Cardiac electromechanics

• US 6,066,094 A
• Filed: 01/09/1998
• Issued: 05/23/2000
• 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): Kamm, William E.
• Application Number:
  US09/005,091
• Time in Patent Office: 865 Days
• Field of Search: 600/508, 600/523, 607/9, 607/77
• US Class Current: 600/437
• 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 cardiac shaping comprising:

generating a map of a heart;

analyzing the map to determine a portion of the heart having a certain level of a physiological value thereat; and

determining a pacing regime for changing the level of the physiological value.

2. A method according to claim 1, comprising pacing the heart using the determined pacing regime.

3. A method according to claim 1, comprising:

determining an effect of the pacing regime on the level of the physiological value; and

repeating the analyzing, determining and pacing until a desired level of the value is reached.

4. A method according to claim 1, wherein the physiological value is changed by changing an activation time of the portion.

5. A method according to claim 1, wherein the physiological value comprises a thickness of local muscle tissue.

6. A method according to claim 1, wherein the physiological value comprises a measure of local stress.

7. A method according to claim 1, wherein the physiological value comprises a measure of local intra-cardiac pressure.

8. A method according to claim 1, wherein changing the level of the physiological value comprises maintaining the physiological value within a given range.

9. A method according to claim 8, wherein the range comprises a phase-dependent range, including a different preferred range of levels of the value for each phase of a cardiac cycle.

10. Apparatus for determining a preferred pacing regime of a heart, comprising:

a sensor for generating a map of the heart and for determining a physiological value at a plurality of locations from said map of the heart; and

a processor which receives the physiological values from the sensor and determines a pacing regime which changes a distribution of the physiological value in a desired manner.

11. Apparatus according to claim 10, wherein the distribution comprises a temporal distribution.

12. Apparatus according to claim 10, wherein the distribution comprises a spatial distribution.

13. Apparatus according to claim 10, and comprising a pacemaker which paces the heart according to the determined pacing regime.

14. Apparatus according to claim 10, wherein the computer compares the physiological values determined under different pacing regimes to determine the effect of the pacing.

15. Apparatus according to claim 10, wherein the physiological value comprises a measure of a thickness of tissue at the location.

16. Apparatus according to claim 10, wherein the physiological value comprises a measure of perfusion.

17. Apparatus according to claim 10, wherein the physiological value comprises a plateau duration.