Method and system for performing ablation to treat ventricular tachycardia

• US 8,195,271 B2
• Filed: 11/06/2007
• Issued: 06/05/2012
• Est. Priority Date: 11/06/2007
• Status: Active Grant

• Current Assignee: Siemens Healthineers AG (Siemens AG)
• Original Assignee: Siemens AG
• Inventors: Rahn, Norbert
• Primary Examiner(s): ROZANSKI, MICHAEL T
• Application Number:
  US11/983,027
• Publication Number:
  US 20090118609A1
• Time in Patent Office: 1,673 Days
• Field of Search: 600/411, 600/424, 600/425, 600/427, 378/4, 378/8, 378/62, 378/63
• 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 2018/00351 Heart
• CPC Class Codes: A61B 2018/00839 Bioelectrical parameters, e.g. ECG, EEG
• CPC Class Codes: A61B 2034/2051 Electromagnetic tracking systems
• CPC Class Codes: A61B 2034/2063 Acoustic tracking systems, e.g. using ultrasound
• CPC Class Codes: A61B 2034/301 for introducing or steering flexible instruments inserted into the body, e.g. catheters or endoscopes
• CPC Class Codes: A61B 2090/3762 using computed tomography systems [CT]
• CPC Class Codes: A61B 34/25 User interfaces for surgical systems
• CPC Class Codes: A61B 34/30 Surgical robots
• CPC Class Codes: A61B 5/7289 Retrospective gating, i.e. associating measured signals or images with a physiological event after the actual measurement or image acquisition, e.g. by simultaneously recording an additional physiological signal during the measurement or image acquisition
• CPC Class Codes: A61B 6/12 Arrangements for detecting or locating foreign bodies
• CPC Class Codes: A61B 90/361 Image-producing devices, e.g. surgical cameras

Abstract

A system and method of treating tachycardias and similar syndromes by the use of catheter ablation of tissue is described. A computed tomography (CT)-like image of the heart is obtained and processed to segment the various types of tissue. Papillary muscle areas are identified and displayed differently from the other nearby tissues so that the muscles can be avoided during treatment to avoid or minimize damage to the muscles during ablation treatment. Electrophysical data and scar tissue may also be identified in the image, which may be of the endoscopic type. The position of the catheter may be displayed as a synthetic image on the endoscopic view.

Claims

1. A system for treatment of a medical syndrome, the system comprising:

an imaging modality configured to obtain data suitable for computing a computed tomographic (CT)-like image;

a computer system configured to;

calculate the CT-like image from the data obtained by the imaging modality pre-operatively, intraoperatively, or pre-operatively and intraoperatively;

identify from the CT-like image healthy tissue that is not intended to be damaged or treated;

distinguish the identified healthy tissue from all other types of tissue; and

segment the identified healthy tissue;

a display configured to display a colored, outlined, or textured image of the identified healthy tissue; and

a treatment device;

wherein the computer system is configured to inhibit operation of the treatment device at a predetermined minimum distance from the identified healthy tissue.

2. The system of claim 1, wherein the treatment device is a catheter configured to perform electrophysiological mapping, ablation, or electrophysiological mapping and ablation.

3. The system of claim 1, wherein the medical syndrome to be treated is tachycardia.

4. The system of claim 1, wherein the imaging modality is a magnetic resonance imager (MRI), a C-arm X-ray device, or a computed tomograph (CT) imager.

5. The system of claim 1, further comprising a device for locating a catheter tip in a coordinate system consistent with the CT-like image.

6. The system of claim 1, wherein a location of a catheter tip obtained intra-operatively is displayed on a CT-like image obtained preoperatively.

7. The system of claim 1, wherein the imaging modality is an X-ray device, and the treatment device is a catheter,

wherein the X-ray device is operable while the catheter is inserted in a patient to obtain images of the catheter, and

wherein the computer system is configured to merge the catheter images with the CT-like image.

8. The system of claim 1, wherein the computer system is configured to merge electrophysiological data obtained pre-operatively with the CT-like image.

9. The system of claim 1, wherein:

the imaging modality is a C-arm X-ray device,

the CT-like image is a synthesized endoscopic view, and

the computer system is configured to;

calculate the synthesized endoscopic view from the data obtained by the C-arm X-ray device and using geometric properties of the C-arm X-ray device, and

display the synthesized endoscopic view on the display.

10. The system of claim 1, wherein the treatment device is a catheter, and

wherein a tip of the catheter is displayed in a coordinate system of the CT-like image.

11. The system of claim 1, wherein the treatment device is a catheter, and

wherein a position of a tip of the catheter is obtained in, or transformed to, a coordinate system of the CT-like image data, and the position of the catheter tip is computed with respect to the identified healthy tissue.

12. The system of claim 11, wherein the computer system is configured to inhibit operation of a catheter tip power source when the catheter tip is within an operator-selectable distance from the identified healthy tissue.

13. The system of claim 1, wherein the computer system is further configured to produce a warning when the treatment device is close to the predetermined minimum distance from the identified healthy tissue.

14. A method of treating a medical syndrome, the method comprising:

obtaining pre-operative imaging data using an imaging modality;

computing, from the pre-operative imaging data, a three dimensional computed tomographic (CT)-like soft tissue image of an interior of a body of a patient in an area of interest;

identifying a healthy region to be avoided in the area of interest;

distinguishing the identified healthy region from all other types of regions in the area of interest;

segmenting the identified healthy region to be avoided during treatment; and

displaying a colored, outlined, or textured image of the identified healthy region to be avoided; and

providing a treatment catheter comprising a catheter tip,

wherein operation of a treatment catheter tip power source is inhibited when the catheter tip is within an operator-selectable distance from the identified healthy region to be avoided.

15. The method of claim 14, further comprising:

obtaining electrophysical data for the area of interest and superimposing the electrophysical data on the three dimensional image.

16. The method of claim 14, further comprising:

obtaining image data representing tissue damaged by a myocardial infarction and superimposing the damaged tissue image data on the three dimensional image.

17. The method of claim 14, wherein the treatment catheter is an ablation catheter, and

wherein the method further comprises:

introducing the ablation catheter into the region of interest;

determining a position of the catheter tip; and

displaying the position of the catheter tip on the colored, outlined, or textured image of the identified healthy region to be avoided.

18. The method of claim 14, wherein obtaining comprises obtaining pre-operative imaging data using a C-arm X-ray device, and wherein computing comprises computing, from the pre-operative imaging data and using geometric properties of the C-arm X-ray device, a three dimensional synthesized endoscopic view of the interior of the body of the patient in the area of interest.

19. The method of claim 14, wherein the healthy region to be avoided is papillary muscle.

20. A non-transitory computer-readable medium having instructions stored thereon, comprising instructions for causing a computer system to:

accept imaging data from an imaging modality;

compute a computed tomographic (CT)-like image from the accepted imaging data;

identify from the CT-like image healthy tissue that is not intended to be damaged or treated;

distinguish the identified healthy tissue from all other types of tissue;

segment the identified healthy tissue;

encode a portion of the CT-like image having the identified healthy tissue using a color, outline, or texture; and

inhibit operation of a treatment device at a predetermined minimum distance from the healthy tissue.

21. The non-transitory computer readable medium of claim 20, wherein:

the imaging modality is a C-arm X-ray device,

the CT-like image is an endoscopic-type image, and

the endoscopic-type image is computed from the accepted imaging data and using geometric properties of the C-arm X-ray device.

22. The non-transitory computer readable medium of claim 20, wherein the treatment device is a treatment catheter or an electrophysical measurement catheter, and

wherein the non-transitory computer readable medium further comprises instructions for:

accepting data characterizing a location of a tip of the treatment catheter or the electrophysical measurement catheter and superimposing an image of the treatment catheter or the electrophysical measurement catheter on the CT-like image.

23. The non-transitory computer readable medium of claim 20, further comprising instructions for:

accepting data from an electrocardiograph (ECG); and

selecting an image from a plurality of CT-like images, the selected image corresponding to a user specified phase of a heart cycle.

24. The non-transitory computer readable medium of claim 20, further comprising instructions for:

superimposing electrophysiological data taken at a corresponding phase of a heart cycle.

25. The non-transitory computer readable medium of claim 20, wherein the treatment device is a catheter, and

wherein the non-transitory computer readable medium further comprises instructions for:

accepting data characterizing a location of a tip of the catheter;

registering the location of the tip of the catheter with respect to a coordinate system of the CT-like image; and

determining a position of the catheter tip with respect to the identified healthy tissue.

26. The non-transitory computer readable medium of claim 20, wherein the treatment device is a catheter configured to perform ablation.

27. A system for treatment of a medical syndrome, the system comprising:

an imaging modality configured to obtain data suitable for computing a computed tomographic (CT)-like image;

a treatment device comprising a catheter;

a computer system configured to;

calculate a CT-like image from the data obtained by the imaging modality pre-operatively, intraoperatively, or pre-operatively and intraoperatively;

identify from the CT-tike image healthy tissue that is not intended to be damaged or treated;

distinguish the identified healthy tissue from all other types of tissue;

segment the identified healthy tissue; and

inhibit operation of a catheter tip power source when a tip of the catheter is at an operator selectable distance from the identified healthy tissue; and

a display configured to display a marked image of the identified healthy tissue, wherein the identified healthy tissue is a healthy structure of a human heart.

28. The system of claim 27, wherein the healthy structure of the heart is papillary muscle.

29. The system of claim 28, wherein the marked image identifies a boundary between the papillary muscle and a surrounding area as a line that encloses the papillary muscle.

30. The system of claim 27, wherein the identified healthy tissue is marked with a color, outline, or texture on the display.

31. The system of claim 27, wherein the computer system is further configured to produce a warning when the treatment device is close to the operator selectable distance from the identified healthy tissue.

32. A system for treatment of a medical syndrome, the system comprising:

an imaging modality configured to obtain data suitable for computing a computed tomographic (CT)-like image;

a computer system configured to;

calculate the CT-like image from the data obtained by the imaging modality pre-operatively, intraoperatively, or pre-operatively and intraoperatively;

identify healthy papillary tissue that is not intended to be damaged or treated from the CT-like image;

distinguish the identified healthy papillary tissue from all other types of tissue; and

segment the identified healthy papillary tissue;

a display configured to display a colored, outlined, or textured image of the segmented healthy papillary tissue; and

a treatment device;

wherein the computer system is configured to inhibit operation of the treatment device when the treatment device is positioned at a predetermined minimum distance from the healthy papillary tissue.