculated locations, The anatomical features of the heart and the location of those anatomical features are located in response to the respective positions of the electrodes and the electrical activity captured by each of the electrodes. The anatomical map is automatically segmented in response to the location where the anatomical features are found. A medical method comprising rendering the aforementioned anatomical map onto a display. (10) The method according to Embodiment 9, wherein the automatic segmentation includes segmenting the anatomical map in response to the found location of the anatomical feature, leaving holes in the anatomical map in place of the anatomical feature.

[0067] (11) The anatomical feature is a heart valve, and the anatomical map includes a map of the atrium. The method according to Embodiment 10, wherein the automatic segmentation includes segmenting the anatomical map, leaving holes in the anatomical map instead of the heart valves. (12) The method according to Embodiment 9, further comprising calculating the local excitation time of each of the electrical activity captured by the electrodes, wherein finding the anatomical features of the heart and the location of the anatomical features in response to the respective locations of the electrodes and the calculated local excitation time of the electrical activity captured by each of the electrodes. (13) The method according to Embodiment 12, wherein the automatic segmentation includes segmenting the anatomical map in response to the found location of the anatomical feature, leaving holes in the anatomical map in place of the anatomical feature. (14) Some of the respective local excitation times show atrial electrical activity, and some of the respective local excitation times show ventricular electrical activity, The method according to Embodiment 12, wherein finding the anatomical features of the heart in response to each of the local excitation times indicating ventricular electrical activity. (15) The anatomical feature is a heart valve, and the anatomical map includes a map of the atrium. The method according to Embodiment 14, wherein the automatic segmentation includes segmenting the anatomical map, leaving holes in the anatomical map instead of the heart valves.

[0068] (16) The catheter includes a shaft and a plurality of flexible arms, each having a proximal end connected to the distal end of the shaft, The method according to embodiment 1, wherein the electrodes are arranged at their respective positions along each of the flexible arms. (17) A software product including a non-temporary computer-readable medium on which program instructions are stored, wherein when the instructions are read by a central processing unit (CPU), the CPU Receiving position signals from a catheter inserted into the heart of a living organism, wherein the catheter includes electrodes for capturing the electrical activity of the heart at each location within the heart. In response to the position signal, the respective positions of the electrodes are calculated, To generate an anatomical map in response to each of the calculated locations, The anatomical features of the heart and the location of those anatomical features are located in response to the respective positions of the electrodes and the electrical activity captured by each of the electrodes. The anatomical map is automatically segmented in response to the location where the anatomical features are found. A software product that renders the aforementioned anatomical map on a display.

Claims

1. A medical system for automated heart valve identification and map segmentation, A catheter configured to be inserted into the heart of a living organism, comprising electrodes configured to capture the electrical activity of the heart at various locations within the heart, The display and A processing circuit, The system receives a position signal from the catheter and calculates the respective positions of the electrodes in response to the position signal. To generate an anatomical map in response to each of the calculated locations, The heart valves of the heart and the position of the heart valves are located in response to the respective positions of the electrodes and the electrical activity captured by each of the electrodes. The method involves automatically segmenting the anatomical map in response to the found location of the heart valve, wherein the segmentation includes excluding the heart valve from the anatomical map. A medical system comprising a processing circuit configured to render the segmented anatomical map onto the display.

2. The system according to claim 1, wherein the anatomical map includes a map of the atrium.

3. The aforementioned processing circuit To calculate the local excitation time of each of the electrical activities captured by the electrodes, The system according to claim 1, configured to locate the heart valves of the heart and the positions of the heart valves in response to the respective positions of the electrodes and the calculated local excitation times of the electrical activity captured by each of the electrodes.

4. Some of the aforementioned local excitation times show atrial electrical activity, and some of the aforementioned local excitation times show ventricular electrical activity. The system according to claim 3, wherein the processing circuit is configured to locate the heart valve of the heart in response to each of the local excitation times indicating ventricular electrical activity.

5. The system according to claim 4, wherein the anatomical map includes a map of the atrium.

6. The catheter includes a shaft and a plurality of flexible arms, each having a proximal end connected to the distal end of the shaft. The system according to claim 1, wherein the electrodes are arranged at their respective positions along each of the flexible arms.

7. A program for automated heart valve identification and map segmentation, On the computer, Receiving position signals from a catheter inserted into the heart of a living organism, wherein the catheter includes electrodes for capturing the electrical activity of the heart at each location within the heart. In response to the position signal, the respective positions of the electrodes are calculated, To generate an anatomical map in response to each of the calculated locations, The heart valves of the heart and the position of the heart valves are located in response to the respective positions of the electrodes and the electrical activity captured by each of the electrodes. The method involves automatically segmenting the anatomical map in response to the found location of the heart valve, wherein the segmentation includes excluding the heart valve from the anatomical map. A program that renders the segmented anatomical map onto a display.

8. The anatomical map includes a map of the atrium, The program according to claim 7.

9. The program according to claim 7, further comprising causing the computer to calculate the local excitation time of each of the electrical activity captured by the electrodes, wherein finding includes finding the heart valves of the heart and the positions of the heart valves in response to the positions of the electrodes and the calculated local excitation times of the electrical activity captured by each of the electrodes.

10. Some of the aforementioned local excitation times show atrial electrical activity, and some of the aforementioned local excitation times show ventricular electrical activity. The program according to claim 9, wherein the finding includes finding the heart valve of the heart in response to each of the local excitation times indicating ventricular electrical activity.

11. The anatomical map includes a map of the atrium, The program according to claim 10.

12. The catheter includes a shaft and a plurality of flexible arms, each having a proximal end connected to the distal end of the shaft. The program according to claim 7, wherein the electrodes are arranged at their respective positions along each of the flexible arms.

13. A software product including a non-temporary computer-readable medium on which program instructions are stored, wherein when the instructions are read by a central processing unit (CPU), the CPU... Receiving position signals from a catheter inserted into the heart of a living organism, wherein the catheter includes electrodes for capturing the electrical activity of the heart at each location within the heart. In response to the position signal, the respective positions of the electrodes are calculated, To generate an anatomical map in response to each of the calculated locations, The heart valves of the heart and the position of the heart valves are located in response to the respective positions of the electrodes and the electrical activity captured by each of the electrodes. The method involves automatically segmenting the anatomical map in response to the found location of the heart valve, wherein the segmentation includes excluding the heart valve from the anatomical map. A software product that renders the segmented anatomical map on a display.

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