System and method to evaluate electrode position and spacing

• US 8,355,774 B2
• Filed: 10/30/2009
• Issued: 01/15/2013
• Est. Priority Date: 10/30/2009
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Markowitz, H. Toby, Zhang, Shangqian Peter
• Primary Examiner(s): Patel, Niketa
• Assistant Examiner(s): LEVICKY, WILLIAM J
• Application Number:
  US12/609,734
• Publication Number:
  US 20110106203A1
• Time in Patent Office: 1,173 Days
• Field of Search: 607/2, 607/27, 128/899, 600/424, 600/547
• US Class Current: 600/424
• 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 34/20 Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
• 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 5/063 using impedance measurements
• CPC Class Codes: A61B 5/287 Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
• CPC Class Codes: A61N 1/37 Monitoring; Protecting
• CPC Class Codes: A61N 1/372 Arrangements in connection with the implantation of stimulators

Abstract

A method and apparatus for tracking and illustrating the location of leads positioned within the volume is disclosed. For example, the lead electrodes can be positioned within a heart of a patient that can be tracked over time. The lead electrodes can be tracked with an electrode potential or bioimpedance tracking system to determine the position of the lead electrodes. A method and apparatus is disclosed to analyze the position information for analyzing the selected position of the lead electrodes.

Claims

1. A method of determining movement of a portion of a subject, comprising:

positioning a first implantable lead having a first implantable electrode into a structure of the subject and positioning the first implantable electrode at a first location;

positioning a second implantable lead having a second implantable electrode into a structure of the subject and positioning the second implantable electrode at a second location;

positioning a third electrode on or in the subject;

injecting at least two axes of current into a volume of the subject;

determining a first impedance using the positioned first implantable electrode and the third electrode;

determining a second impedance using the positioned second implantable electrode and the third electrode;

executing instructions with a processor external to the subject to determine a plurality of sequential first positions of the first implantable electrode and a plurality of sequential second positions of the second implantable electrode based on the determined first impedance and the determined second impedance using the positioned first implantable electrode, the positioned second implantable electrode, and the third electrode;

calculating a unit vector;

projecting a first displacement vector representing motion of the positioned first implantable electrode onto the unit vector and a second displacement vector representing motion of the positioned second implantable electrode onto the unit vector;

illustrating a plurality of projected positions on a plane of the subject over time; and

determining motion of the structure of the subject based on the determined plurality of sequential first positions of the first implantable electrode and the plurality of sequential second positions of the second implantable electrode.

2. The method of claim 1, wherein selecting the unit vector includes rotating an initial unit vector around one of two injected axes relative to the selected unit vector.

3. The method of claim 2, further comprising:

injecting three axes into the volume of the subject;

wherein selecting the unit vector includes rotating the initial unit vector around two of the three injected axes relative to the selected unit vector.

4. The method of claim 1, wherein rotating a component of a first vector and a second vector includes executing instructions with the processor to mathematically compute the rotations.

5. The method of claim 1, wherein illustrating the plurality of positions on the plane over time includes illustrating a line.

6. The method of claim 1, further comprising:

implanting an implantable medical device into the subject to at least one of cardiovert the heart of the subject, pace the heart of the subject, defibrillate the heart of the subject or combinations thereof.

7. The method of claim 6, further comprising:

implanting the first implantable electrode and the second implantable electrode; and

connecting the first implantable electrode and the second implantable electrode to the implantable medical device.

8. The method of claim 1, further comprising:

selecting a pacing parameter;

pacing the structure of the subject with the selected pacing parameter; and

determining whether synchrony exists in the structure with the selected pacing parameter.

9. The method of claim 8, further comprising;

when dysynchrony exists, alter the pacing parameter to achieve synchrony prior to implanting an implantable medical device.

10. The method of claim 9, further comprising:

when synchrony exists, maintaining the first implantable electrode and the second implantable electrode at the first and second respective positions;

implanting an implantable medical device into the subject; and

connecting the first lead and the second lead to the implantable medical device.

11. The method of claim 8, further comprising:

when dysynchrony exists, moving at least one of the first implantable electrode or the second implantable electrode to a third position different from the first or second position in the structure of the subject.

12. A method of determining movement of a portion of a subject, comprising:

positioning a first implantable lead having a first implantable electrode into a right heart portion of the subject and positioning the first implantable electrode at a first location in the right heart portion;

positioning a second implantable lead having a second implantable electrode into a left heart portion of the subject and positioning the second implantable electrode at a second location in the left heart portion;

selecting first pacing parameters;

pacing the heart of the subject according to the selected first pacing parameters with the first implantable electrode and the second implantable electrode;

tracking, relative to a reference portion, the location of the first implantable electrode in the right heart portion and the second implantable electrode in the left heart portion with an external tracking system;

executing instructions with a processor external to the subject to determine a plurality of sequential first positions of the first implantable electrode and a plurality of sequential second positions of the second implantable electrode based on a determined impedance using both the positioned first implantable electrode and the positioned second implantable electrode;

calculating a selected plane of the subject, the selected plane having a unit vector;

projecting the plurality of first sequential positions and the plurality of second sequential positions onto the unit vector of the selected plane of the subject; and

determining whether synchrony of the heart of the subject exists based on the projected plurality of first sequential positions and plurality of second sequential positions;

wherein determining existence of synchrony of the heart includes observing the plurality of positions during pacing the heart.

13. The method of claim 12, further comprising:

injecting at least two axes of current into a volume of the subject with the external tracking system;

wherein tracking the location of the first implantable electrode in the right heart portion and the second implantable electrode in the left heart portion with an external tracking system includes determining an impedance using the positioned first implantable electrode and the positioned second implantable electrode relative to a third reference electrode.

14. The method of claim 13, further comprising:

displaying on a display device the projection;

wherein the projection can include two lines illustrating the plurality of first and second sequential positions;

wherein synchrony is determined by observing an existence of opposition of the relative positions of the projected plurality of first sequential positions and the plurality of second sequential positions.

15. The method of claim 14, wherein the lines illustrate a first trace of the plurality of first sequential positions of the first implantable electrode and a second trace of the plurality of second sequential positions of the second implantable electrode over time relative to a selected unit vector.

16. The method of claim 15, wherein the plurality of first and second sequential positions are projected positions of the respective first and second implantable electrodes relative to the subject and include projection on the selected unit vector.

17. The method of claim 16, further comprising:

moving at least one of the first implantable electrode or the second implantable electrode to achieve synchrony; and

,

determining the existence of synchrony of the heart of the subject after moving the at least one of the first implantable electrode or the second implantable electrode.

18. The method of claim 13, further comprising:

selecting alternative pacing parameters;

wherein determining the existence of synchrony includes determining the existence of synchrony after applying the alternative pacing parameters.

19. The method of claim 13, wherein executing instructions with a processor external to the subject to determine a plurality of first sequential positions of the first implantable electrode and a plurality of second sequential positions of the second implantable electrode, further comprises:

wherein positioning a reference includes positioning a reference electrode relative to the subject;

determining a first initial position vector of the first implantable electrode and a second initial position vector of the second implantable electrode relative to the reference electrode;

determining subsequent first position vectors for the first implantable electrode and subsequent second position vectors for the second implantable electrode relative to the reference electrode; and

determining the difference between the initial and the subsequent position vectors for each of the first and second electrode.

20. The method of claim 13, further comprising:

when synchrony is determined to exist, maintaining the first implantable electrode at the first position and the second implantable electrode at the second position;

connecting the first lead and the second lead to an implantable medical device; and

implanting the implantable medical device into the subject.

21. The method of claim 12, wherein tracking the location of the first implantable electrode in the right heart portion and the second implantable electrode in the left heart portion with an external tracking system includes:

tracking, relative to an electromagnetic reference position, a first location of a first electromagnetic tracking device associated with the first implantable electrode and a second location of a second electromagnetic tracking device associated with the second implantable electrode.

22. The method of claim 12, wherein tracking the location of the first implantable electrode in the right heart portion and the second implantable electrode in the left heart portion with an external tracking system includes:

positioning an excitable reference member at a position relative to the heart;

tracking a first location of a first excitable marker tracking device associated with the first implantable electrode relative to the positioned excitable reference member; and

tracking a second location of a second electromagnetic tracking device associated with the second implantable electrode relative to the positioned excitable reference member.

23. A system to determine motion of a structure in a subject, the system having a first lead electrode operable to be implanted and connected to an implantable medical device, a second lead electrode operable to be implanted and connected to the implantable medical device, and at least two pair of axis electrodes operable to inject two axes of current into the subject, the system further comprising:

a processor operable to execute instructions to;

determine a position of the first electrode and the second electrode based on a determined impedance with the first electrode and the second electrode;

selecting a unit vector;

project the determined positions of the first electrode and the second electrode onto the selected unit vector; and

determine a trend of positions over time of the first electrode and the second electrode for illustration relative to the selected unit vector; and

a display device to display the determined trend of positions on the selected unit vector over time including a first icon representing a trace of positions of the first electrode over time and a second icon representing a trace of positions of the second electrode over time;

wherein the first icon and the second icon are operable to be viewed to determine synchrony of movement of the structure in the subject.

24. The system of claim 23, further comprising:

the first lead electrode having a first lead extending therefrom;

the second lead electrode having a second lead extending from;

an implantable medical device having a first connection to connect to the first lead and a second connection to connect to the second lead;

a third electrode for reference relative to the first lead electrode and the second lead electrode;

wherein the implantable medical device is operable to inject a current into the structure of the subject through the first and second lead electrodes.

25. The system of claim 24, further comprising:

a pacing analyzer operable to apply pacing parameters to the structure with the first lead electrode and the second lead electrode prior to connection to the implantable medical device.