|Publication number||US7613499 B2|
|Application number||US 11/392,035|
|Publication date||Nov 3, 2009|
|Filing date||Mar 29, 2006|
|Priority date||Mar 30, 2005|
|Also published as||DE102005014854A1, US20060241421|
|Publication number||11392035, 392035, US 7613499 B2, US 7613499B2, US-B2-7613499, US7613499 B2, US7613499B2|
|Inventors||Norbert Rahn, Arne Westphal|
|Original Assignee||Siemens Aktiengesellschaft|
|Export Citation||BiBTeX, EndNote, RefMan|
|Patent Citations (17), Classifications (13), Legal Events (2)|
|External Links: USPTO, USPTO Assignment, Espacenet|
This application claims priority to the German Application No. 10 2005 014 854.9, filed Mar. 30, 2005 which is incorporated by reference herein in its entirety.
The invention relates to a method for providing measuring data for the precise local positioning of an operation catheter, in particular an ablation catheter.
An ablation catheter used with the operation concerning the heart serves to ablate tissue from the interior wall of the heart with the purpose of ablating (isolating) atrioventricular channels on the interior wall of the heart. The aim here is to remedy a medical condition relating to the functionality of the heart. This includes cardiac arrhythmias. One problem with different arrhythmias, for example with the AV Nodal Reentry Tachycardia, is that the abnormal area of the heart must be located, i.e. the best area for an ablation must be determined.
Two catheters are used for this, namely the operation catheter and the reference catheter. The reference catheter remains fixed. In specific chamber regions of the heart, the operation catheter is guided to different positions. In each position, signals of an electrophysiological potential curve are recorded by the operation catheter. This is set in each instance in relation to a potential measurement on the reference catheter. In particular, a temporal offset is determined between the reference catheter and the operation catheter. In other words, it is determined how to propagate signals in the heart. A signal can first be determined in the reference catheter and can then appear in the electrophysiological potential curve, which is recorded by the operation catheter. As corresponding signals repeatedly appear in the same manner, the same signal forms can be detected for the plurality of positions of the operation catheter. To determine the best area for an ablation, the site at which the earliest signal appears must be found, because the signal originates from the abnormal area. It regularly happens that said site of the earliest stimulation propagation has already been left, until it transpires that this is the site of the earliest stimulation propagation.
The problem for electrophysiologists who record the electrophysiological potential curves is therefore to deliver the catheter to an area where it has already previously been and for which the electrophysiological potentials have been recorded. On the basis of the potential curves, he has hitherto been able to orientate himself in the space, which however can lead to long examination times.
In order to support the electrophysiologist, a measuring method can also be used in a three-dimensional space. By way of example, the Carto positioning system by the company Biosense-Webster also uses an electromagnetic field, in which catheters equipped with coils are moved. The catheter position is indicated three-dimensionally in the virtual space on an additional workstation pertaining to the system. The complete system is very complex and expensive. The electrophysiologist must acquire an additional system. He can only use special and expensive catheters. In particular, catheters priced at approximately 2,500 euros each must be employed for single use.
It is an object of the invention to reliably but also cost-effectively assist the user (the electrophysiologist) with the precise local positioning of an operation catheter, in particular an ablation catheter.
The invention is based on the fact that nowadays, in every electrophysiological operation which executes ablations, an x-ray fluoroscopy system exists for the heart catheter, in addition to electrophysiological registration system. In accordance with the invention, an x-ray image is also recorded in each of the positions in which an electrophysiological potential curve is recorded. In the x-ray image, the operation catheter can be at least partially recognized. The position of the operation catheter can in each instance then be identified on the x-ray image by a marker.
The special feature of the invention is that the data from the electrophysiological potential curves is assigned to the markers, i.e. the data is ‘interlinked’. This allows an associated electrophysiological potential curve to be queried when the marker is activated on a screen displaying the x-ray image, and/or conversely allows the x-ray image with the marker to be queried when the potential curve is activated on a screen displaying the potential curve.
The simplest method of activation is to click using a computer mouse (or a similar means such as a touchpad for instance), and the querying preferably results in a display on a screen. Potential curves and x-ray images are thus currently queried at the same time. Two screens thus exist, with the data being coupled to other data on the screen (interlinked). It would also be possible to display a part of the data in a screen segment, for instance, to show the electrophysiological potential curves in a segment on the x-ray screen.
With an alternative of the invention, the marker is set by an operator, preferably by clicking on a screen displaying the x-ray image.
Since the operation catheter has an easily recognizable form, e.g. a tip which can be recognized on an x-ray image, the marker can also be automatically set according to another alternative, with the aid of an image recognition system.
A plurality of different potential curves exists if the catheter passes through a plurality of positions. To facilitate the display of the data-related coupling, the different potential curves can be displayed in different colors, and the associated markers correspondingly displayed in the same color on the screen. Alternatively to the colors, specific forms of line comprising dashes or dashes and dots are possible, butcolors can be recognized particularly quickly.
A color coding is preferably carried out as a function of a delay time of a signal from the potential curve compared with a reference signal in the reference catheter. As already mentioned above, this delay time allows the ideal site for the ablation to be determined. If a large delay time is now displayed for instance in dark blue and a very short delay time in red, a whole spectrum of colors from blue to red can be seen on the associated x-ray image, whereby when the color red is approached, the ideal site for the ablation is approached.
The data settings of the x-ray system, which serves to record the x-ray image, ideally remain the same throughout the whole time. The x-ray images can thus be superimposed on each other and the markers can be set in one individual image. The operation catheter is subsequently moved into the position meant for the ablation and an x-ray image is repeatedly recorded there. The electrophysiologist now examines whether this is the position which corresponds to the short delay time, e.g. an area marked with red, and thus knows whether the target point has been reached. If necessary, the operation catheter is moved a little again and a further x-ray image is recorded.
It can occasionally be necessary or advantageous to modify the data settings of the x-ray system while the ablation catheter is passing through the plurality of positions. Correspondingly, a number of x-ray images exist with the associated markers, with the corresponding x-ray image the being displayed after a respective potential curve has been activated (clicked-on) on the corresponding screen.
With a preferred embodiment, the data settings of the x-ray system are also indicated when the potential curve is activated. With a particularly preferred embodiment, the data settings on the x-ray system are recorded again when the potential curve is activated, for instance a repeated activation or activation using the right mouse button. By way of example, the C-arm of an x-ray angiography system can move into a specific position so as to repeat the recorded x-ray image. This enables the electrophysiologist to deliver the ablation catheter into the optimal position, after recording the different potential curves in the different positions, because the original recording situation, which has resulted in the x-ray image with the marker, is repeated.
The invention also relates to an x-ray recording system. This is connected to a registration system for recording electrophysiological potential curves via a data line, in particular a network link, such that it can exchange data with said registration system.
In an associated image processing system, the data from the x-ray recording system and the registration system can be coupled. In particular the x-ray recording system and the registration system are synchronized for instance via a network clock, so that the assignment of the data to one another is facilitated or even simply enabled.
The x-ray recording system is preferably an x-ray angiography system.
A preferred embodiment of the invention is now described with reference to the drawing, in which:
When recording the curves 10, 12, 14, 16 and 18, the electrophysiologist or an automatic system has set the markers 110, 112, 114, 116 and 118. The analysis of the electrophysiological potential curves 10 12, 14, 16 and 18 has now shown that the site 114 is best suited to an ablation. The potential curve 14 is thus marked in red (characterized here by a widening of the line) and the associated cross 114 is likewise marked in red. The other potential curves 10, 12, 16 and 18 can also be marked in color, as a function for instance of the time delay. The curve 10 could then be marked in yellow, the curve 18 in green and the curve 12 in blue. Accordingly, the crosses in
Further curves can be queried in the right of the screen 250 in
A precise data-related assignment of the electrophysiological potential curves 10, 12, 14, 16 and 18 to corresponding markers 110, 112, 114, 116 and 118 on an x-ray image and a data-related coupling allows the data to be alternately queried between the two images displayed in
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|U.S. Classification||600/426, 600/424, 600/427, 600/509|
|Cooperative Classification||A61B5/042, A61B6/12, A61B18/1492, A61B2018/00351, A61B5/06, A61B5/7445|
|European Classification||A61B5/74D10, A61B5/042|
|Mar 29, 2006||AS||Assignment|
Owner name: SIEMENS AKTIENGESELLSCHAFT, GERMANY
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:RAHN, NORBERT;WESTPHAL, ARNE;REEL/FRAME:017702/0205
Effective date: 20060321
|Mar 7, 2013||FPAY||Fee payment|
Year of fee payment: 4