Method and Apparatus To Synchronize a Location Determination in a Structure With a Characteristic of the Structure

• US 20090264745A1
• Filed: 04/14/2009
• Published: 10/22/2009
• Est. Priority Date: 04/18/2008
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Fleming, Iona, Receveur, Rogier, Markowitz, H. Toby, Falkner, Phillip, Warman, Eduardo N., Karamanoglu, Mustafa, Waldhauser, Steven L., Zhang, Shangqian Peter, Larik, Vincent, Michels, Koen, Giese, Chad, Eick, Olaf, Jannicke, Jeff, Scanlon, David A., Kryger, Michael, Campbell-Massa, Sean, Hefner, Don, Mehta, Pooja, Steeves, James
• Granted Patent: US 9,332,928 B2
• Time in Patent Office: Days
• US Class Current: 600/424
• CPC Class Codes: A61B 2017/00022 Sensing or detecting at the treatment site
• CPC Class Codes: A61B 2017/00026 Conductivity or impedance, e.g. of tissue
• CPC Class Codes: A61B 2017/00053 Mapping
• CPC Class Codes: A61B 2017/00084 Temperature
• CPC Class Codes: A61B 2017/00243 cardiac
• CPC Class Codes: A61B 2017/00336 with a protective sleeve, e.g. retractable or slidable
• CPC Class Codes: A61B 2017/22051 with an inflatable part, e.g. balloon, for positioning, blocking, or immobilisation A61B2017/22048, A61B2017/3486 take precedence
• CPC Class Codes: A61B 2034/105 Modelling of the patient, e.g. for ligaments or bones
• CPC Class Codes: A61B 2090/376 using X-rays, e.g. fluoroscopy
• CPC Class Codes: A61B 2090/378 using ultrasound
• CPC Class Codes: A61B 2090/3983 Reference marker arrangements for use with image guided surgery
• 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 34/25 User interfaces for surgical systems
• CPC Class Codes: A61B 5/05 Detecting, measuring or recording for diagnosis by means of electric currents or magnetic fields; Measuring using microwaves or radio waves impedance plethysmography A61B5/0295; measuring movement of the entire body or parts thereof A61B5/11; detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof A61B5/24
• CPC Class Codes: A61B 5/053 Measuring electrical impedance or conductance of a portion of the body
• CPC Class Codes: A61B 5/0538 invasively, e.g. using a catheter
• CPC Class Codes: A61B 5/06 Devices, other than using radiation, for detecting or locating foreign bodies for removing same A61B17/50 ; determining position of probes within or on the body of the patient
• CPC Class Codes: A61B 5/061 Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body A61B1/00158 takes precedence
• CPC Class Codes: A61B 5/062 using magnetic field
• CPC Class Codes: A61B 5/063 using impedance measurements
• CPC Class Codes: A61B 5/066 : Superposing sensor position on an image of the patient, e.g. obtained by ultrasound or x-ray imaging
• CPC Class Codes: A61B 5/287 : Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
• CPC Class Codes: A61B 5/304 : Switching circuits
• CPC Class Codes: A61B 5/333 : Recording apparatus specially adapted therefor
• CPC Class Codes: A61B 5/339 : Displays specially adapted therefor
• CPC Class Codes: A61B 5/742 : using visual displays A61B5/339 takes precedence
• CPC Class Codes: A61B 8/06 : Measuring blood flow measuring volume flow in general G01F, e.g. G01F1/66, G01F1/72; measuring speed of fluids in general G01P5/00
• CPC Class Codes: A61B 8/4472 : Wireless probes

Abstract

An volume of a patient can be mapped with a system operable to identify a plurality of locations and save a plurality of locations of a mapping instrument. The mapping instrument can include one or more electrodes that can sense a voltage that can be correlated to a three dimensional location of the electrode at the time of the sensing or measurement. Therefore, a map of a volume can be determined based upon the sensing of the plurality of points without the use of other imaging devices. An implantable medical device can then be navigated relative to the mapping data.

Claims

1. A method of synchronizing a position determination within a volume of a patient and a physiological cycle of the patient, comprising:

determining at least a first portion and a second portion of a physiological cycle of the patient;

collecting a plurality of map data from an instrument in the patient during the determined physiological cycle;

classifying the collected plurality of map data as in the first portion of the physiological cycle or the second physiological cycle, wherein a first sub-plurality of the collected plurality of map data is classified as in the first portion of the physiological cycle and a second sub-plurality of the collected plurality of map data is classified as in the second portion of the physiological cycle; and

displaying at least one of the first sub-plurality of map data and the second sub-plurality of map data.

2. The method of claim 1, further comprising:

displaying only one of the first sub-plurality of map data and the second sub-plurality of map data.

3. The method of claim 1, further comprising:

successively displaying a representation of the first sub-plurality of map data and then the second sub-plurality of map data;

wherein in the physiological cycle the first portion is immediately prior to the second portion.

4. The method of claim 1, wherein determining the physiological cycle includes determining a first physiological cycle and a second physiological cycle including a cardiac cycle and a respiratory cycle.

5. The method of claim 4, further comprising:

identifying a plurality of portions of both of the first and the second physiological cycles.

6. The method of claim 1, wherein determining the physiological cycle includes connecting an electrocardiogram with the patient to measure the systole and diastole of the patient.

7. The method of claim 6, wherein displaying includes:

displaying the map data classified as in systole and displaying the map data classified as diastole to illustrate motion of the heart.

8. The method of claim 7, wherein collecting a plurality of map data includes:

positioning a position element of the instrument in a heart of the patient;

determining a position of the position element in a plurality of successive times;

wherein the map data is collected only with the position element of the instrument.

9. The method of claim 1, wherein determining the physiological cycle includes:

connecting a first electrode and a second electrode to the patient;

injecting a current into the patient;

measuring an impedance between the first electrode and the second electrode connected to the patient;

determining the physiological cycle based at least in part on the measured impedance between the first electrode and the second electrode connected to the patient based least in part on a volume of blood in a heart of the patient.

10. A method of synchronizing a position determination within a volume of a patient and a physiological cycle of the patient, comprising:

determining at least a first portion and a second portion of a physiological cycle of the patient;

positioning an instrument in the patient;

collecting a first plurality of map data with the instrument in the patient during the first portion of the determined physiological cycle;

collecting a second plurality of map data with the instrument in the patient during the second portion of the determined physiological cycle; and

displaying at least one of the first plurality of map data and the second plurality of map data on a display device.

11. The method of claim 10, further comprising;

determining at least a third portion of the physiological cycle; and

collecting a third plurality of map data during the third portion of the physiological cycle.

12. The method of claim 11, further comprising;

successively displaying the first plurality of map data, then the second plurality of map data, then the third plurality of map data on the display device;

wherein the successive display illustrates a motion of the patient during the determined physiological cycle.

13. The method of claim 12, wherein the first plurality of map data, the second plurality of map data, and the third plurality of map data are all collected within a heart of the patient;

wherein the motion illustrated is a motion of the heart.

14. The method of claim 13, further comprising;

determining a position within the heart; and

superimposing an icon on the illustrated motion of the heart representing a real time position of the instrument.

15. The method of claim 13, wherein the first plurality of map data, the second plurality of map data, and the third plurality of map data are all generated only with a position sensing unit including:

positioning a set of axis electrodes on the patient;

injecting a current into the patient between the set of axis electrodes; and

determining a position in the patient of the instrument based on a sensed electrical property.

16. The method of claim 15, further comprising:

determining a plurality of portions of the physiological cycle and classifying map data into each of the plurality of portions;

collecting a plurality of map data during a plurality of each of the portions to the physiological cycle; and

reducing error in the classified map data by at least averaging the collected plurality of map data for each of the plurality of portions of the physiological cycle.

17. The method of claim 10, wherein the first plurality of map data and the second plurality of map data is collected with no fluoroscopic image data, magnetic resonance image data, or ultrasound image data.

18. A system to synchronize a position determination within a volume of a patient and a physiological cycle of the patient, comprising:

a position sensing unit, including;

a set of axis electrodes positioned on the patient;

a driver to inject a current into the patient between the set of axis electrodes;

a mapping instrument positionable in the patient having a position element to sense an electrical property based on the injected current; and

a processor operable to determine a position of the position element based on the sensed electrical property;

a physiological synchronizing system having a physiological sensing portion operable to determine at least a first portion and a second portion of a physiological cycle of the patient; and

a display device to display map data;

wherein the processor is operable to classify the determined positions of the position element as within the first portion or the second portion of the physiological cycle and display the classified map data.

19. The system of claim 18, wherein the map data is generated solely with the mapping instrument

wherein the map data classified as in the first portion of the physiological cycle is displayed separately from the map data classified in the second portion.

20. The system of claim 19, wherein the processor is operable to morph the map data classified in the first portion to the map data classified in the second portion to illustrate pseudo motion of the patient.

21. The system of claim 20, wherein the physiological sensing portion includes an electrocardiogram operable to sense systole and diastole of a heart of the patient;

wherein the map data is classified in the first portion as in systole and in the second portion as in diastole;

wherein the morphed image is operable to illustrate motion of the hear of the patient without addition image data.