Interference blocking and frequency selection

• US 8,843,189 B2
• Filed: 04/14/2009
• Issued: 09/23/2014
• Est. Priority Date: 04/18/2008
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Markowitz, H. Toby, Karamanoglu, Mustafa, Mehta, Pooja, Fleming, Ioana, Scanlon, David A., Kryger, Michael, Campbell-Massa, Sean, Giese, Chad, Waldhauser, Steven L., Zhang, Shangqian Peter, Jannicke, Jeff, Falkner, Phillip, Hefner, Don, Warman, Eduardo N., Steeves, James, Receveur, Rogier, Michels, Koen, Eick, Olaf, Larik, Vincent
• Primary Examiner(s): Koharski, Christopher D
• Assistant Examiner(s): KIMBALL, JEREMIAH T
• Application Number:
  US12/423,487
• Publication Number:
  US 20090264743A1
• Time in Patent Office: 1,988 Days
• Field of Search: 607/523
• US Class Current: 600/374
• CPC Class Codes: A61B 2017/00022 Sensing or detecting at the treatment site
• 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 2017/00243 cardiac
• CPC Class Codes: A61B 2017/00336 with a protective sleeve, e.g. retractable or slidable
• CPC Class Codes: A61B 2017/22051 with an inflatable part, e.g. balloon, for positioning, blocking, or immobilisation A61B2017/22048, A61B2017/3486 take precedence
• CPC Class Codes: A61B 2034/105 Modelling of the patient, e.g. for ligaments or bones
• CPC Class Codes: A61B 2090/376 using X-rays, e.g. fluoroscopy
• CPC Class Codes: A61B 2090/378 using ultrasound
• CPC Class Codes: A61B 2090/3983 Reference marker arrangements for use with image guided surgery
• 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 5/05 Detecting, measuring or recording for diagnosis by means of electric currents or magnetic fields; Measuring using microwaves or radio waves impedance plethysmography A61B5/0295; measuring movement of the entire body or parts thereof A61B5/11; detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof A61B5/24
• CPC Class Codes: A61B 5/053 Measuring electrical impedance or conductance of a portion of the body
• CPC Class Codes: A61B 5/0538 invasively, e.g. using a catheter
• 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 5/061 Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body A61B1/00158 takes precedence
• CPC Class Codes: A61B 5/062 using magnetic field
• CPC Class Codes: A61B 5/063 using impedance measurements
• CPC Class Codes: A61B 5/066 : Superposing sensor position on an image of the patient, e.g. obtained by ultrasound or x-ray imaging
• CPC Class Codes: A61B 5/287 : Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
• CPC Class Codes: A61B 5/304 : Switching circuits
• CPC Class Codes: A61B 5/333 : Recording apparatus specially adapted therefor
• CPC Class Codes: A61B 5/339 : Displays specially adapted therefor
• CPC Class Codes: A61B 5/742 : using visual displays A61B5/339 takes precedence
• 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 8/4472 : Wireless probes

Abstract

A volume of a patient can be mapped with a system operable to identify a plurality of locations and save a plurality of locations of a mapping instrument. The mapping instrument can include one or more electrodes that can sense a voltage that can be correlated to a three dimensional location of the electrode at the time of the sensing or measurement. Therefore, a map of a volume can be determined based upon the sensing of the plurality of points without the use of other imaging devices. An implantable medical device can then be navigated relative to the mapping data.

Claims

1. A method of determining a position of an instrument in a patient, comprising:

moving the instrument into a volume of the patient;

determining a position of a position element only with a position sensing system, including;

providing a set of axis generation electrodes on an exterior surface of the patient establishing an axis and a conductive path therebetween;

selecting a first frequency for injection of a current into the patient between the axis generation electrodes;

injecting an axis current into the patient at the selected first frequency between the set of axis generation electrodes and generating a voltage gradient between the set of axis generation electrodes; and

evaluating an electrical property including sensing a voltage at the position element between the set of axis generation electrodes;

determining a position of the position element based at least on the sensed voltage along the voltage gradient between the set of axis generation electrodes;

measuring for an anomalous current frequency within the patient at a frequency other than the selected first frequency;

determining if the measured anomalous current frequency is an interfering frequency; and

changing the selected first frequency to a selected second frequency for injection of the axis current between the axis generation electrodes if it is determined that the measured anomalous current frequency is an interfering frequency.

2. The method of claim 1, further comprising:

collecting a plurality of map data points based on the determining a position of the position element at a plurality of positions;

wherein measuring for the anomalous current frequency within the patient at a frequency other than the selected first frequency and determining if the anomalous current frequency is an interfering frequency is performed prior to the collecting of the plurality of map data points.

3. The method of claim 1, further comprising:

marking as invalid the determined position of the position element if the anomalous current frequency is determined to be the interfering frequency.

4. The method of claim 1, further comprising:

measuring for an anomalous current frequency within the patient at a frequency other than the selected second frequency;

determining if the measured anomalous current frequency is an interfering frequency with the selected second frequency; and

changing the selected second frequency to another selected frequency for injection of the axis current between the axis generation electrodes if it is determined that the anomalous frequency is the interfering frequency.

5. The method of claim 1, wherein measuring for an anomalous current frequency within the patient at a frequency other than the selected first frequency is performed periodically during a procedure including determining the position of the position element.

6. The method of claim 5, wherein injecting an axis current into the patient is periodically stopped prior to periodically measuring for an anomalous current frequency within the patient at a frequency other than the selected first frequency during determining the position of the position element with only the position sensing system.

7. The method of claim 6, further comprising:

automatically restarting injecting the axis generation current into the patient based on a determination of no anomalous current frequency or that the measured anomalous current frequency is not the interfering frequency.

8. The method of claim 6, wherein changing the selected first frequency to the selected second frequency includes automatically changing the selected first frequency to the selected second frequency in a manner transparent to a user if it is determined that the measured anomalous frequency is the interfering frequency.

9. The method of claim 8, further comprising:

automatically restarting injecting the axis generation current into the patient after changing the selected first frequency to the selected second frequency in a manner transparent to the user based on a determination that the measured frequency is the interfering frequency.

10. The method of claim 1, wherein changing the selected first frequency to a selected second frequency for injection of the axis current between the axis generation electrodes includes:

determining if the measured anomalous current frequency can be removed if it is determined that the measured anomalous current frequency is the interfering frequency; and

changing the selected first frequency to the selected second frequency for injection of the axis current between the axis generation electrodes if it is determined that the measured anomalous current frequency is the interfering frequency and that the measured anomalous current frequency cannot be removed.

11. The method of claim 1, wherein measuring for an anomalous current frequency within the patient includes measuring with the position element for an anomalous current frequency at a frequency other than the selected first frequency.

12. The method of claim 1, wherein moving the instrument into a volume of the patient includes moving the instrument into a volume of a heart of the patient.

18. The method claim 1, further comprising:

tracking a position of the position element in a volume;

collecting positions of the position element;

determining a validity of the collected positions;

generating a map based on the collected positions;

displaying the map on a display device;

measuring a rhythmic feature of a volume;

wherein tracking the position element, includes at least one of;

selecting between a uni-polar and bi-polar collection of positions;

inflating a portion of the instrument;

fixing a location of the position element having a first position element relative to a second position element;

moving a flexible member with the first position element relative to the second position element at a fixed position and measuring the position of the first member position element relative to the second position element;

measuring a temperature within the volume at least one of the position element, the first position element, and the second position element; and

displaying on a display device at least one of;

a corrected map data generated by reducing distortion of a measured position of the instrument by determining a scaling factor between two position elements of the instrument;

a pseudo location of an axis electrode relative to the map;

a location of a reference electrode relative to the map;

a location of a feature determined by generating a filled volume and determining curvilinear portions to be displayed relative to the filled volume with the instrument;

a map point determined by generating a virtual point based on a known position of a physical portion of the instrument relative to the position element of the instrument;

the map based on locations categorized relative to the measured rhythmic feature;

a virtual map data point determined based on a geometry of the instrument relative to the position element; and

a location of an introducer through which the instrument or the procedure instrument is passed.

13. A method of determining a position of an instrument in a patient, comprising:

moving the instrument with a position element into a volume of a heart of the patient;

determining a position of the instrument using only a position sensing system, including;

injecting current at a selected amperage into the patient at a selected first frequency and generating a voltage in the patient; and

sensing the voltage with the position element and determining a position of the instrument based on the sensed voltage;

determining if there is an anomalous current at an anomalous amperage within the patient at an anomalous frequency that is interfering with the selected first frequency; and

changing the selected first frequency to a selected second frequency if it is determined that the anomalous current is interfering with the selected first frequency.

14. The method of claim 13, further comprising:

determining a plurality of map data points based on determining a position of the instrument at a plurality of positions;

displaying the plurality of map data points on a display device; and

determining if the map data points are valid at least based on the determination if the anomalous frequency is interfering with the selected first frequency.

15. The method of claim 13, wherein determining the anomalous frequency is interfering with the selected first frequency is performed prior to determining the position of the instrument using only the position sensing system.

16. The method of claim 13, wherein determining if there is the anomalous current at the anomalous amperage within the patient at the anomalous frequency that is interfering with the selected first frequency is performed periodically during a procedure including determining the position of the instrument.

17. The method of claim 13, wherein injecting current into the patient is periodically stopped in a manner transparent to a user prior to the determining if there is the anomalous current at the anomalous amperage within the patient at the anomalous frequency that is interfering with the selected first frequency;

and

wherein injecting current into the patient is restarted in a manner transparent to the user after one of determining that there is not the anomalous frequency that is interfering with the selected first frequency, and changing the selected first frequency to a selected second frequency based on a determination that there is the anomalous frequency that is interfering with the selected first frequency.

19. A system for determining a position of a device in a patient comprising:

an instrument having a portion arranged to be inserted into a volume of a heart of the patient;

a position element affixed to an exterior surface of the portion of the instrument arranged to be inserted into the volume, the position element arranged to sense an electrical property in the volume;

a position sensing unit having a set of axis generation electrodes for injecting current at a selected first frequency into the patient, the axis generation electrodes adapted to be positioned on an outer surface of the patient and establish an axis via a conductive path through the patient, the injected current generating a voltage gradient in the patient between the set of electrodes; and

a processor coupled to the position sensing unit, the position element and a display device, the processor operable to execute instructions to determine the position of the position element using only the position sensing unit and the position element, and to determine if an anomalous current at an anomalous frequency is present within the patient at an anomalous frequency other than the selected first frequency that is an interfering frequency.

20. The system of claim 19, wherein the position element comprises an electrode arranged to sense a voltage in the volume.

21. The system of claim 20, wherein the processor is operable to determine a plurality of positions of the electrode based on instructing the electrode to sense voltage at a plurality of positions along the voltage gradient;

and

wherein the processor is operable to generate a plurality of map data points based on the plurality of determined positions, and to display the plurality of map data points on the display device.

22. The system of claim 21, wherein the processor is operable to determine if there is the anomalous current within the patient using the position element prior to determining the plurality of positions of the electrode.

23. The system of claim 20, wherein the processor is operable to automatically change the selected first frequency to a selected second frequency in a manner transparent to a user based on a determination that the anomalous current at the anomalous frequency that is the interfering frequency.

24. The system of claim 20, wherein the processor is operable to periodically determine if there is the anomalous current at the anomalous frequency within the patient that is the interfering frequency at least by instructing the position sensing unit to periodically stop injecting current into the volume prior to periodically determining if there is the anomalous current at the anomalous frequency within the patient that is the interfering frequency.

25. The system of claim 24, wherein the processor is operable to automatically restart injecting current into the volume in a manner transparent to the patient after a determination that there is not the anomalous current at the anomalous frequency within the patient that is the interfering frequency.

26. The system of claim 19, wherein the processor is operable to mark as invalid a determined position of the position element based on determining that the anomalous current at the anomalous frequency is the interfering frequency;

and

wherein the processor is operable to display the determined position of the position element and a graphical representation indicative of the determined position being invalid on the display device.

27. The system of claim 19, further comprising:

the instrument further includes at least one of;

an inflatable portion;

at least two electrodes as the position element;

a guidewire operable to be positioned through a cannula;

a plurality of the position elements along a length of the instrument; and

a temperature sensor;

a display device operable to display a map based at least on the determined position of the instrument;

a display processor operable to augment the map on the display device, wherein the display processor is operable to at least one of;

determine a position of the position element that is positioned to sense a voltage formed in the volume;

determine a position of an input impedance reference electrode and display it on the display device relative to the map; and

determine a pseudo position of the axis electrodes on the display device relative to the map;

a physiological measuring device;

an introducer operable to be located with the processor;

a reference electrode at a fixed position on a surface of the volume and a location of the reference electrode is operable to be determined with the processor; and

a procedure instrument with a second position element operable to be located relative to the map;

wherein a map of a volume is displayed on the display device for visualization by a user based solely on determined positions of one or more of the position elements.