Automating the Ablation Procedure to Minimize the Need for Manual Intervention

• US 20080300588A1
• Filed: 11/15/2006
• Published: 12/04/2008
• Est. Priority Date: 12/02/2005
• Status: Abandoned Application

• Current Assignee: Koninklijke Philips Electronics N.V. (Koninklijke Philips N.V.)
• Original Assignee: Koninklijke Philips Electronics N.V. (Koninklijke Philips N.V.)
• Inventors: Groth, Alexandra, Eck, Kai
• Application Number:
  US12/094,615
• Publication Number:
  US 20080300588A1
• Time in Patent Office: Days
• US Class Current: 606/34
• CPC Class Codes: A61B 18/1206 Generators therefor
• CPC Class Codes: A61B 18/1233 with circuits for assuring patient safety
• CPC Class Codes: A61B 18/1492 having a flexible, catheter-like structure, e.g. for heart ablation A61B18/1477 takes precedence
• CPC Class Codes: A61B 2017/003 Steerable
• CPC Class Codes: A61B 2018/00577 Ablation
• CPC Class Codes: A61B 2018/00642 with feedback, i.e. closed loop control
• CPC Class Codes: A61B 2018/00815 measured by a thermistor
• CPC Class Codes: A61B 2018/00821 measured by a thermocouple
• CPC Class Codes: A61B 2018/00839 Bioelectrical parameters, e.g. ECG, EEG
• CPC Class Codes: A61B 2018/00875 Resistance or impedance
• CPC Class Codes: A61B 2018/00982 combined with or comprising means for visual or photographic inspections inside the body, e.g. endoscopes
• CPC Class Codes: A61B 2034/102 Modelling of surgical devices, implants or prosthesis
• CPC Class Codes: A61B 2034/105 Modelling of the patient, e.g. for ligaments or bones
• CPC Class Codes: A61B 2034/107 Visualisation of planned trajectories or target regions
• CPC Class Codes: A61B 2034/2051 Electromagnetic tracking systems
• CPC Class Codes: A61B 2034/301 for introducing or steering flexible instruments inserted into the body, e.g. catheters or endoscopes
• CPC Class Codes: A61B 34/20 Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
• CPC Class Codes: A61B 34/73 Manipulators for magnetic surgery
• CPC Class Codes: A61B 90/361 Image-producing devices, e.g. surgical cameras
• CPC Class Codes: A61M 25/0127 Magnetic means; Magnetic markers

Abstract

Cardiac ablation is automated to require minimal user intervention, to thereby reduce X-ray exposure to staff and patients, increase patient throughput, simplify ablation and make ablation more precise. Steering between ablation points on the heart is automatic by use of a localizer system (132) and a magnetic navigator (160). Ablation is performed, interrupted and detected as complete automatically by monitoring system parameters (S630, S670). Ablation path planning automatically takes into account particular heart morphology of the patient and specifications of the catheter system (S310, S330), and automatically saves to storage an optimal ablation path from which ablation points are then selected (S340, S350).

Claims

1. A computer-implemented ablation method, comprising:

selecting a plurality of points that reside along a predetermined ablation path in tissue of a body, and saving the selected points (S210);

determining, automatically and without user intervention, when ablation, by an ablation device, is completed at a current point of the plural points (S420); and

upon said determining of completion, steering, automatically and without user intervention, said device from said current point to a next of the plural points (S410).

2. The method of claim 1, wherein said tissue is of a heart that is to undergo the ablation (S310).

3. The method of claim 1, wherein said steering moves said device within said body (S310).

4. The method of claim 1, further comprising:

detecting arrival of said device to said next point; and

upon arrival, starting said ablation automatically and without user intervention (S410).

5. The method of claim 1, wherein said ablation, determining and steering are iterative such that, following said steering, said ablation and determining are again performed, with said next point as said current point, and are followed by said steering until said current point is a last of the selected points (S430, S440).

6. The method of claim 1, further comprising, upon detecting a predetermined condition, automatically and without user intervention, a) interrupting said ablation at said current point, b) moving said device to said next of the plural points, and c) performing ablation at said next point (S630, S670).

7. An apparatus configured for executing the method of claim 1 (100).

8. A computer program product having a computer readable medium in which is embedded a computer program comprising instructions for executing the method of claim 1 (106).

9. A method of preparing for cardiac ablation, said method comprising:

making an electrophysiological map of heart that is to undergo ablation (S320);

at least one of analyzing morphology of said heart to form a heart model and providing specifications of a catheter system to be used in said ablation (S310, S330);

creating, automatically and without user intervention, an ablation path, based on the made map and subject, correspondingly, to at least one of the formed model and the provided specifications (S340); and

recording, automatically and without user intervention, the formed path (S350).

10. A computer implemented method of ablation comprising:

monitoring parameters during said ablation at a point (S670); and

determining, automatically and without user intervention, when said ablation at said point is completed, subject to, automatically and without user intervention, terminating, before completion, said ablation at said point based on the monitored parameters (S410).

11. The method of claim 10, further comprising:

detecting that a catheter performing said ablation has lost physical contact with body tissue (S640) or that a temperature at said point has fallen below a predetermined threshold (S670); and

performing said terminating if either situation occurs (S630).

12. The method of claim 11, further comprising:

checking whether impedance encountered by an electric circuit drops below a predefined threshold within a pre-set ablation duration (S650); and

terminating said ablation at said point if impedance is determined to not drop by said predefined threshold within the pre-set duration (S630).

13. A computer implemented ablation method comprising:

executing, automatically and without user intervention, for a set of predefined ablation points, each of the following steps a) through d);

a) steering an ablation device to approach a current one of the points for commencement of ablation at the current point when said current point is reached (S410);

b) determining whether said approach is unsuccessful, and, if so, storing a location of said current point (S630);

c) if it is determined that said approach is successful, determining whether said ablation at said current point is unsuccessful, and, if so, storing said location (S630); and

d) repeating steps a) through c) for a next point, until a last point is processed (S430).

14. The method of claim 13, wherein said determining comprises at least one of checking whether and being notified that a predetermined time period has expired before a detected position of said device matches an expected position of said device (S730).

15. The method of claim 13, further comprising, for an ablation line in body tissue created by said method, and for re-execution of said method based on a new set of points, navigating, automatically and without user intervention, a visual inspection device, along an ablation path that was saved to storage memory and from which said set of predefined ablation points was sampled, to detect gaps in said line, and storing point locations of said gaps as said new set (S540).

16. An apparatus configured for executing the method of claim 13 (100).

17. A computer program product having a computer readable medium in which is embedded a computer program comprising instructions for executing the method of claim 13 (106).

18. An ablation method comprising:

planning, to derive a path (S210);

automatically steering to ablation points on the derived path to arrive at said points (S220);

automatically controlling ablation at the arrived-at points based on parameters that vary during the ablation (S230);

automatically determining ones of the arrived-at points at which the ablation has failed (S240);

automatically recording locations of the arrived-at points where it is determined that ablation has failed (S250); and

performing functional outcome control that automatically approaches, in succession, new ablation points arising from said outcome control (S260).

19. The method of claim 18, further comprising automatically performing optical outcome control (S270).

20. An ablation apparatus comprising:

means for automatically steering to ablation points on a pre-planned path to arrive at said points (160);

means for automatically controlling ablation at the arrived-at points based on parameters that vary during the ablation (104);

means for automatically determining ones of the arrived-at points at which the ablation has failed (S240);

means for automatically recording locations of the arrived-at points where it is determined that ablation has failed (S250); and

means for automatically approaching, in succession, new ablation points arising from functional outcome control (S260).

21. The apparatus of claim 20, wherein said means for automatically approaching comprises means for comparing a post-ablation remapping with a pre-ablation mapping, said arising resulting from said comparing (S530).

22. The apparatus of claim 20, further comprising optical output control for visually scanning along a path that includes said new ablation points (S540).