Apparatus and method for cardiac ablation

• US 5,433,198 A
• Filed: 03/11/1993
• Issued: 07/18/1995
• Est. Priority Date: 03/11/1993
• Status: Expired due to Term

• Current Assignee: Catheffects, Inc.
• Original Assignee: Jawahar M. Desai
• Inventors: Desai, Jawahar M.
• Primary Examiner(s): Cohen, Lee S.
• Assistant Examiner(s): Jastrzab, Jeffrey R.
• Application Number:
  US08/029,771
• Time in Patent Office: 859 Days
• Field of Search: 128/642, 128/710, 128/702, 128/705, 128/712, 607/116, 607/119, 607/122, 607/125, 607/126, 607/127, 607/128, 607/9, 607/14
• US Class Current: 600/374
• CPC Class Codes: A61B 18/1206 Generators therefor
• 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 2018/0016 Energy applicators arranged in a two- or three dimensional array
• CPC Class Codes: A61B 2018/00357 Endocardium
• CPC Class Codes: A61B 2018/00577 Ablation
• CPC Class Codes: A61B 2018/0066 without feedback, i.e. open loop control
• CPC Class Codes: A61B 2018/00839 Bioelectrical parameters, e.g. ECG, EEG
• CPC Class Codes: A61B 2018/1465 Deformable electrodes
• CPC Class Codes: A61B 2034/2053 Tracking an applied voltage gradient
• CPC Class Codes: A61B 5/287 Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
• CPC Class Codes: A61B 5/339 Displays specially adapted therefor
• CPC Class Codes: A61B 5/6852 Catheters
• CPC Class Codes: A61B 5/6858 with a distal basket, e.g. expandable basket
• CPC Class Codes: A61B 5/7425 Displaying combinations of multiple images regardless of image source, e.g. displaying a reference anatomical image with a live image geometric transforms for image registration G06T3/14; enhancement using image fusion G06T5/50; algorithms for registration of images G06T7/30
• CPC Class Codes: A61B 5/743 Displaying an image simultaneously with additional graphical information, e.g. symbols, charts, function plots
• CPC Class Codes: A61B 5/7445 Display arrangements, e.g. multiple display units
• CPC Class Codes: A61B 6/464 involving a plurality of displays
• CPC Class Codes: A61B 6/5235 combining images from the same or different ionising radiation imaging techniques, e.g. PET and CT

Abstract

A system and method for cardiac mapping and ablation includes a multi-electrode catheter introduced percutaneously into a subject'"'"'s heart and deployable adjacent to various endocardial sites. The electrodes are connectable to a mapping unit, an ablation power unit a pacing unit, all of which are under computer control. Intracardiac electrogram signals emanated from a tachycardia site of origin are detectable by the electrodes. Their arrival times are processed to generate various visual maps to provide real-time guidance for steering the catheter to the tachycardia site of origin. In another aspect, the system also include a physical imaging system which is capable of providing different imaged physical views of the catheter and the heart. These physical views are incorporated into the various visual maps to provide a more physical representation. Once the electrodes are on top of the tachycardia site of origin, electrical energy is supplied by the ablation power unit to effect ablation.

Claims

1. A cardiac mapping and ablation system for locating and ablating a tachycardia site of origin in an endocardium of a subject'"'"'s heart, comprising:

a cluster of electrodes;

catheter means for disposing said cluster of electrodes about the endocardium site-by-site, each electrode capable of detecting intracardiac electrogram signals emanating from the tachycardia site of origin;

means responsive to the intracardiac electrogram signals detected at each electrode for computing an arrival time of the intracardiac electrogram signals thereat and for forming a map;

means for interactively displaying said map derived from said arrival times of intracardiac electrogram signals, said map including the cluster of electrodes and a display of arrival time associated with each electrode, whereby those electrodes being closer to the tachycardia site of origin than others will register earlier arrival times than others, and electrodes that are substantially coincident with the tachycardia site of origin will register an earliest possible arrival time, thereby said map providing guidance for moving said catheter mean in the direction of those electrodes having earlier arrival times; and

means for supplying power to at least one of said cluster of electrodes when said at least one of said cluster of electrodes is placed substantially coincident with the tachycardia site of origin, thereby to effect ablation to the tachycardia site.

2. A cardiac mapping and ablation system as in claim 1, further including means for computing contours of equal arrival time or isochrones, and wherein said map includes local isochrones computed from arrival times detected at the cluster of electrodes, said local isochrones providing guidance and confirmation that when said cluster of electrodes is placed substantially coincident with the tachycardia site of origin, said local isochrones are characterized by elliptical contours encircling the site of origin.

3. A cardiac mapping and ablation system as in claim 2, further including means for estimating and displaying on the map the tachycardia site of origin relative to the cluster of electrodes, thereby providing direct visual guidance for steering the catheter means to the site of origin.

4. A cardiac mapping and ablation system as in claim 3, wherein:

said intracardiac electrogram signals emanating from the tachycardia site of origin have definite velocities derivable from the arrival time detected at each electrode; and

said means for estimating and displaying includes computing a displacement vector from the cluster of electrodes to the tachycardia site of origin, said displacement vector being in a direction where the local isochrones have the earliest arrival time, and said displacement vector having a length estimated from the velocities and arrival times of the intracardiac electrogram signals.

5. A cardiac mapping and ablation system as in claim 3, further comprising means for physically imaging that displays a physical image of the heart in relation to said cluster of electrodes and the estimated location of tachycardia focus site of origin.

6. A cardiac mapping and ablation system as in claim 5, wherein said means for physically imaging is a fluoroscope.

7. A cardiac mapping and ablation system as in claim 5, wherein said means for physically imaging is an ultrasonic imaging system.

8. A cardiac mapping and ablation system as in claim 1, further including means for estimating and displaying on the map the tachycardia site of origin relative to the cluster of electrodes, thereby providing direct visual guidance for steering the catheter means to the site of origin.

9. A cardiac mapping and ablation system as in claim 8, wherein:

said intracardiac electrogram signals emanating from the tachycardia site of origin have definite velocities derivable from the arrival time detected at each electrode; and

said means for estimating and displaying includes computing a displacement vector from the cluster of electrodes to the tachycardia site of origin, said displacement vector being in a direction where the local isochrones have the earliest arrival time, and said displacement vector having a length estimated from the velocities and arrival times of the intracardiac electrogram signals.

10. A cardiac mapping and ablation system as in claim 1, further comprising physical imaging means for displaying at least one view of a physical image of said cluster of electrodes relative to the heart.

11. A cardiac mapping and ablation system as in claim 7, wherein said physical imaging means is a fluoroscope.

12. A cardiac mapping and ablation system as in claim 10, wherein said physical imaging means is an ultrasonic imaging system.

13. A cardiac mapping and ablation system as in claim 10, further comprising:

means for estimating the tachycardia site of origin relative to said cluster of electrodes; and

means for synthesizing said map with views from said physical imaging means for producing one or more synthesized video displays reproducing said at least one view of said physical image of said cluster of electrodes relative to the heart and an estimated tachycardia site of origin, thereby providing direct visual guidance for steering the catheter means to the tachycardia site of origin.

14. A cardiac mapping and ablation system as in claim 13, wherein:

said intracardiac electrogram signals emanating from the tachycardia site of origin have definite velocities derivable from the arrival time detected at each electrode; and

said means for estimating includes computing a displacement vector from the cluster of electrodes to the tachycardia site of origin, said displacement vector being in a direction where local isochrones have an earliest arrival time, and said displacement vector having a length estimated from the velocities and arrival times of the intracardiac electrogram signals.

15. A cardiac mapping and ablation system as in claim 13, wherein said one or more synthesized video displays are three-dimensional projection views.

16. A cardiac mapping and ablation system as in claim 13, wherein said one or more synthesized video displays are three-dimensional perspective views.

17. A cardiac mapping and ablation system as in claim 13, wherein said physical imaging means is a fluoroscope.

18. A cardiac mapping and ablation system as in claim 13, wherein said physical imaging means is an ultrasonic imaging system.

19. A cardiac mapping and ablation system as in claim 1, further including:

one or more surface electrode means for detecting electrocardiogram signals, wherein said means for computing the arrival time of intracardiac electrogram signals derives a reference time therefrom, and computes the arrival time of intracardiac electrogram signals relative to the reference time.

20. A cardiac mapping and ablation system for locating and ablating a tachycardia site of origin in an endocardium of a subject'"'"'s heart, comprising:

a cluster of electrodes;

catheter means for disposing said cluster of electrodes about the endocardium site-by-site, each electrode capable of detecting a discernable arrival time of intracardiac electrogram signals emanating from the tachycardia site of origin;

means for computing an estimated position of the tachycardia site of origin by interpolation of arrival times of intracardiac electrogram signals detected at a plurality of electrodes among said cluster;

means for interactively forming and displaying a map of said estimated position of the tachycardia site of origin and each of the plurality of electrodes interpolated therefrom; and

means for supplying power to at least one of said cluster of electrodes when said at least one of said cluster of electrodes is placed substantially coincident with the tachycardia site of origin, thereby to effect ablation to the tachycardia site.

21. A cardiac mapping system for locating a tachycardia site of origin in an endocardium of a subject'"'"'s heart, comprising:

a cluster of electrodes;

catheter means for disposing said cluster of electrodes about the endocardium site-by-site, each electrode capable of detecting a discernable arrival time of intracardiac electrogram signals emanating from the tachycardia site of origin;

means for computing an estimated position of the tachycardia site of origin by interpolation of arrival times of intracardiac electrogram signals detected by a plurality of electrodes among said cluster;

means for interactively forming and displaying a map of said estimated position of the tachycardia site of origin and each of the plurality of electrodes interpolated therefrom.

22. A method for cardiac mapping and ablation of a tachycardia site in an endocardium of a subject'"'"'s heart, comprising the steps of:

disposing a cluster of electrodes about the endocardium site-by-site, each electrode capable of detecting a discernable arrival time of intracardiac electrogram signals emanating from the tachycardia site of origin;

interactively displaying a map derived from said arrival times of intracardiac electrogram signals, said map including the cluster of electrodes and a display of arrival time associated with each electrode, whereby those electrodes being closer to the tachycardia site of origin than others will register earlier arrival times than others, and electrodes that are substantially coincident with the tachycardia site of origin will register an earliest possible arrival time, thereby said map providing guidance for moving said cluster of electrodes in the direction of those electrodes having earlier arrival times; and

supplying power to at least one of said cluster of electrodes when said at least one of said cluster of electrodes is placed substantially coincident with the tachycardia site of origin, thereby to effect ablation to the tachycardia site.

23. A method for cardiac mapping and ablation as in claim 22, further including the step of computing contours of equal arrival time or isochrones, and wherein said map includes local isochrones computed from arrival times detected at the cluster of electrodes, said local isochrones providing guidance and confirmation that when said cluster of electrodes is placed substantially coincident with the tachycardia site of origin, said local isochrones are characterized by elliptical contours encircling the site of origin.

24. A method for cardiac mapping and ablation as in claim 23, further including the step of estimating and displaying on the map the tachycardia site of origin relative to the cluster of electrodes, thereby providing direct visual guidance for steering said cluster of electrodes to the site of origin.

25. A method for cardiac mapping and ablation as in claim 24, wherein:

said intracardiac electrogram signals emanating from the tachycardia site of origin have definite velocities derivable from the arrival time detected at each electrode; and

the step of estimating and displaying includes computing a displacement vector from the cluster of electrodes to the tachycardia site of origin, said displacement vector being in a direction where the local isochrones have the earliest arrival time, and said displacement vector having a length estimated from the velocities and arrival times of the intracardiac electrogram signals.

26. A method for cardiac mapping and ablation as in claim 24, further including the step of displaying a superimposed display of said physical image with said map such that said cluster of electrodes and the estimated location of the tachycardia site of origin are displayed in relation to the heart.

27. A method of cardiac mapping and ablation as in claim 26, wherein said step of physically imaging includes fluoroscopic imaging.

28. A method of cardiac mapping and ablation system as in claim 26, wherein said step of physically imaging includes ultrasonic imaging.

29. A method for cardiac mapping and ablation as in claim 22, further including the step of estimating and displaying on the map the tachycardia site of origin relative to the cluster of electrodes, thereby providing direct visual guidance for steering said cluster of electrodes to the site of origin.

30. A method for cardiac mapping and ablation as in claim 29, wherein:

said intracardiac electrogram signals emanating from the tachycardia site of origin have definite velocities derivable from the arrival time detected at each electrodes; and

the step of estimating and displaying includes computing a displacement vector from the cluster of electrodes to the tachycardia site of origin, said displacement vector being in a direction where local isochrones have an earliest arrival time, and said displacement vector having a length estimated from the velocities and arrival times of the intracardiac electrogram signals.

31. A method for cardiac mapping and ablation as in claim 22, further including the step of physically imaging for displaying at least one view of a physical image of said cluster of electrodes relative to the heart.

32. A method for cardiac mapping and ablation as in claim 31, wherein said physically imaging step includes fluoroscopic imaging.

33. A method for cardiac mapping and ablation system as in claim 31, wherein said physically imaging step includes ultrasonic imaging.

34. A method for cardiac mapping and ablation as in claim 31, further including the steps of:

estimating the tachycardia site of origin relative to said cluster of electrodes; and

producing one or more video displays reproducing said at least one view of said physical image of said cluster of electrodes relative to the heart and an estimated tachycardia site of origin, thereby providing direct visual guidance for steering said cluster of electrodes to the tachycardia site of origin.

35. A method of cardiac mapping and ablation as in claim 34, wherein:

said intracardiac electrogram signals emanating from the tachycardia site of origin have definite velocities derivable from the arrival time detected at each electrodes; and

the step of estimating includes computing a displacement vector from the cluster of electrodes to the tachycardia site of origin, said displacement vector being in a direction where local isochrones have an earliest arrival time, and said displacement vector having a length estimated from the velocities and arrival times of the intracardiac electrogram signals.

36. A method of cardiac mapping and ablation as in claim 34, wherein said at least one view of said physical image of said cluster of electrodes relative to the heart and an estimated tachycardia site of origin are three-dimensional projection views.

37. A method of cardiac mapping and ablation as in claim 34, wherein said at least one view of said physical image of said cluster of electrodes relative to the heart and an estimated tachycardia site of origin are three-dimensional perspective views.

38. A method of cardiac mapping and ablation as in claim 34, wherein said step of physically imaging includes fluoroscopic imaging.

39. A method of cardiac mapping and ablation as in claim 34, wherein said step of physically imaging includes ultrasonic imaging.

40. A method for cardiac mapping and ablation as in claim 22, further including the step of:

deploying one or more additional electrodes for detecting cardiac signals external to the subject'"'"'s heart, said cardiac signals capable of providing a reference time relative to the arrival time of intracardiac electrogram signals emanating from the tachycardia site of origin.

41. A method of cardiac mapping and ablation for locating and ablating a tachycardia site of origin in an endocardium of a subject'"'"'s heart, comprising the steps of:

disposing by means of a catheter a cluster of electrodes about the endocardium site-by-site, each electrode capable of detecting a discernable arrival time of intracardiac electrogram signals emanating from the tachycardia site of origin;

computing an estimated position of the tachycardia site of origin by interpolation of arrival times of intracardiac electrogram signals detected at a plurality of electrodes among said cluster;

interactively forming and displaying a map of said estimated position of the tachycardia site of origin and each of the plurality of electrodes interpolated therefrom; and

supplying power to at least one of said cluster of electrodes when said at least one of said cluster of electrodes is placed substantially coincident with the tachycardia site of origin, thereby to effect ablation to the tachycardia site.

42. A method of cardiac mapping system for locating a tachycardia site of origin in an endocardium of a subject'"'"'s heart, comprising the steps of:

disposing by means of a catheter a cluster of electrodes about the endocardium site-by-site, each electrode capable of detecting a discernable arrival time of intracardiac electrogram signals emanating from the tachycardia site of origin;

computing an estimated position of the tachycardia site of origin by interpolation of arrival times of intracardiac electrogram signals detected at a plurality of electrodes among said cluster;

interactively forming and displaying a map of said estimated position of the tachycardia site of origin and each of the plurality of electrodes interpolated therefrom.

43. A method for cardiac mapping and ablation as in claim 42, further comprising the step of displaying the location of each electrode relative to the tachycardia site of origin.

44. A method for cardiac mapping and ablation as in claim 43, further comprising the step of physically imaging the location of each electrode relative to the subject'"'"'s heart.

45. A method for cardiac mapping and ablation as in claim 43, wherein said each electrode, the subject'"'"'s heart and tachycardia site of origin are superpositioned into one display, thereby showing their relative locations.

46. A method for cardiac mapping and ablation as in claim 42, further comprising the step of physically imaging the location of each electrode relative to the subject'"'"'s heart.