Apparatus and method for cardiac ablation

• US 6,522,905 B2
• Filed: 08/06/2001
• Issued: 02/18/2003
• Est. Priority Date: 03/11/1993
• Status: Expired due to Fees

• Current Assignee: Catheffects, Inc.
• Original Assignee: Jawahar M. Desai
• Inventors: Desai, Jawahar M.
• Primary Examiner(s): Jastrzab, Jeffrey R.
• Application Number:
  US09/923,869
• Publication Number:
  US 20020010392A1
• Time in Patent Office: 561 Days
• Field of Search: 606/41, 600/373-375, 600/515, 600/518, 600/523, 600/525, 607/115, 607/116, 607/119, 607/122, 607/125-128, 607/9, 607/14
• US Class Current: 600/374
• 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 5/287 Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
• CPC Class Codes: A61B 5/6858 with a distal basket, e.g. expandable basket
• CPC Class Codes: A61B 5/743 Displaying an image simultaneously with additional graphical information, e.g. symbols, charts, function plots
• CPC Class Codes: A61B 6/464 involving a plurality of displays
• CPC Class Codes: A61B 6/5235 combining images from the same or different ionising radiation imaging techniques, e.g. PET and CT

Abstract

A system and method for cardiac mapping and ablation include a multi-electrode catheter introduced percutaneously into a subject'"'"'s heart and deployable adjacent to various endocardial sites. The electrodes are connectable to a mapping unit, an ablation power unit a pacing unit, all of which are under computer control. Intracardiac electrogram signals emanated from a tachycardia site of origin are detectable by the electrodes. Their arrival times are processed to generate various visual maps to provide real-time guidance for steering the catheter to the tachycardia site of origin. In another aspect, the system also include a physical imaging system which is capable of providing different imaged physical views of the catheter and the heart. These physical views are incorporated into the various visual maps to provide a more physical representation. once the electrodes are on top of the tachycardia site of origin, electrical energy is supplied by the ablation power unit to effect ablation.

Claims

1. A cardiac catheterization system for operation on an endocardium of a subject'"'"'s heart, comprising:

a cluster of electrodes disposable by a catheter about the endocardium site-by-site;

each electrode detecting intracardiac electrogram signals including that emanating from a tachycardia site of origin;

a storage for storing the detected intracardiac electorgram signals accumulated site-by-site;

a computer to derive from each said detected intracardiac electrogram signals an arrival time thereof and to form a map based on the arrival times derived from existing detected sites; and

means for interactively displaying said map, said map including locations of existing detected sites and a current location of said cluster of electrodes, whereby those electrodes being closer to the tachycardia site of origin than others will be in a region of said map having earlier arrival times than others, and electrodes that are substantially coincident with the tachycardia site of origin will be in a region of said map having an earliest possible arrival time, thereby said map providing guidance for moving said cluster of electrodes towards the region having earlier arrival times.

2. A cardiac catheterization system as in claim 1, further comprising:

a power supply switchably supplying power to at least one of said cluster of electrodes when said at least one of said cluster of electrodes is placed substantially coincident with the tachycardia site of origin to ablate there at.

3. A cardiac catheterization system as in claim 2, wherein said power supply supplies radio frequency power of different phases to different electrodes among said cluster of electrodes.

4. A cardiac catheterization system as in claim 1, further comprising:

a physical imager displaying at least one view of a physical image of said cluster of electrodes relative to the heart.

5. A cardiac catheterization system as in claims 4, further comprising:

means for synthesizing said map with said at least one view from said physical imager to produce at least one synthesized video display showing at least one view of said physical image of said cluster of electrodes relative to the heart and an estimated tachycardia site of origin, thereby providing direct visual guidance for steering the cluster of electrodes to the tachycardia site of origin.

6. A cardiac catheterization system as in any one of claims 1-5, wherein said computer further computes contours of equal arrival time or isochrones;

and

said map includes isochrones computed from arrival times derived from existing detected sites.

7. A cardiac catheterization system as in any one of claims 1-5, wherein

said map further includes an interactive track of said cluster of electrodes as it scans along a path on the endocardium.

8. A cardiac catheterization system for operation on an endocardium of a subject'"'"'s heart, comprising:

a cluster of electrodes disposable by a catheter about the endocardium site-by-site;

each electrode detecting intracardiac electrogram signals including that emanating from a tachycardia site of origin;

means for storing the detected intracardiac electorgram signals accumulated site-by-site;

means for deriving from each said detected intracardiac electrogram signals an arrival time thereof and to form a map based on the arrival times derived from existing detected sites; and

means for interactively displaying said map, said map including locations of existing detected sites and a current location of said cluster of electrodes, whereby those electrodes being closer to the tachycardia site of origin than others will be in a region of said map having earlier arrival times than others, and electrodes that are substantially coincident with the tachycardia site of origin will be in a region of said map having an earliest possible arrival time, thereby said map providing guidance for moving said cluster of electrodes towards the region having earlier arrival times.

9. A method of cardiac catheterization for operation on an endocardium of a subject'"'"'s heart, comprising:

disposing a cluster of electrodes of a catheter about the endocardium site-by-site;

each electrode detecting intracardiac electrogram signals including that emanating from a tachycardia site of origin;

storing the detected intracardiac electorgram signals accumulated site-by-site;

deriving from each said detected intracardiac electrogram signals an arrival time thereof and to form a map based on the arrival times derived from existing detected sites; and

interactively displaying said map, said map including locations of existing detected sites and a current location of said cluster of electrodes, whereby those electrodes being closer to the tachycardia site of origin than others will be in a region of said map having earlier arrival times than others, and electrodes that are substantially coincident with the tachycardia site of origin will be in a region of said map having an earliest possible arrival time, thereby said map providing guidance for moving said cluster of electrodes towards the region having earlier arrival times.

10. A method of cardiac catheterization as in claim 9, further comprising:

supplying power to at least one of said cluster of electrodes when said at least one of said cluster of electrodes is placed substantially coincident with the tachycardia site of origin to ablate there at.

11. A method of cardiac catheterization as in claim 10, wherein said power is in the form of radio frequency power of different phases being supplied to different electrodes among said cluster of electrodes.

12. A method of cardiac catheterization as in claim 9, further comprising:

physically imaging and displaying at least one view of a physical image of said cluster of electrodes relative to the heart.

13. A method of cardiac catheterization as in claim 12, further comprising:

synthesizing said map with said at least one view from said physical imager to produce at least one synthesized video display showing at least one view of said physical image of said cluster of electrodes relative to the heart and an estimated tachycardia site of origin, thereby providing direct visual guidance for steering the cluster of electrodes to the tachycardia site of origin.

14. A method of cardiac catheterization as in any one of claims 9-13, further comprising:

computing contours of equal arrival time or isochrones; and

displaying said map with said isochrones computed from arrival times derived from existing detected sites.

15. A method of cardiac catheterization as in any one of claims 9-13, further comprising:

displaying said map with an interactive track as said cluster of electrodes is scanning along a path on the endocardium.