Medical diagnosis, treatment and imaging systems

• US 6,788,967 B2
• Filed: 03/23/1999
• Issued: 09/07/2004
• Est. Priority Date: 05/14/1997
• Status: Expired due to Fees

• Current Assignee: Biosense, Inc. (Cardinal Health, Inc.)
• Original Assignee: Biosense, Inc. (Cardinal Health, Inc.)
• Inventors: Ben-Haim, Shlomo, Greenberg, Ilan, Osadchy, Daniel, Peless, Udi
• Primary Examiner(s): Smith, Ruth S.
• Application Number:
  US09/273,646
• Publication Number:
  US 20020165448A1
• Time in Patent Office: 1,995 Days
• Field of Search: 600/424, 600/407, 606/130, 606/10, 606/15, 606/6-7, 606/11, 606/13-14, 606/18, 606/374, 606/509, 128/899, 324/207.1, 324/207.13, 324/207.17, 324/207.26, 607/88, 607/89, 607/122
• US Class Current: 600/424
• CPC Class Codes: A61B 1/2733 Oesophagoscopes
• 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 2017/00243 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 2034/2051 Electromagnetic tracking systems
• CPC Class Codes: A61B 2090/367 creating a 3D dataset from 2D images using position information
• 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 5/065 Determining position of the probe employing exclusively positioning means located on or in the probe, e.g. using position sensors arranged on the probe
• 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 5/285 : Endotracheal, oesophageal or gastric probes
• 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 8/0833 : involving detecting or locating foreign bodies or organic structures
• CPC Class Codes: A61M 25/0127 : Magnetic means; Magnetic markers
• CPC Class Codes: A61M 25/0147 : with movable mechanical means, e.g. pull wires
• 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 1/403 : for thermotherapy, e.g. hyperthermia

Abstract

A locating system for determining the location and orientation of an invasive medical instrument, for example a catheter or endoscope, relative to a reference frame, comprising: a plurality of field generators which generate known, distinguishable fields, preferably continuous AC magnetic fields, in response to drive signals; a plurality of sensors situated in the invasive medical instrument proximate distal end thereof which generate sensor signals in response to said fields; and a signal processor which has an input for a plurality of signals corresponding to said drive signals and said sensor signals and which produces the three location coordinates and three orientation coordinates of a point on the invasive medical instrument.

Claims

1. A system for percutaneous treatment of a patient'"'"'s heart, comprising:

a catheter, the catheter having a proximal end and a distal end;

an active portion at the distal end of the catheter for sensing electrical signals generated on the heart and for applying laser energy operable to ablate a portion of the heart;

a position sensor responsive to magnetic fields for generating signals for determining position and orientation coordinates of the catheter distal end; and

a signal processor for receiving the signals from the position sensor and reconstructing a three-dimensional surface representing a surface of the patient'"'"'s heart based on the signals received from the position sensor and for generating a map on the three-dimensional surface showing the sensed electrical signals generated by the heart.

2. The system for percutaneous treatment of claim 1, further including an optical waveguide for energizing the active portion.

3. The system for percutaneous treatment of claim 2, further including an ECG monitor for synchronizing with the position sensor.

4. The system for percutaneous treatment of claim 3, further including a reference sensor to correct for breathing motion or patient movement.

5. The system for percutaneous treatment of claim 2, wherein the catheter comprises means for rotating or deflecting the distal end of the catheter.

6. The system for percutaneous treatment of claim 1, wherein the position sensor includes at least two non-coplanar magnetic elements.

7. The system for percutaneous treatment of claim 6, further comprising a plurality of external magnetic elements for placement outside the patient.

8. The system for percutaneous treatment of claim 7, wherein the external magnetic elements establish magnetic fields which are sensed by the position sensor.

9. The system for percutaneous treatment of claim 8, wherein the plurality of external magnetic elements establish different magnetic fields sequentially and the position sensor is operable to sense the different fields.

10. The system for percutaneous treatment of claim 9, wherein the plurality of external magnetic elements are three coils, the coils being sequentially energized.

11. The system for percutaneous treatment of claim 6, wherein the position sensor includes wires for carrying position signals between the position sensor and the catheter proximal end.

12. The system for percutaneous treatment of claim 1, wherein the position sensor includes at least one magnetic element and further comprises a plurality of external magnetic elements for placement outside the patient.

13. A method of treating a patient'"'"'s heart comprising the steps of:

(a) percutaneously inserting a catheter into a heart of a patient, the catheter having a proximal end and a distal end, an active portion at the distal end of the catheter for sensing electrical signals generated on the heart and for applying laser energy, and a position sensor responsive to magnetic fields for generating location signals;

(b) generating magnetic fields;

(c) using the position sensor to generate location signals based on the generated magnetic fields;

(d) sensing the position of the catheter distal end based on the location signals generated by the position sensor for determining position and orientation coordinates of the catheter distal end at a number of places on a surface of the heart by touching the catheter distal end on the surface at each place;

(e) using the position sensor to reference the catheter distal end based on the position and orientation coordinates;

(f) reconstructing a three-dimensional surface representing the surface of the heart based on the location signals generated by the position sensor;

(g) sensing electrical signals generated by the heart;

(h) mapping the electrical activity of the heart on the three-dimensional surface using the sensed electrical signals;

(i) positioning the catheter such that its distal end is adjacent tissue of the heart to be treated based on the position and orientation coordinates; and

(j) applying laser energy from the active portion to the patient'"'"'s heart tissue.

14. The method of claim 13, including utilizing an ECG monitor for synchronization with the position sensor.

15. The method of claim 14, including utilizing a reference sensor to correct for breathing motion or patient movement.

16. The method of claim 13, wherein laser energy is applied to the active portion through an optical waveguide.

17. The method of claim 16, wherein a chamber of the patient'"'"'s heart is treated.