Implantable electrode location selection

• US 10,251,555 B2
• Filed: 06/12/2013
• Issued: 04/09/2019
• Est. Priority Date: 06/12/2013
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Ghosh, Subham, Justen, Manfred, Schilling, Eric
• Primary Examiner(s): Koharski, Christopher
• Assistant Examiner(s): So, Elizabeth K
• Application Number:
  US13/916,377
• Publication Number:
  US 20140371833A1
• Time in Patent Office: 2,127 Days
• Field of Search: 607129
• CPC Class Codes: A61B 5/0037 Performing a preliminary scan, e.g. a prescan for identifying a region of interest
• CPC Class Codes: A61B 5/0044 for the heart
• CPC Class Codes: A61B 5/316 Modalities, i.e. specific diagnostic methods
• CPC Class Codes: A61B 5/349 Detecting specific parameters of the electrocardiograph cycle
• CPC Class Codes: A61B 5/489 Blood vessels
• CPC Class Codes: A61B 6/12 Arrangements for detecting or locating foreign bodies
• CPC Class Codes: A61B 6/504 for diagnosis of blood vessels, e.g. by angiography
• CPC Class Codes: A61B 6/547 involving tracking of position of the device or parts of the device
• CPC Class Codes: A61N 1/0484 Garment electrodes worn by the patient
• CPC Class Codes: A61N 1/056 Transvascular endocardial electrode systems
• CPC Class Codes: A61N 1/372 Arrangements in connection with the implantation of stimulators

Abstract

Systems, methods, and interfaces are described herein for assisting in noninvasive location selection for an implantable electrode for use in cardiac therapy. Mechanical motion information and surrogate electrical activation times may be used to identify one or more candidate site regions.

Claims

1. A system for assisting in noninvasive location selection for an implantable electrode comprising:

electrode apparatus comprising a plurality of external electrodes configured to be located proximate tissue of a patient;

imaging apparatus configured to capture mechanical motion of at least a portion of blood vessel anatomy of the patient'"'"'s heart;

a display apparatus comprising a graphical user interface, wherein the graphical user interface is configured to depict the at least a portion of blood vessel anatomy of the patient'"'"'s heart; and

computing apparatus coupled to the electrode apparatus, imaging apparatus, and display apparatus and configured to provide the graphical user interface displayed on the display apparatus to assist a user in noninvasively selecting a location for an implantable electrode, wherein the computing apparatus is further configured to;

display, on the graphical user interface, at least a portion of blood vessel anatomy of the patient'"'"'s heart,

measure mechanical motion of the at least a portion of blood vessel anatomy of the patient'"'"'s heart using the imaging apparatus,

display, on the graphical user interface, mechanical motion information of one or more regions of the at least a portion of blood vessel anatomy of the patient'"'"'s heart on the displayed at least a portion of the blood vessel anatomy of the patient'"'"'s heart based on the measured mechanical motion,

allow a user, using the graphical user interface, to select an identified region of the one or more regions of the displayed at least a portion of blood vessel anatomy of the patient'"'"'s heart comprising mechanical motion information displayed thereon,

noninvasively measure, without use of an implantable electrode, a surrogate electrical activation time by selectively using one or more external electrodes of the plurality of external electrodes of the electrode apparatus proximate the identified region of the at least a portion of blood vessel anatomy of the patient'"'"'s heart in response to the user'"'"'s selection of the identified region of the one or more regions of the at least a portion of blood vessel anatomy of the patient'"'"'s heart using the graphical user interface, wherein the surrogate cardiac electrical activation time is representative of depolarization of cardiac tissue that propagates through the torso of the patient, and

display, on the graphical user interface, the noninvasively measured surrogate activation time for the identified region of the at least a portion of blood vessel anatomy of the patient'"'"'s heart.

2. The system of claim 1, wherein, to measure surrogate electrical activation time using one or more external electrodes of the plurality of external electrodes of the electrode apparatus proximate the identified region of the at least a portion of blood vessel anatomy of the patient'"'"'s heart, the computing apparatus is further configured to:

identify positions of the plurality of external electrodes with respect to the identified region of the at least a portion of blood vessel anatomy of the patient'"'"'s heart using the imaging apparatus; and

measure surrogate electrical activation time using the one or more external electrodes of the plurality of external electrodes of the electrode apparatus that are closest to the identified region of the at least a portion of blood vessel anatomy of the patient'"'"'s heart.

3. The system of claim 2, wherein the computing apparatus is further configured to display, on the graphical user interface, graphical representations of positions associated with the plurality of external electrodes with respect to the at least a portion of blood vessel anatomy of the patient'"'"'s heart.

4. The system of claim 1, wherein the plurality of external electrodes are configured to be positioned proximate tissue of the patient by a user, wherein each external electrode of the plurality of external electrodes is positionable proximate a different specific area of the patient than the other external electrodes of the plurality of external electrodes, wherein each different specific area corresponds to a different region of the patient'"'"'s heart,

wherein, to measure surrogate electrical activation time using one or more external electrodes of the plurality of external electrodes of the electrode apparatus proximate the identified region of the at least a portion of blood vessel anatomy of the patient'"'"'s heart, the computing apparatus is further configured to measure surrogate electrical activation time using the one or more external electrodes of the plurality of electrodes of the electrode apparatus that correspond to the identified region of the at least a portion of blood vessel anatomy of the patient'"'"'s heart.

5. The system of claim 1, wherein the at least a portion of blood vessel anatomy of the patient'"'"'s heart comprises at least a portion of the coronary sinus.

6. The system of claim 1, wherein, to display mechanical motion information of the at least a portion of blood vessel anatomy of the patient'"'"'s heart, the computing apparatus is further configured to color scale the at least a portion of blood vessel anatomy of the patient'"'"'s heart on the graphical user interface according to the measured mechanical motion.

7. The system of claim 1, wherein, to display the measured surrogate activation time for the identified region of the one or more regions of the at least a portion of blood vessel anatomy of the patient'"'"'s heart, the computing apparatus is further configured to alphanumerically depict the measured surrogate activation time proximate the identified region of the one or more regions of the at least a portion of blood vessel anatomy of the patient'"'"'s heart on the graphical user interface.

8. The system of claim 1, wherein the at least a portion of blood vessel anatomy of the patient'"'"'s heart displayed on the graphical user interface is a three-dimensional graphical representation.

9. The system of claim 1, wherein the plurality of external electrodes comprises surface electrodes positioned in an array configured to be located proximate the skin of the patient.

10. The system of claim 1, wherein the graphical user interface displayed on the display apparatus is configured to assist a user in noninvasively selecting an implant location for at least one implantable electrode coupled to at least one lead.

11. The system of claim 1, wherein the computing apparatus is further configured to display, on the graphical user interface, scar information for the identified region of the one or more regions of the at least a portion of blood vessel anatomy of the patient'"'"'s heart indicating a likelihood of the identified region comprising scar tissue.

12. A method for assisting in noninvasive location selection for an implantable electrode comprising:

displaying on a graphical user interface at least a portion of blood vessel anatomy of a patient'"'"'s heart;

measuring mechanical motion of the at least a portion of blood vessel anatomy of the patient'"'"'s heart using imaging apparatus configured to capture mechanical motion of the at least a portion of blood vessel anatomy of the patient'"'"'s heart;

displaying on the graphical user interface mechanical motion information of one or more regions of the at least a portion of blood vessel anatomy of the patient'"'"'s heart on the displayed at least a portion of the blood vessel anatomy of the patient'"'"'s heart based on the measured mechanical motion;

allowing a user, using the graphical user interface, to select an identified region of the one or more regions of the displayed at least a portion of blood vessel anatomy of the patient'"'"'s heart comprising mechanical motion information displayed thereon;

noninvasively measuring, without use of an implantable electrode, a surrogate electrical activation time by selectively using one or more external electrodes proximate the identified region of the one or more regions of the at least a portion of blood vessel anatomy of the patient'"'"'s heart in response to the user'"'"'s selection of the identified region of the one or more regions of the at least a portion of blood vessel anatomy of the patient'"'"'s heart using the graphical user interface, wherein the one or more external electrodes are located proximate tissue of a patient, wherein the surrogate cardiac electrical activation time is representative of depolarization of cardiac tissue that propagates through the torso of the patient;

displaying on the graphical user interface the noninvasively measured surrogate activation time for the identified region of the one or more regions of the at least a portion of blood vessel anatomy of the patient'"'"'s heart; and

navigating at least one implantable electrode to the identified region of the one or more regions of the at least a portion of blood vessel anatomy of the patient'"'"'s heart using the graphical user interface.

13. The method of claim 12, wherein measuring surrogate electrical activation time using one or more external electrodes proximate the identified region of the one or more regions of the at least a portion of blood vessel anatomy of the patient'"'"'s heart comprises:

identifying positions of a plurality of external electrodes with respect to the identified region of the one or more regions of the at least a portion of blood vessel anatomy of the patient'"'"'s heart using the imaging apparatus; and

measuring surrogate electrical activation time using the one or more external electrodes of the plurality of external electrodes that are closest to the identified region of the one or more regions of the at least a portion of blood vessel anatomy of the patient'"'"'s heart.

14. The method of claim 13, wherein measuring surrogate electrical activation time using one or more external electrodes proximate the identified region of the one or more regions of the at least a portion of blood vessel anatomy of the patient'"'"'s heart further comprises displaying on the graphical user interface graphical representations of the positions associated with the plurality of external electrodes with respect to the at least a portion of blood vessel anatomy of the patient'"'"'s heart.

15. The method of claim 13, wherein measuring surrogate electrical activation time using one or more external electrodes proximate the identified region of the one or more regions of the at least a portion of blood vessel anatomy of the patient'"'"'s heart comprises:

positioning a plurality of external electrodes proximate tissue of the patient, wherein each external electrode of the plurality of external electrodes is positioned proximate a different specific area of the patient than the other external electrodes of the plurality of external electrodes, wherein each different specific area corresponds to a different region of the patient'"'"'s heart; and

measuring surrogate electrical activation time using the one or more external electrodes of the plurality of external electrodes that correspond to the identified region of the one or more regions of the at least a portion of blood vessel anatomy of the patient'"'"'s heart.

16. The method of claim 13, wherein the at least a portion of blood vessel anatomy of the patient'"'"'s heart comprises at least a portion of the coronary sinus.

17. The method of claim 13, wherein displaying mechanical motion information of the at least a portion of blood vessel anatomy of the patient'"'"'s heart comprises color scaling the at least a portion of blood vessel anatomy of the patient'"'"'s heart on the graphical user interface according to the measured mechanical motion.

18. The method of claim 13, wherein displaying the measured surrogate activation time for the identified region of the one or more regions of the at least a portion of blood vessel anatomy of the patient'"'"'s heart comprises alphanumerically depicting the measured surrogate activation time proximate the identified region of the one or more regions of the at least a portion of blood vessel anatomy of the patient'"'"'s heart on the graphical user interface.

19. The method of claim 13, wherein the at least a portion of blood vessel anatomy of the patient'"'"'s heart displayed on the graphical user interface is a three-dimensional graphical representation.

20. The method of claim 13, wherein the one or more external electrodes comprise surface electrodes positioned in an array configured to be located proximate the skin of the patient.

21. The method of claim 13, wherein the method further comprises displaying, on the graphical user interface, scar information for the identified region of the one or more regions of the at least a portion of blood vessel anatomy of the patient'"'"'s heart indicating a likelihood of the identified region comprising scar tissue.

22. A system for assisting in noninvasive location selection for an implantable electrode comprising:

a display apparatus comprising a graphical user interface, wherein the graphical user interface is configured to depict at least a portion of blood vessel anatomy of the patient'"'"'s heart; and

computing apparatus coupled to the display apparatus and configured to provide the graphical user interface displayed on the display apparatus to assist a user in noninvasively selecting a location for an implantable electrode, wherein the computing apparatus is further configured to;

display, on the graphical user interface, at least a portion of blood vessel anatomy of the patient'"'"'s heart,

display, on the graphical user interface, mechanical motion information of one or more regions of the at least a portion of blood vessel anatomy of the patient'"'"'s heart on the displayed at least a portion of the blood vessel anatomy of the patient'"'"'s heart, and

display, on the graphical user interface, a noninvasively measured surrogate activation time for an identified region of the one or more regions of the at least a portion of blood vessel anatomy of the patient'"'"'s heart in response to the user'"'"'s selection, using the graphical user interface, of the identified region of the one or more regions of the at least a portion of blood vessel anatomy of the patient'"'"'s heart comprising mechanical motion information displayed thereon, wherein the noninvasively measured surrogate electrical activation time by selectively using one or more external electrodes without use of an implantable electrode, wherein the surrogate cardiac electrical activation time is representative of depolarization of cardiac tissue that propagates through the torso of the patient.

23. A method for assisting in noninvasive location selection for an implantable electrode comprising:

displaying on a graphical user interface at least a portion of blood vessel anatomy of a patient'"'"'s heart;

displaying on the graphical user interface mechanical motion information of one or more regions of the at least a portion of blood vessel anatomy of the patient'"'"'s heart on the displayed at least a portion of the blood vessel anatomy of the patient'"'"'s heart; and

displaying on the graphical user interface a noninvasively measured surrogate activation time for an identified region of the one or more regions of the at least a portion of blood vessel anatomy of the patient'"'"'s heart in response to the user'"'"'s selection, using the graphical user interface, of the identified region of the one or more regions of the at least a portion of blood vessel anatomy of the patient'"'"'s heart comprising mechanical motion information displayed thereon, wherein the noninvasively measured surrogate electrical activation time is noninvasively measured by selectively using one or more external electrodes without use of an implantable electrode, wherein the surrogate cardiac electrical activation time is representative of depolarization of cardiac tissue that propagates through the torso of the patient.