Cardiac electromechanics

• US 5,738,096 A
• Filed: 02/01/1996
• Issued: 04/14/1998
• 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): JAWORSKI, FRANCIS J
• Application Number:
  US08/595,365
• Time in Patent Office: 803 Days
• Field of Search: 128/660.03, 128/899, 128/662.06, 128/642, 128/695 R, 607/122, 607/116, 607/119, 607/125
• US Class Current: 600/407
• 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 2017/00061 spectrum
• CPC Class Codes: A61B 2017/00243 cardiac
• CPC Class Codes: A61B 2017/00247 Making holes in the wall of the heart, e.g. laser Myocardial revascularization
• CPC Class Codes: A61B 2018/00392 Transmyocardial revascularisation
• CPC Class Codes: A61B 2018/00869 Phase
• CPC Class Codes: A61B 2034/105 Modelling of the patient, e.g. for ligaments or bones
• CPC Class Codes: A61B 2034/2051 Electromagnetic tracking systems
• CPC Class Codes: A61B 2090/3958 emitting a signal
• 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 5/0215 by means inserted into the body catheters A61M25/00
• CPC Class Codes: A61B 5/029 Measuring or recording blood output from the heart, e.g. minute volume A61B8/065 takes precedence
• 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 5/145 : Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissuemeasuring of blood pressure or blood flow A61B5/02; non-radiation detecting or locating of foreign bodies in blood A61B5/06
• CPC Class Codes: A61B 5/287 : Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
• CPC Class Codes: A61B 5/352 : Detecting R peaks, e.g. for synchronising diagnostic apparatus; Estimating R-R interval
• CPC Class Codes: A61B 5/6843 : Monitoring or controlling sensor contact pressure
• CPC Class Codes: A61B 5/6859 : with multiple distal splines
• CPC Class Codes: A61B 5/6885 : Monitoring or controlling sensor contact pressure
• CPC Class Codes: A61B 8/0833 : involving detecting or locating foreign bodies or organic structures
• CPC Class Codes: A61M 25/0133 : Tip steering devices
• CPC Class Codes: A61N 1/06 : for high-frequency therapy
• CPC Class Codes: A61N 1/32 : alternating or intermittent currents applying electric fields by inductive or capacitive coupling A61N1/40; microwave apparatus A61N5/02
• 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 1/36564 : controlled by blood pressure
• CPC Class Codes: A61N 1/368 : comprising more than one electrode co-operating with different heart regions A61N1/3622, A61N1/3627 take precedence
• CPC Class Codes: A61N 1/403 : for thermotherapy, e.g. hyperthermia

Abstract

A method of constructing a cardiac map of a heart having a heart cycle including; bringing an invasive probe into contact with a location on a wall of the heart; determining, at at least two different phases of the heart cycle, a position of the invasive probe; and determining a local non-electrical physiological value at the location. The method is repeated for a plurality of locations in the heart. The positions are combined to form a time-dependent map of at least a portion of the heart and local relationships between changes in positions of the invasive probe and determined local non-electrical physiological values are determined. Preferably, local electrical activity at the plurality of locations is also acquired.

Claims

1. A method of constructing a map of the heart having a heart cycle comprising:

(a) bringing a probe into contact with a location on a wall of the heart;

(b) determining a position of the probe at the location;

(c) repeating (a) and (b) for a multiplicity of locations of the heart; and

(d) combining the determined positions of the probe to determine a structural map of at least a portion of the heart.

2. A method according to claim 1 comprising determining local pathologies in the heart based on the map.

3. A method according to claim 1 and comprising determining at least a second position of the probe at a phase of the cycle different from the phase at the position determination of (b) and wherein the map is a phase dependent geometric map.

4. A method according to claim 3, wherein the second position determination is performed at the location.

5. A method according to claim 4 comprising analyzing the map to determine underutilized portions of the heart.

6. A method according to claim 4 comprising analyzing the map to determine procedures for improving the operation of the heart.

7. A method according to claim 4 comprising, determining a local change in the geometry of the heart.

8. A method according to claim 7 comprising determining local pathologies in the heart based on the local changes in geometry.

9. A method according to claim 7, wherein the local change comprises a change in a local radius of the heart wall at the location.

10. A method according to claim 9 comprising determining an intra-cardiac pressure of the heart.

11. A method according to claim 10 comprising determining a tension of the heart at the location by applying Laplace'"'"'s law to the change in the local radius and the determined pressure.

12. A method according to claim 9, further comprising determining a relative tension of the heart at the location by applying Laplace'"'"'s law to the change in the local radius.

13. A method according to claim 4 comprising determining the activity of the heart at the location.

14. A method according to claim 13, wherein determining the activity comprises determining a relative motion profile of the location on the heart wall relative to neighboring locations.

15. A method according to claim 14 comprising determining local pathologies in the heart based on the relative motion profile.

16. A method according to claim 13, wherein determining the activity comprises determining a motion profile of the heart at the location.

17. A method according to claim 16 comprising determining local pathologies in the heart based on the motion profile.

18. A method according to claim 16 comprising monitoring the stability of the contact between the probe and the heart based on the motion profile.

19. A method according to claim 18, wherein monitoring comprises detecting changes in the motion profile for different heart cycles.

20. A method according to claim 18, wherein monitoring comprises detecting differences in positions of the probe at the same phase for different heart cycles.

21. A method according to claim 4 comprising binning positions according to characteristics of the heart cycle.

22. A method according to claim 21 comprising separately combining the information in each bin into a map.

23. A method according to claim 22 comprising determining differences between the maps.

24. A method according to claim 23 comprising determining local pathologies in the heart based on the determined differences between maps.

25. A method according to claim 21, wherein the characteristics comprise a heart rate.

26. A method according to claim 21, wherein the characteristics comprise a morphology of an ECG of the heart.

27. A method according to claim 1 comprising determining local information at the location at which the position of the probe is determined and wherein combining the positions comprises combining the positions and the local information to form a map incorporating the local information.

28. A method according to claim 27 comprising, analyzing the map to determine overstressed portions of the heart.

29. A method according to claim 27, wherein the local information is determined using a sensor not mounted on the probe.

30. A method according to claim 27, wherein the local information is determined using a sensor external to the body.

31. A method according to claim 27, wherein the local information is determined using a sensor on the probe.

32. A method according to claim 27, wherein the local information and the position of the probe are determined at substantially the same time.

33. A method according to claim 27, wherein the local information and the position of the probe are determined at substantially different times.

34. A method according to claim 27 comprising determining a relationship between changes in positions of the probe and determined local information at at least one location.

35. A method according to claim 34 comprising determining local pathologies in the heart based on the at least one local relationship.

36. A method according to claim 27, wherein the local information comprises a chemical concentration value.

37. A method according to claim 27, wherein the local information comprises a thickness of the heart at the location.

38. A method according to claim 37, wherein the thickness of the heart is determined using an ultrasonic transducer mounted on the probe.

39. A method according to claim 27, wherein the local information comprises a measure of a perfusion of the heart at the location.

40. A method according to claim 27, wherein the local information comprises a measure of the work performed by the heart portion at the location.

41. A method according to claim 27, wherein the local information comprises local electrical activity.

42. A method according to claim 41, wherein the electrical activity comprises a local electrogram.

43. A method according to claim 41, wherein the electrical activity comprises a local activation time.

44. A method according to claim 41, wherein the electrical activity comprises a local plateau duration of heart tissue at the location.

45. A method according to claim 27, wherein the probe is located in a coronary vein or artery.

46. A method according to claim 27, wherein the probe is located outside a blood vessel.

47. A method according to claim 1 comprising determining local information at at least two phases of the heart cycle at a location and wherein combining the positions comprises combining the positions and the local information to form a map comprising phase dependent local information.

48. A method according to claim 47 comprising analyzing changes in the determined local information.

49. A method according to claim 48 comprising determining local pathologies in the heart based on the changes in the local information.

50. A method according to claim 49, wherein the changes are a function of the heart cycle and further comprising determining the phase of the heart cycle at which the local information is determined.

51. A method according to claim 49, comprising determining local electrical activity at the location and wherein the changes are related to local electrical activity at the location.

52. A method according to claim 47 comprising analyzing the map to determine underutilized portions of the heart.

53. A method according to claim 47 comprising analyzing the map to determine procedures for improving the operation of the heart.

54. A method according to claim 47, wherein the local information comprises a thickness of the heart, and further comprising determining a reaction of the heart to an activation signal by analyzing changes in the thickness of the heart.

55. A method according to claim 47, further comprising binning local information according to characteristics of the heart cycle.

56. A method according to claim 55, wherein the characteristics comprise a heart rate.

57. A method according to claim 55, wherein the characteristics comprise a morphology of an ECG of the heart.

58. A method according to claim 1, further comprising reconstructing a surface portion of the heart.

59. A method according to claim 58 comprising determining local pathologies in the heart based on the reconstructed surface portion.

60. A method according to claim 1, wherein the positions of the probe are positions determined relative to a reference location.

61. A method according to claim 60, wherein the reference location is a predetermined portion of the heart.

62. A method according to claim 60, wherein a position of the reference location is determined using a position sensor.

63. A method according to claim 60, comprising periodically determining a position of the reference location.

64. A method according to claim 63, wherein the position of the reference location is acquired at the same phase of consecutive cardiac cycles.

65. A method according to claim 1, wherein the probe is located in a coronary vein or artery.

66. A method according to claim 1, wherein the probe is located outside a blood vessel.

67. A method of determining the structure of at least a portion of a heart having a heart cycle comprising:

(a) bringing a probe into contact with a location on a wall of the heart;

(b) determining a position in space of the probe at the location;

(c) acquiring data at the position in space;

(d) repeating (a), (b) and (c) for a multiplicity of locations of the heart to determine a multiplicity of data each associated with a determined position of the probe in space; and

(e) combining the multiplicity of the data and the determined positions of the probe in space to determine a map, containing said data, of at least a portion of the heart, said positions in space being determined solely from information other than that derived from an image of the vicinity of the probe at the locations.

68. A method according to claim 67 wherein the map is a phase dependent map of said data.

69. A method according to claim 67 wherein the data comprises local chemical concentration values and wherein the map comprises a map of said chemical concentration values.

70. A method according to claim 67 wherein said data comprises the thickness of the heart at said locations and wherein the map comprises a map of thickness of the heart.

71. A method according to claim 67 wherein the data comprises local perfusion of the heart at at least some of said locations and wherein the map comprises a perfusion map of at least a portion of the heart.

72. A method according to claim 67 wherein the data is used to determine local work performed at at least some of said locations and wherein the map comprises a map of the work performed at locations of the heart.

73. A method according to claim 67 wherein the data comprises electrical activity at at least some of the locations and wherein the map comprises a map of local electrical activity.

74. A method according to claim 67 wherein the data comprises local activation time at at least some of the locations and wherein the map comprises a map of local activation time.

75. A method according to claim 67 wherein the data is utilized to determine a local plateau duration at a plurality of locations and wherein the map comprises a map of local plateau duration.

76. A method according to claim 67 wherein the positions are determined with respect to a reference location.

77. A method according to claim 76 wherein the reference location is a location which is fixed in the moving heart.

78. A method according to claim 77 wherein the position in space of the reference location is determined using a position sensor.

79. A method of performing measurements of a heart having a heart cycle comprising:

(a) bringing a probe into contact with a location on a wall of the heart;

(b) determining a first position in space of the probe at the location for a first phase of the heart;

(c) repeating (b) at the location, for a second phase of the heart, to determine a second position of the probe in space; and

(d) calculating the movement of the heart at the location utilizing the first and second determined positions of the probe in space.

80. A method according to claim 79 wherein the positions are determined with respect to a reference location.

81. A method according to claim 80 wherein the reference location is a location which is fixed in the moving heart.

82. A method according to claim 79 and including repeating steps (a) to (d) for a multiplicity of different locations on the heart.

83. A method according to claim 82 and including mapping the determined motions of the heart at different locations to generate a map of heart wall motion for at least a portion of the heart.

84. A method according to claim 82 wherein the position in space of the probe is determined using a position sensor.

85. A method of determining the structure of at least a portion of a heart having a heart cycle comprising:

(a) bringing a probe into contact with a location on a wall of the heart;

(b) determining a position in space of the probe at the location;

(c) acquiring data at the position of the probe in space;

(d) repeating (a), (b) and (c) for a multiplicity of locations of the heart to determine a multiplicity of data each associated with a determined position of the probe in space; and

(e) combining the multiplicity of the data and the determined positions of the probe in space to determine a map of at least a portion of the heart containing said data, without utilizing, prior to or during said combining, an image of the heart other than one reconstructed from the determined positions of the probe in space.

86. A method according to claim 85 wherein the map is a phase dependent map of said data.

87. A method according to claim 85 wherein the data comprises local chemical concentration values and wherein the map comprises a map of said chemical concentration values.

88. A method according to claim 85 wherein said data comprises the thickness of the heart at said locations and wherein the map comprises a map of thickness of the heart.

89. A method according to claim 85 wherein the data comprises local perfusion of the heart at at least some of said locations and wherein the map comprises a perfusion map of at least a portion of the heart.

90. A method according to claim 85 wherein the data is used to determine local work performed at at least some of said locations and wherein the map comprises a map of the work performed at locations of the heart.

91. A method according to claim 85 wherein the data comprises electrical activity at at least some of the locations and wherein the map comprises a map of local electrical activity.

92. A method according to claim 85 wherein the data comprises local activation time at at least some of the locations and wherein the map comprises a map of local activation time.

93. A method according to claim 85 wherein the data is utilized to determine a local plateau duration at a plurality of locations wherein the map comprises a map of local plateau duration.

94. A method according to claim 85 wherein the positions are determined with respect to a reference location.

95. A method according to claim 94 wherein the reference location is a location which is fixed in the moving heart.

96. A method according to claim 95 wherein the position in space of the reference location is determined using a position sensor.

97. Apparatus for constructing a map of the heart having a heart cycle comprising:

a probe, having a distal end and adapted for contact of the distal end with a location on the inner heart wall;

means for determining the position in space of the distal end of the probe at the location; and

computing circuitry which combines a multiplicity of positions of the distal end of the probe in space determined at different locations on the heart to form a structural map of at least a portion of the heart.

98. Apparatus according to claim 97 wherein the probe has a position sensor located adjacent the distal end wherein the means for determining the position determines the position based on a determination of the position of the position sensor.

99. Apparatus according to claim 97 and including means for determining contact of the probe during said position determination.

100. Apparatus according to claim 97 wherein the means for determining the position of the distal end of the probe comprises means for determining the position of the distal end of the probe with respect to a reference location.

101. Apparatus according to claim 100 wherein the means for determining the position of the distal end of the probe with respect to a reference location comprises means for determining the position of a reference location fixed in the moving heart.

102. Apparatus according to claim 101 wherein the means for determining the position of a reference location fixed in the moving heart comprises a position sensor placed at the reference location.

103. Apparatus for performing measurements of a heart having a heart cycle, the apparatus comprising:

a probe, having a distal end and adapted for contact of the distal end with a location on the inner heart wall;

means for determining the position in space of the distal end of the probe at the location; and

computing circuitry which combines a multiplicity of positions in space of the distal end of the probe determined at different locations on the heart to form a map without utilizing an image of a region surrounding the distal end of the probe at the position.

104. Apparatus according to claim 103 wherein the probe has a position sensor located adjacent the distal end wherein the means for determining the position determines the position based on a determination of the position of the position sensor.

105. Apparatus according to claim 103 and including means for determining contact of the probe during said position determination.

106. Apparatus according to claim 103 wherein the map is a structural map of at least a portion of the heart.

107. Apparatus according to claim 103 wherein the means for determining the position of the distal end of the probe comprises means for determining the position of the distal end of the probe with respect to a reference location.

108. Apparatus according to claim 107 wherein the means for determining the position of the distal end of the probe with respect to a reference location comprises means for determining the position of a reference location fixed in the moving heart.

109. Apparatus according to claim 108 wherein the means for determining the position of a reference location fixed in the moving heart comprises a position sensor placed at the reference location.

110. Apparatus for performing measurements of a heart having a heart cycle, the apparatus comprising:

a probe, having a distal end and adapted for contact of the distal end with a location on the heart wall;

means for determining the position in space of the distal end of the probe at the location; and

computing circuitry which combines a plurality of positions of the distal end of the probe in space, determined at a particular location for a plurality of cycles of the heart.

111. Apparatus according to claim 110 wherein the plurality of positions are combined by the computing circuitry to determine the movement of the heart wall at the location.

112. Apparatus according to claim 111 wherein the computing circuitry combines a plurality of determined movements at different locations of the heart wall to form a map of heart wall movement.

113. Apparatus according to claim 110 wherein the means for determining the position of the distal end of the probe comprises means for determining the position of the distal end of the probe with respect to a reference location.

114. Apparatus according to claim 113 wherein the means for determining the position of the distal end of the probe with respect to a reference location comprises means for determining the position of a reference location fixed in the moving heart.

115. Apparatus according to claim 114 wherein the means for determining the position of a reference location fixed in the moving heart comprises a position sensor placed at the reference location.

116. Apparatus for performing measurements of a heart having a heart cycle, the apparatus comprising:

a probe, having a distal end and adapted for contact of the distal end with a location on the inner heart wall;

means for determining the position in space of the distal end at the location;

means for determining local information at the location, referenced to the position of the distal end in space; and

computing circuitry which combines the multiplicity of the data and the determined positions of the probe in space to determine a map, containing said data, of at least a portion of the heart, without utilizing, prior to or during said combining, an image of the heart other than one reconstructed from the determined positions.

117. Apparatus according to claim 116 wherein the means for determining the position of the distal end of the probe comprises means for determining the position of the distal end of the probe with respect to a reference location.

118. Apparatus according to claim 117 wherein the means for determining the position of the distal end of the probe with respect to a reference location comprises means for determining the position of a reference location fixed in the moving heart.

119. Apparatus according to claim 118 wherein the means for determining the position of a reference location fixed in the moving heart comprises a position sensor placed at the reference location.