Apparatus and method for intrabody mapping

• US 5,713,946 A
• Filed: 10/28/1996
• Issued: 02/03/1998
• Est. Priority Date: 07/20/1993
• Status: Expired due to Term

• Current Assignee: Biosense, Inc. (Cardinal Health, Inc.)
• Original Assignee: Biosense, Inc. (Cardinal Health, Inc.)
• Inventors: Ben-Haim, Shlomo
• Primary Examiner(s): MANUEL, GEORGE C
• Application Number:
  US08/738,896
• Time in Patent Office: 463 Days
• Field of Search: 128/653.1, 128/653.2, 128/656, 128/899, 607/2, 607/3, 607/119, 607/122
• US Class Current: 607/122
• CPC Class Codes: A61B 18/00 Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body eye surgery A61F9/007; ear surgery A61F11/00
• CPC Class Codes: A61B 18/02 by cooling, e.g. cryogenic techniques devices for cooling specific reflex points of the body within cell-life limits A61H39/06
• CPC Class Codes: A61B 18/14 Probes or electrodes 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 18/18 by applying electromagnetic radiation, e.g. microwaves radiation therapy A61N5/00
• CPC Class Codes: A61B 18/20 using laser
• CPC Class Codes: A61B 18/24 with a catheter A61B18/26, A61B18/28 take precedence
• CPC Class Codes: A61B 2017/00044 Sensing electrocardiography, i.e. ECG
• CPC Class Codes: A61B 2017/00243 cardiac
• CPC Class Codes: A61B 2034/2051 Electromagnetic tracking systems
• CPC Class Codes: A61B 2034/2063 Acoustic tracking systems, e.g. using ultrasound
• CPC Class Codes: A61B 2090/378 using ultrasound
• 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 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 5/062 using magnetic field
• CPC Class Codes: A61B 5/352 Detecting R peaks, e.g. for synchronising diagnostic apparatus; Estimating R-R interval
• CPC Class Codes: A61B 5/363 Detecting tachycardia or bradycardia
• CPC Class Codes: A61B 5/6843 Monitoring or controlling sensor contact pressure
• CPC Class Codes: A61B 5/6885 Monitoring or controlling sensor contact pressure
• CPC Class Codes: A61N 1/06 for high-frequency therapy
• CPC Class Codes: A61N 1/3621 : for treating or preventing abnormally high heart rate
• CPC Class Codes: A61N 1/3627 : for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
• CPC Class Codes: A61N 1/403 : for thermotherapy, e.g. hyperthermia

Abstract

This invention concerns an apparatus and method for the treatment of cardiac arrhythmias. More particularly, this invention is directed to a method for ablating a portion of an organ or bodily structure of a patient, which comprises obtaining a perspective image of the organ or structure to be mapped; advancing one or more catheters having distal tips to sites adjacent to or within the organ or structure, at least one of the catheters having ablation ability; sensing the location of each catheter'"'"'s distal tip using a non-ionizing field; at the distal tip of one or more catheters, sensing local information of the organ or structure; processing the sensed information to create one or more data points; superimposing the one or more data points on the perspective image of the organ or structure; and ablating a portion of the organ or structure.

Claims

1. A method for ablating a portion of an organ or bodily structure of a patient, which comprises the steps of:

(a) advancing one or more catheters to sites adjacent to or within an organ or bodily structure, at least one of said catheters having ablation ability;

(b) sensing the location of each catheter'"'"'s distal tip using a non-ionizing field;

(c) at the distal tip of one or more catheters sensing local information of the organ or structure;

(d) processing the sensed information from steps (b) and (c) to create one or more data points;

(e) transmitting said one or more data points to a receiving means; and

(f) ablating a portion of the organ or structure.

2. The method of claim 1, wherein steps (c) and (d) are repeated a number of times sufficient to create a map to be transmitted in step (e).

3. The method of claim 1, wherein in step (e) said one or more data points are projected onto an imaging receiving means.

4. A method for treating cardiac arrhythmias, which comprises the steps of:

(a) advancing one or more reference catheters and one or more mapping/ablation catheters, all of which have distal tips, to sites within a patient'"'"'s heart;

(b) sensing the location of each catheter distal tip using a non-ionizing field;

(c) at the distal tip of the mapping/ablation catheter sensing information concerning the heart'"'"'s electrical activity;

(d) processing the information sensed in steps (b) and (c) to create one or more data points;

(e) transmitting said one or more data points to a receiving means; and

(f) ablating a portion of the inner surface of the ventricle.

5. The method of claim 4, wherein steps (c) and (d) are repeated a number of times sufficient to create a map to be projected in step (e).

6. The method of claim 4, wherein in step (e) said one or more data points are projected onto an image receiving means.

7. A method of prognosing the likelihood of successful treatment of cardiac arrhythmia at a specific site in a patient'"'"'s heart, said method comprising calculating the similarity of a patient'"'"'s body electrogram morphology during arrhythmia to the patient'"'"'s body surface electrogram during pacing in a plurality of sites on the endocardium of the patient'"'"'s heart.

8. The method of claim 7, wherein said method is a closed-heart method.

9. The method of claim 7, wherein said calculating comprises the steps of:

(a) determining the similarity of the patient'"'"'s body surface electrogram morphology during arrhythmia to the body surface electrogram morphology during pacing from a plurality of sites, and

(b) creating a map of corresponding similarity discriminant of said locations of endocardium.

10. The method of claim 7, wherein said calculating is carried out by determining the correlation between an ECG of the patient during arrhythmia and pacing in a plurality of sites on the endocardium.

11. A method for intrabody mapping, comprising the steps of:

(a) inserting a probe into the body of a subject;

(b) applying a non-ionizing electromagnetic field to the body, so that energy from the field impinges on the probe;

(c) finding the position of the probe by sensing the field at the probe;

(d) receiving a signal responsive to electrophysiological activity in the body at the probe; and

(e) processing the signal together with the position found in step (c) to determine a localized characteristic of the electrophysiological activity.

12. A method according to claim 11, wherein sensing the field at the probe comprises receiving a field-responsive signal generated at the probe.

13. A method according to claim 11 or 12, comprising the additional step:

(f) repeating steps (c), (d), and (e) at a plurality of positions of the probe, so as to produce a map of the electrophysiological activity.

14. A method according to claim 13, comprising the additional step:

(g) ablating tissue in the body based on the map.

15. A method according to claim 11 or 12, comprising the additional step:

(f'"'"') ablating tissue in the body based on the localized characteristic of the electrophysiological activity.

16. A method according to claim 11 or 12, comprising the additional steps:

(f") obtaining a perspective image of a portion of the body; and

(g") marking the localized characteristic on the image at the position of the probe.

17. Apparatus for intrabody mapping, comprising:

a probe, having a distal end which is inserted into the heart of a subject and positioned at each of a plurality of sites therein, the probe including one or more electrodes adjacent the distal end, for use in generating signals responsive to a local physiological characteristic;

a position sensor, which generates position signals responsive to the position of the probe; and

a signal processor, which receives and processes the position signals and the signals responsive to the physiological characteristic, to create sufficient data points for a map representative of the characteristic.

18. Apparatus according to claim 17, wherein the one or more electrodes comprise a sensor electrode, which senses a local electrogram.

19. Apparatus according to claim 17 or 18, wherein the one or more electrodes comprise a pacing electrode, which paces the heart in the at least some of the plurality of sites.

20. Apparatus according to claim 19, comprising one or more body surface electrodes, coupled to the signal processor, which electrodes receive ECG signals responsive to pacing of the heart by the pacing electrode.

21. Apparatus according to claim 17, comprising one or more body surface electrodes, coupled to the signal processor, for receiving ECG signals.

22. Apparatus according to claim 17, wherein the map is representative of electrical conduction in the heart.

23. Apparatus according to claim 22, wherein the one or more electrodes comprise an ablation electrode, which ablates a portion of the heart indicated by the map.

24. Apparatus according to claim 17, wherein the position sensor comprises at least one field generator, which generates a non-ionizing electromagnetic field, and at least one receiver, which produces the position signals responsive to the field.

25. Apparatus according to claim 24, wherein the at least one field generator and the at least one receiver comprise antennas.

26. Apparatus according to claim 24, wherein the at least one field generator is positioned outside the body of the subject, and the at least one receiver is fixed to the probe.

27. Apparatus according to claim 24, wherein the at least one field generator is fixed to the probe, and the at least one receiver is positioned outside the body of the subject.

28. Apparatus according to claim 17, comprising a display, which displays the map representative of the characteristic.

29. Apparatus according to claim 17, comprising one or more reference catheters, which are placed at fixed positions in the heart so as to establish a frame of reference for determining the position of the probe.