System and method for magnetic-resonance-guided electrophysiologic and ablation procedures

• US 7,155,271 B2
• Filed: 04/28/2003
• Issued: 12/26/2006
• Est. Priority Date: 11/04/1998
• Status: Expired due to Term

• Current Assignee: Johns Hopkins University
• Original Assignee: Johns Hopkins University
• Inventors: Berger, Ronald D., McVeigh, Elliot R., Halperin, Henry R., Atalar, Ergin, Calkins, Hugh, Lima, Joao, Lardo, Albert
• Primary Examiner(s): MANTIS MERCADER, ELENI M
• Application Number:
  US10/424,093
• Publication Number:
  US 20030199755A1
• Time in Patent Office: 1,338 Days
• Field of Search: 600/410, 600/411, 600/420, 600/421, 600/422, 600/423, 600/424, 607/119, 607/121, 607/122, 607/123, 324/307, 324/309, 324/318
• US Class Current: 600/411
• 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 2017/00039 Electric or electromagnetic phenomena other than conductivity, e.g. capacity, inductivity, Hall effect
• CPC Class Codes: A61B 2017/00053 Mapping
• CPC Class Codes: A61B 2090/374 NMR or MRI
• CPC Class Codes: A61B 5/055 involving electronic [EMR] or nuclear [NMR] magnetic resonance, e.g. magnetic resonance imaging
• CPC Class Codes: A61B 5/415 the glands, e.g. tonsils, adenoids or thymus
• CPC Class Codes: A61B 5/418 lymph vessels, ducts or nodes
• CPC Class Codes: A61B 90/36 Image-producing devices or illumination devices not otherwise provided for
• CPC Class Codes: G01R 33/285 Invasive instruments, e.g. catheters or biopsy needles, specially adapted for tracking, guiding or visualization by NMR
• CPC Class Codes: G01R 33/34084 implantable coils or coils being geometrically adaptable to the sample, e.g. flexible coils or coils comprising mutually movable parts
• CPC Class Codes: G01R 33/4808 Multimodal MR, e.g. MR combined with positron emission tomography [PET], MR combined with ultrasound or MR combined with computed tomography [CT]
• CPC Class Codes: G01R 33/5601 involving use of a contrast agent for contrast manipulation, e.g. a paramagnetic, super-paramagnetic, ferromagnetic or hyperpolarised contrast agent

Abstract

A system and method for using magnetic resonance imaging to increase the accuracy of electrophysiologic procedures is disclosed. The system in its preferred embodiment provides an invasive combined electrophysiology and imaging antenna catheter which includes an RF antenna for receiving magnetic resonance signals and diagnostic electrodes for receiving electrical potentials. The combined electrophysiology and imaging antenna catheter is used in combination with a magnetic resonance imaging scanner to guide and provide visualization during electrophysiologic diagnostic or therapeutic procedures. The invention is particularly applicable to catheter ablation, e.g., ablation of atrial fibrillation. In embodiments which are useful for catheter ablation, the combined electrophysiology and imaging antenna catheter may further include an ablation tip, and such embodiment may be used as an intracardiac device to both deliver energy to selected areas of tissue and visualize the resulting ablation lesions, thereby greatly simplifying production of continuous linear lesions. The invention further includes embodiments useful for guiding electrophysiologic diagnostic and therapeutic procedures other than ablation. Imaging of ablation lesions may be further enhanced by use of MR contrast agents. The antenna utilized in the combined electrophysiology and imaging catheter for receiving MR signals is preferably of the coaxial or “loopless” type. High-resolution images from the antenna may be combined with low-resolution images from surface coils of the MR scanner to produce a composite image. The invention further provides a system for eliminating the pickup of RF energy in which intracardiac wires are detuned by filtering so that they become very inefficient antennas. An RF filtering system is provided for suppressing the MR imaging signal while not attenuating the RF ablative current. Steering means may be provided for steering the invasive catheter under MR guidance. Other ablative methods can be used such as laser, ultrasound, and low temperatures.

Claims

1. A method for performing an electrophysiological procedure on a mammalian patient having a heart, comprising:

placing the patient such that the heart is in a main magnetic field of an MRI scanner;

introducing an MR-compatible catheter into the heart;

attenuating a frequency induced in the catheter by the MRI scanner, wherein the attenuated frequency corresponds to a radio frequency emitted by the scanner;

acquiring a magnetic resonance image of the heart;

using the magnetic resonance image to determine a location of said MR-compatible electrode catheter in the heart, and

at substantially the same time that the image is acquired, using said MR-compatible electrode catheter to acquire electrical signals of the heart.

2. The method according to claim 1, wherein said electrical signals indicative of an electrophysiological state comprise intracardiac electrograms.

3. The method according to claim 1, wherein said MR-compatible electrode catheter includes a tip comprising gold.

4. The method according to claim 3, wherein said MR-visible material comprises a metal.

5. The method according to claim 1, wherein said MR-compatible electrode catheter comprises an MR-visible material.

6. The method according to claim 1, further comprising using a magnetic resonance contrast agent to enhance said image acquired in said step of using magnetic resonance imaging to determine the location of said MR-compatible electrode catheter and a heart tissue lesion produced by an ablation.

7. A method for treating cardiac arrhythmias in a mammalian patient having a heart, comprising:

positioning the patient such that the heart is in a main magnetic field of an MRI magnetic scanner;

attenuating a frequency induced in the catheter by the MRI scanner, wherein the attenuated frequency correspond to a radio frequency emitted by the scanner;

acquiring a magnetic resonance image of the heart;

introducing an ablation catheter into the patient and the heart and applying the catheter to create ablation lesions in the heart;

using said catheter to acquire electrical signals indicative of an electrophysiological state of the heart and,

using the magnetic resonance image to visualize the ablation lesions while the said ablation catheter is proximate said lesions.

8. A magnetic resonance imaging compatible cardiac catheter, comprising:

an electrode for applying an RF ablation current to a heart, and

an attenuation device adapted to attenuate in the catheter a radio frequency (RF) signal corresponding to an RF magnetic resonance imaging signal generated by an MR system for a magnetic resonance imaging-guided catheter ablation operation of the heart in a mammalian patient.

9. The catheter according to claim 8, wherein said RF magnetic resonance imaging signal comprises a 64 MHz RF magnetic resonance signal and wherein said attenuation device comprises a filter tuned to attenuate the 64 MHz RF magnetic signal resonating in the catheter.

10. The catheter according to claim 9, wherein said filter comprises a low-pass filter.

11. The catheter according to claim 9 wherein said filter comprises a multi-stage filter.

12. The catheter according to claim 9, wherein said filter further comprises a gradient filter tuned to a gradient-induced noise.

13. The catheter according to claim 12, wherein said gradient filter comprises a series of active filters.

14. A method for treating cardiac arrhythmia in a heart of a mammalian comprising:

positioning the heart of the patient in a main magnetic field of an MRI system;

acquiring a magnetic resonance image of the heart;

introducing a catheter into the patient and the heart;

attenuating a frequency induced in the catheter by the MRI scanner, wherein the attenuated frequency correspond to a radio frequency emitted by the scanner;

acquiring electrical heart signals using said catheter that are indicative of an electrophysiological state of the heart;

detecting an area of abnormal electric activity in the heart based on the signals;

ablating the area of abnormal activity with the catheter, and

using the magnetic resonance image to visualize ablation lesions caused by the ablation while the catheter is proximate the lesions.

15. A method for treating cardiac arrhythmia as in claim 14 further comprising establishing an electrically conductive connection between the catheter and the heart.

16. An ablation system to perform an electrophysiological procedure on a beating heart of a patient in an MRI scanner, comprising:

an MR-compatible catheter including an ablation circuit and an intracardiac electrogram measuring circuit;

an RF filter adapted to suppress a radio frequency (RF) imaging signal in said intracardiac electrogram measuring circuit; and

a electronic filter adapted to suppress noise induced by gradient fields of the MRI scanner.

17. The system according to claim 16, wherein said gradient induced filter is an active filter.

18. The system according to claim 16, wherein said gradient induced filter is a part of the intracardiac electrogram measuring circuit.

19. The system according to claim 16, wherein the RF filter does not attenuate the cardiac electrical signal from an ablation catheter between 30 and 300 Hz.

20. An ablation system to perform an electrophysiological procedure on a beating heart of a patient in an MRI, comprising:

MR-compatible catheter equipped with an ablation circuit and an intracardiac electrogram measuring circuit;

an RF filter designed to suppress a radio frequency (RF) imaging signal and pass without attenuation the cardiac electrical signal from an ablation catheter between 30 and 300 Hz in the said ablation circuit; and

an active gradient induced noise filter in the said intracardiac electrogram measuring circuit.

21. A method for performing an electrophysiological procedure on a mammalian patient having a heart, comprising:

positioning a the patient such that the heart is in a main magnetic field of an MRI scanner;

introducing an MR-compatible catheter into the heart;

attenuating a frequency induced in the catheter by the MRI scanner, wherein the attenuated frequency correspond to a radio frequency emitted by the scanner;

acquiring a magnetic resonance image of the heart by applying static and gradient magnetic fields to the patient and sensing radio frequency (RF) emissions from precession of protons in the heart excited by the magnetic fields;

using the magnetic resonance image to position said MR-compatible electrode catheter in the heart while continuing to acquire additional magnetic resonance images of the heart; and

establishing a conductive connection between the catheter and the heart and monitoring electrical signals in the heart.

22. A method as in claim 21 wherein the magnetic resonance image is repeatedly acquired during the electrophysiological procedure.

23. A method as in claim 21 wherein the magnetic resonance image is acquired at least ten times per second during the electrophysiological procedure.

24. A method as in claim 21 further comprising applying electromagnetic shielding to the MR-compatible catheter and filtering the acquired electrical signals to suppress electrical currents induced in the catheter due to the imaging.

25. A method as in claim 21 further comprising ablating the heart with the catheter to create ablation lesions in the heart and magnetic resonance imaging the lesions.

26. A method as in claim 21 wherein visualization of the lesions further comprises identifying gaps in the lesions and said method further comprise ablating the identified gap.

27. A method for treating cardiac arrhythmia in a heart of a mammalian comprising:

positioning the heart of the patient in a main magnetic field of an MRI system;

introducing a catheter into the heart of the patient;

ablating an area of the heart with the catheter;

using magnetic resonance (MR) imaging to visualize an ablation lesion caused by the ablation;

identifying a region of the visualized ablation lesions requiring further ablation, and

ablating the identified region.

28. The method of claim 27 further comprising attenuating a frequency induced in the catheter by the MRI scanner, wherein the attenuated frequency correspond to a radio frequency emitted by the scanner.

29. The method of claim 27 further comprising using the magnetic resonance image to position said MR-compatible electrode catheter in the heart while continuing to acquire additional magnetic resonance images of the heart and catheter.

30. The method of claim 27 further comprising establishing a conductive connection between the catheter and the heart and monitoring electrical signals in the heart;

using the monitored signals to identify an area of abnormal activity in the heart, and the ablated area is the area of abnormal activity.

31. The method of claim 27 wherein the identified area is a gap in the ablation lesion.

32. The method of claim 31 further comprising forming a continuous line of lesions by ablating the identified area.

33. The method of claim 27 further comprising introducing a contrast agent into the heart, wherein the contrast agent is adsorbed by the lesion.

34. The method of claim 33 wherein the contrast agent is gadolinium.

35. The method of claim 27 further comprising introduction a contrast agent into a blood stream of the patient prior to ablation, wherein the contrast agent penetrates the lesion formed by ablation.

36. The method of claim 27 further comprising introduction a contrast agent into a blood stream of the patient prior to ablation, wherein the contrast agent later penetrates the lesion formed by ablation, and wherein said identifying the region of the visualized ablation lesion further comprises visualizing the ablation lesion enhanced by the contrast agent.

37. The method of claim 27 further comprising MR imaging the ablation lesion while moving an ablation electrode of the catheter to the identified region.