Prediction and assessment of ablation of cardiac tissue

• US 7,306,593 B2
• Filed: 01/14/2004
• Issued: 12/11/2007
• Est. Priority Date: 10/21/2002
• Status: Expired due to Term

• Current Assignee: Biosense Webster Incorporated (Johnson & Johnson)
• Original Assignee: Biosense, Inc. (Cardinal Health, Inc.)
• Inventors: Keidar, Yaron, Govari, Assaf, Schwartz, Yitzhack
• Primary Examiner(s): PEFFLEY, MICHAEL F
• Application Number:
  US10/757,288
• Publication Number:
  US 20040147920A1
• Time in Patent Office: 1,427 Days
• Field of Search: 606 31- 35, 606/41, 606 48- 50, 607/101, 607/102, 607/116, 607/122, 600/437, 600/439, 600/459, 600/461
• US Class Current: 606/34
• 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 18/24 with a catheter A61B18/26, A61B18/28 take precedence
• CPC Class Codes: A61B 2017/00026 Conductivity or impedance, e.g. of tissue
• CPC Class Codes: A61B 2017/00053 Mapping
• CPC Class Codes: A61B 2017/00084 Temperature
• CPC Class Codes: A61B 2017/00106 ultrasonic
• CPC Class Codes: A61B 2017/00243 cardiac
• CPC Class Codes: A61B 2017/00274 Prostate operation, e.g. prostatectomy, turp, bhp treatment
• CPC Class Codes: A61B 2018/00351 Heart
• CPC Class Codes: A61B 2018/00547 Prostate
• CPC Class Codes: A61B 2018/00839 Bioelectrical parameters, e.g. ECG, EEG
• CPC Class Codes: A61B 2034/102 Modelling of surgical devices, implants or prosthesis
• CPC Class Codes: A61B 2034/104 Modelling the effect of the tool, e.g. the effect of an implanted prosthesis or for predicting the effect of ablation or burring
• CPC Class Codes: A61B 2034/105 Modelling of the patient, e.g. for ligaments or bones
• CPC Class Codes: A61B 2034/107 Visualisation of planned trajectories or target regions
• CPC Class Codes: A61B 2034/2051 Electromagnetic tracking systems
• CPC Class Codes: A61B 2034/2072 Reference field transducer attached to an instrument or patient
• CPC Class Codes: A61B 2090/378 using ultrasound
• CPC Class Codes: A61B 2090/3784 both receiver and transmitter being in the instrument or receiver being also transmitter
• CPC Class Codes: A61B 2090/3975 active
• 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 34/25 : User interfaces for surgical systems
• 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 8/06 : Measuring blood flow measuring volume flow in general G01F, e.g. G01F1/66, G01F1/72; measuring speed of fluids in general G01P5/00
• CPC Class Codes: A61B 8/12 : in body cavities or body tracts, e.g. by using catheters catheters per se A61M25/00
• CPC Class Codes: A61B 8/445 : Details of catheter construction
• CPC Class Codes: A61B 8/4461 : Features of the scanning mechanism, e.g. for moving the transducer within the housing of the probe
• CPC Class Codes: A61B 90/92 : coded with colour

Abstract

A method for ablating tissue in an organ inside a body of a subject includes bringing a probe inside the body into a position in contact with the tissue to be ablated, and measuring one or more local parameters at the position using the probe prior to ablating the tissue. A map of the organ is displayed, showing, based on the one or more local parameters, a predicted extent of ablation of the tissue to be achieved for a given dosage of energy applied at the position using the probe. The given dosage of energy is applied to ablate the tissue using the probe, and an actual extent of the ablation at the position is measured using the probe subsequent to ablating the tissue. The measured actual extent of the ablation is displayed on the map for comparison with the predicted extent.

Claims

1. Apparatus for ablating cardiac tissue in a heart of a subject, comprising:

a catheter, which is adapted to be inserted into the body and within the heart so as to contact the cardiac tissue to be ablated at a desired position in the heart, the catheter comprising;

at least one sensor, which measures one or more local parameters at the position prior to and after ablating the tissue and a position sensor which generates signals for determining position and orientation coordinates of the distal end of the catheter; and

an ablation device, which applies a given dosage of energy to the tissue so as to ablate the tissue;

a display, which displays a map of the heart; and

a controller, which determines the position and orientation coordinates of the distal end of the catheter using the signals generated by the position sensor and generates the map showing, based on the one or more local parameters measured by the at least one sensor, a predicted extent of ablation of the tissue to be achieved for the given dosage of energy, and an actual extent of the ablation determined subsequent to ablating the tissue, for comparison with the predicted extent using the position and orientation coordinates.

2. The apparatus according to claim 1, wherein the controller is adapted, responsively to the output of the position sensor, to determine at least one of a penetration depth of the catheter in the cardiac tissue and an orientation angle of the catheter relative to the cardiac tissue, and to predict the extend of the ablation responsively to the at least one of the penetration depth and the orientation angle.

3. The apparatus according to claim 1, wherein the controller is adapted to generate the map by processing the output of the position sensor as the distal end of the catheter is brought into contact with the cardiac tissue at multiple positions inside the heart.

4. The apparatus according to claim 3, wherein the at least one sensor comprises an electrical sensor, which is adapted to measure electrical potentials at the multiple positions, and wherein the controller is adapted to provide an indication of electrical activity on the map, based on the measured electrical potentials.

5. The apparatus according to claim 1, wherein the at least one sensor comprises one or more ultrasonic transducers, which are adapted to transmit ultrasonic waves into the tissue and to generate an output signal responsively to the ultrasonic waves reflected from the tissue.

6. The apparatus according to claim 5, wherein the controller is adapted to measure a propagation speed of the ultrasonic waves in the tissue responsively to the output signal from the one or more ultrasonic transducers, and to estimate a temperature of the tissue based on the propagation speed.

7. The apparatus according to claim 5, wherein the controller is adapted to assess blood flow in the tissue responsively to the output signal from the one or more ultrasonic transducers.

8. The apparatus according to claim 5, wherein the controller is adapted to determine the actual extent of the ablation based on the output signal from the one or more ultrasonic transducers after applying the given dosage of the energy.

9. The apparatus according to claim 1, wherein the controller is adapted to determine an orientation angle of the distal end of the catheter relative to the cardiac tissue, and to predict the extent of the ablation responsively to the orientation angle.

10. The apparatus according to claim 1, wherein the one or more local parameters comprise at least one of a penetration depth of the distal end of the catheter in the cardiac tissue, an electrical impedance between the catheter and the tissue, a temperature of the tissue and a flow of blood associated with the tissue.

11. The apparatus according to claim 1, wherein the controller is adapted to adjust the dosage of the energy responsively to the map.

12. The apparatus according to claim 1, wherein the ablation device comprises an electrode, which is adapted to apply radio frequency (RF) energy to ablate the tissue.

13. The apparatus according to claim 1, wherein the catheter is adapted to ablate a succession of mutually-adjacent sites in the tissue, and wherein the controller is adapted to provide a visual indication of overlap between the sites.

14. Apparatus for ablating cardiac tissue in a heart of a subject, comprising:

a catheter, which is adapted to be inserted into the body and within the heart so as to contact the cardiac tissue to be ablated, the catheter comprising;

a position sensor, which generates an output indicative of a position and orientation of the distal end of the catheter relative to the cardiac tissue with which the catheter is in contact; and

an ablation device, which applies a given dosage of energy to the tissue so as to ablate the tissue;

a display, which displays a map of the heart; and

a controller, which computes position and orientation coordinates of the distal end of the catheter based on the output from the position sensor and, a prediction of an extent of ablation of the tissue to be achieved for the given dosage of energy, so as to enable the dosage to be adjusted responsively to the prediction using the position and orientation coordinates of the distal end of the catheter.

15. The apparatus according to claim 14, wherein the position sensor comprises one or more sensor coils, which are adapted to generate the output indicative of the position and orientation responsively to an externally-applied magnetic field.

16. The apparatus according to claim 14, wherein the controller is adapted to generate a map of the heart by processing the output of the position sensor as the catheter is brought into contact with the cardiac tissue at multiple positions inside the heart, and recording position coordinates of the distal end of the catheter at the multiple positions.

17. The apparatus according to claim 16, wherein the controller is adapted to determine an orientation angle of the distal end of the catheter relative to the cardiac tissue using the map.

18. The apparatus according to claim 17, wherein the controller is adapted to determine a depth of penetration of the catheter into the cardiac tissue, based on the position coordinates of the catheter and on the map, and to predict the extent of the ablation responsively to the depth of penetration and the orientation angle of the catheter.

19. The apparatus according to claim 14, wherein the catheter comprises a sensor, which is adapted to measure at least one local parameter selected from a list of local parameters consisting of an electrical impedance between the catheter and the cardiac tissue, a temperature of the tissue and a flow of blood associated with the tissue, and wherein the controller is adapted to predict the extent of the ablation responsively to the at least one local parameter.

20. The apparatus according to claim 14, wherein the controller is adapted to adjust the dosage of the energy responsively to the map.

21. The apparatus according to claim 14, wherein the ablation device comprises an electrode, which is adapted to apply radio frequency (RF) energy to ablate the tissue.