MXPA06002404A - Method and device for visually supporting an electrophysiology catheter application in the heart - Google Patents

Abstract

The invention relates to a method and a device for visually supporting an electrophysiology catheter application in the heart, whereby electroanatomical 3D mapping data of an area of the heart to be treated which are provided during performance of the catheter application are visualized. Before the catheter application is carried out, 3D image data of the area to be treated are recorded by means of a tomogrophical 3D imaging method, a 3D surface profile of objects in the area to be treated is extracted from the 3D image data by segmentation and the electroanatomical 3D mapping data provided and the 3D images representing the 3D surface profile are associated with each other in the correct position and dimension relative each other and e.g. visualized in an superimposed manner during the catheter application. The present method and the corresponding device allow for an improved orientation of the user who carries out an electrophysiology catheter application in the heart.

Description

PROCEDURE AND DEVICE FOR THE VISUAL ASSISTANCE OF THE ELECTROPHISIOLOGICAL USE OF A CATHETER IN THE HEART FIELD OF THE INVENTION The present invention relates to a method and a device for the visual assistance of the electrophysiological use of a catheter in the heart, in which during the use of the catheter 3D electroanatomically processed data maps of an area of the heart are visualized. heart under treatment. BACKGROUND OF THE INVENTION The treatment of heart rhythm problems has been transformed in an essential manner since the introduction of the catheter ablation technique by means of high frequency current. In this technique, under a radiographic control, an ablation catheter is introduced into a cardiac chamber through veins or arteries and by means of current at high frequency the tissue that produces the problems in the heart rhythm is roughened. The conditions for the successful performance of catheter ablation is the exact location of the origin of the problem in the heart rhythm within the cardiac chamber. This location is performed through an electrophysiological study, in which electrical potentials are detected with a mapping catheter introduced into the cardiac chamber. From this electrophysiological study, called electroanatomical mapping, we obtain 3D mapping data, which can be visualized in a monitor. The mapping function and the ablation function therefore in many cases are unified in a catheter, such that the mapping catheter simultaneously is an ablation catheter. A known electroanatomical 3D mapping procedure, such as that carried out with the Carto-System of the firm Biosense Webster Inc., USA, is based on electromagnetic principles. Under the study table three different variable magnetic fields are formed with a low intensity. By means of the electromagnetic sensors integrated in the tips of the mapping catheter it is possible to measure the variations in tension induced by the movements of the catheter within the magnetic field and with the help of mathematical algorithms calculate at that moment the position of the mapping catheter. By making punctual contact with the endocardial contour of a heart chamber with the mapping catheter with the simultaneous detection of the electrical signals, an electroanatomical three-dimensional map is formed, in which the electrical signals are represented with color codes. The operator orientation required for the introduction of the catheter up to now has been done by means of fluoroscopic visualization. Since the position of the mapping catheter is always known in the case of electroanatomical mapping, with this technique after the detection of a sufficiently large number of measuring points the orientation can also be realized by means of the continuous representation of the tip of the catheter on the electroanatomical map, so that in this case the technique of fluoroscopic imaging can be omitted by means of X-rays. The operator orientation possibilities that are not optimal until now represent a basic problem during the performance of the catheter ablation within the heart. A more accurate representation of the morphological environment during the introduction of the catheter on the one hand raises the accuracy of catheter ablation and on the other hand also reduces the time for performing electroanatomical mapping. In addition, in many cases the X-ray radiation still necessary for electroanatomical mapping could be reduced or avoided and with this the dose of X-rays applied can also be reduced. To improve the orientation of the operator during the introduction of the catheter, different techniques are known. In one technique a special catheter is used with an ultrasound measuring head, for example that offered by the Siemens AG Medical Solutions under the name Acunav. Through the capture by means of ultrasound of the environment as well as that part of the catheter can be visualized in real time parts of the tissue that are to be cut together with the catheter. The use of this type of catheter in any case does not provide information in three-dimensional images. Ultrasound imaging can therefore only be used to, for example, use a catheter called Lasso in the orifice of the pulmonary vein. After the placement of the Lasso catheter, tissue detachment around the orifice of a pulmonary vein can be performed under the visualization of both the Lasso catheter and the X-ray ablation catheter. In the case of another known technique, a catheter is placed. Lasso in the orifice of the pulmonary vein without the assistance of a 2D ultrasound technique with pulmonary vein imaging, for which a contrast medium is applied through the left atrium in the area of the catheter introduced through the orifice of the pulmonary vein by means of X-ray illumination. The contrast medium is distributed leaving a small part with the blood flow through the pulmonary vein. This brief visualization of the pulmonary vein allows the placement of the Lasso catheter in the hole. The ablation with the catheter can then be carried out with one of the aforementioned techniques. Furthermore, it is known in the art that the orifice of the pulmonary vein is located by means of the electroanatomical mapes of the left atrium and of the pulmonary veins, for which the mapping catheter is first introduced into a pulmonary vein and then it is removed until electrical activity is detected in the atrium. This position corresponds to the position of the orifice of the pulmonary vein, around which the desired tissue should be exposed. SUMMARY OF THE INVENTION The task of the present invention is to provide a method and a device for the visual assistance of the use of an electrophysiological catheter in the heart, which makes possible a better orientation during the introduction of the catheter during its use, especially during electroanatomical mapping and / or during catheter ablation. The task of the present invention is thus solved with a device according to claims 1 and 16. Advantageous embodiments of the method as well as the device are the objects of the subclaims or may be derived from the following description as well as from the examples of realization. In the present procedure for the visual assistance of the electrophysiological use of a catheter in the heart, especially for ablation with the catheter, before the use of the catheter, data are first taken in 3D images of the area to be treated by means of the training procedure. of tomographic 3D images. With 3D image data by means of segmentation, a 3D surface profile of the objects, especially one or more cardiac chambers or vessels, is extracted in the area to be treated. The 3D image data that make up the 3D surface profile, which are then designated as the 3D image data, are assigned to the electro-anatomical 3D mapping data processed during the use of the catheter with respect to the correct position and dimension. . The 3D mapping data and at least the data of selected 3D images, preferably during the use of the catheter, are visualized superimposed on each other in a representation with correct position and dimension. By means of this superposition of the 3D surface profile, with which the morphology reproduces very well the zone that is going to be treated or that was treated, with the electroanatomical 3D mapping data obtained during the use of the catheter, the catheter operator during the use of the catheter has a better orientation and can obtain more exact details than in the case of the procedures known up to now for visual assistance. The representation of superimposed images can for example be performed on a monitor in a control or work area. On the monitor the operator during the use of the catheter, can recognize the anatomical tissues and their electrophysiological properties in a real-time representation. This makes a safer and more precise work possible.

To obtain the 3D image data, for example, the procedures of X-ray computed tomography, magnetic resonance tomography or 3D ultrasound imaging can be used. Obviously, combinations of these imaging methods are also possible. Mainly, it should be taken into account that 3D images are taken in the same cardiac phase as processed electroanatomical 3D map data, in order to capture the same state of the heart each time. This can be guaranteed with the known technique of EKG-gating during the acquisition of image data as well as electroanatomical mapping data. For the segmentation of the obtained 3D image data different techniques can be used. Thus, the three-dimensional surface profile of the objects obtained in 3D data images, especially the vessels and / or one or more cardiac chambers, can be carried out, for example, by segmenting all the 2D layers obtained with the imaging procedure. In addition to this layered segmentation, 3D segmentation of one or more cameras and / or cases is also possible. Suitable segmentation techniques are known to the person skilled in the field of image processing of clinical image data. The correct assignment of dimension and position of the electroanatomical 3D mapping data and of the selected 3D image data can be done by means of different techniques. One possibility is to record between the data by means of visual adjustment of the extracted 3D surface profile to the representation of the electroanatomical 3D mapping data. In addition, synthetic markers or natural marker points that are recognizable in both data sets can be used. In addition, it is possible that the important point during the recording of the data is in the vicinity of the tissue to be trimmed, then also called target tissue, or also at the tip of the catheter. In an advantageous embodiment of the method as well as of the device, the recording is carried out either in a first stage in which only a small part of the electroanatomical 3D mapping data is counted, with the aid of synthetic markers or with marker points or in one or several subsequent stages, in which a large number of electroanatomical 3D mapping data are available, by means of surface adjustment. In this way, the registration during the use of the catheter is improved with a greater number of electoanatomical 3D mapping data. With the overlaying of the 3D image data with the electroanatomical 3D mapping data, the representation of the 3D image data can be performed by means of a volume transformation technique. In another additional embodiment, the 3D surface profile is represented by means of a polygonal network, such as is known in the field of computer graphics. The overlap can be made with an adjustable transparency and with an adjustable attenuation factor. Endoscopic perspectives can also be calculated and represented. Since the electroanatomical 3D mapping data also contains the momentary position of the catheter tip, the position of the catheter in real time can also be temporarily visualized primarily in the representation of the 3D image data without representing the other 3D mapping data. In addition, thanks to the registration between the 3D mapping data and the 3D image data, the separation of the catheter to the desired image points of the 3D image data can be calculated. This makes possible an advantageous embodiment of the present method, in which the tip of the catheter in the visualization appears colored, the color changing depending on the separation of the determined image points, especially the position of the ob ective tissue. The present device for performing the method includes at least one or several input interfaces for the electroanatomical 3D mapping data and the 3D image data obtained by means of the image producing tomographic process. The device has a segmentation module to segment the 3D image data, to extract the 3D surface profile of the objects, which are inside the volume obtained with the 3D image data. A registration module is attached to the segmentation module, which is shaped for the assignment of the correct position and dimension of the electroanatomical 3D mapping data and the selected 3D image data. To this registration module is in turn linked a display module, which superimposes the 3D mapping data and the 3D image data selected relative to the correct position and dimension for visualization with an appropriate apparatus, especially a monitor or projector.

The individual modules of the device have different conformations corresponding to the realization of the different embodiments of the method. BRIEF DESCRIPTION OF THE FIGURE The present method as well as the corresponding device will again be described in detail with the help of Figure 1. Figure 1 shows the individual steps of the embodiment of the present method or the individual modules of the corresponding device. DESCRIPTION OF THE INVENTION In a first step 1 in the present procedure the obtaining of the data of 3D images of the area that is going to receive the treatment, especially the cardiac chamber that is going to receive the treatment, is carried out. By obtaining such 3D image data a larger part of the heart can be included for later registration. The obtaining of the 3D image data is carried out with a procedure for the tomographic formation of 3D images, such as for example X-ray computed tomography, magnetic resonance tomography or 3D ultrasound techniques. During the acquisition of 3D image data, care must be taken that the image data is obtained for the same cardiac phase, in which the electroanatomical 3D mapping data is subsequently processed. This can be ensured with the known technique of EKG-gating during the acquisition of image data as well as electroanatomical mapping data, for example by taking as a reference a percentage value of the RR interval or a fixed period of time before or after the peak R. In the case of performing the procedure, it is important to obtain high-resolution cardiac camera image data, which are electroanatomically measured during the use of the catheter. Therefore, preferably for obtaining the 3D image data, a contrast medium is used in conjunction with a test bolus or a bolus follow-up. In the second stage, segmentation 2 of the 3D image data is performed to extract the 3D surface profile of the vessels and cardiac chambers therein contained. This segmentation is required on the one hand for the subsequent representation of the surface profile of these objectives in the representation of superimposed images and on the other hand in an advantageous mode of the procedure for the assignment with the correct position and dimension to the 3D mapping data. Segmentation is performed in the segmentation module 11 of the present device 10. That segmentation module 11 contains the 3D image data obtained through a corresponding input interface 14. In the same way, the 3D mapping data are usually conducted continuously to the device 10 through the same or another interface 15 during the use of the electrophysiological catheter. Electrophysiological procedures are usually performed in one of the cardiac chambers. Under the term cardiac chambers, both the ventricles and the atria are understood below. In addition to the camera that is going to receive the treatment, it is possible to electroanatomically measure other chambers or vessels, such as the right atrium and the cow vein for pulmonary vein catheter ablation in the left atrium. In this case the mapping data 3D electroanatomics encompass one or more cameras and / or cardiac vessels. The segmentation of the 3D image data can in the same way be applied to one or several cameras and / or cardiac vessels, such as the vena cava or the pulmonary veins, to obtain joint surfaces through which the data can be represented. of electroanatomical 3D mapping. For recording by means of surface adjustment, however, it is not necessary to segment the entire surface, for example, of the cardiac chamber to be treated. For this it is sufficient to obtain, by means of some superficial points, a representation of the surface of an area of interest of the camera, for example the left atrium or the interesting parts of the cardiac vessels, for example the pulmonary veins, with which the superficial adjustment can be made for the record. On the other hand it may be advantageous, however, to include a wide area in the register, especially the other cardiac chambers or vessels. The segmentation of the cardiac chamber that will receive the treatment, or other cardiac chambers or vessels, can be carried out in the form of a 2D segmentation of the individual layers. One possibility is to perform a fully automatic segmentation of all the layers of the cardiac chamber obtained by means of the imaging procedure. Alternatively, one or more layers can also be segmented interactively by means of an operator and the subsequent layers can be automatically segmented based on the knowledge of the previously segmented layers. The interactive segmentation of individual layers can also be supported by semi-automatic techniques, such as the technique of active contours. After the segmentation of all the individual layers, the 3D surface profile of the cardiac chamber can then be reconstructed. Segmentation can also be performed as 3D segmentation of the cardiac chamber subjected to treatment or other cardiac chambers or vessels, by means of known 3D segmentation techniques. Examples of these 3D segmentation techniques are the threshold value technique or the region growth technique. In the event that these fully automatic 3D segmentation algorithms in some individual cases do not work reliably, then the possibility of interactive data entry for the operator may be included, for example to previously indicate for example gray or gray threshold values. space blockers.

The 3D surface profile obtained from the segmentation of the objects is conducted to the registration module 12, where the correct position and dimension of the 3D image data or of the data obtained from the 3D surface profile is assigned to the data. of 3D mapping produced in stage 3. 3D mapping data is obtained through a mapping catheter, which by means of a 6D position sensor integrated in the tip of the catheter produces 3D coordinates of the surface points of the camera cardiac to treat. This type of catheter is known from the prior art for catheter ablation or for electroanatomical mapping. For this the catheter is introduced by the operator through the veins or arteries in the cardiac chamber in question. The conduction of the catheter as well as the obtaining of the 3D mapping data do not form part of the present procedure. During catheter ablation or electroanatomical measurement of the cardiac chamber to treat the mapping data, more surface points are added with the transperfil of time. These superficial points are used for the reconstruction of the morphological structure of the camera, this is for its visualization. In this way, with the electroanatomical 3D mapping data, with the transperfil of time an increasingly detailed image of the cardiac chamber to be treated is formed. Here also before performing catheter ablation, it is possible to obtain and reconstruct the complete anatomical surfaces of other chambers and vessels, for example the right atrium with the vena cava in the case of a catheter ablation in the pulmonary vein orifice . These electroanatomical 3D mapping data are processed before the realization and ablation with a catheter and can contribute to the subsequent registration. In the registration step 4 in the registration module 12 in addition to the assignment depending on the position, an adjustment of the dimensions of the 3D image data and the 3D mapping data is also performed. This is required to obtain a best match of the image data 3D of the cardiac chamber and its surface in the same orientation, scale and shape with the corresponding visualization of the cardiac chamber of the 3D mapping data. For this, a transformation of 3D image data or 3D mapping data is usually necessary, which may include three degrees of freedom of translation, three degrees of freedom of rotation, three degrees of freedom on the scale and / or a number of vectors for deformation. In a first mode, registration can be made by means of visual adjustments. For this, an operator modifies the visualization data until the position, orientation, scale and / or shape of the represented camera coincide in both representations, this is based on the 3D image data and based on the 3D mapping data. . Visual adjustment can be done through an appropriate graphical user interface 9. In addition, artificial markers can be used for registration. Thus, in an embodiment prior to obtaining the 3D image data, artificial markers can be fixed on the patient's chest. These markers remain fixed in the same position, throughout the subsequent use of the catheter. At least three of those markers are required to obtain the correct registration, this is the assignment of the image data to the mapping data. For this, markers must be used, which are recognized in the 3D image data and can also be identified by means of the position sensor of the mapping system. Another modality envisages using global anatomical markers for the record, ie natural marker points of the area to be treated or of the surrounding area. These marker points should be identifiable in the 3D image data and preferably activated with the mapping catheter using a fluoroscopic imaging technique. These types of marker points are, for example, the orifices of the superior and inferior vena cava or the coronary sinus. The marker points can then be automatically detected in the 3D image data as well as in the 3D mapping data, so that the correct position assignment and dimension of that data can be calculated. Additionally, registration between the position of the mapping catheter and the 3D image data can be performed through markers or marker points.

By means of this registration it is possible to visualize the position of the mapping catheter within the 3D image data. Another advantageous possibility for recording the 3D image data and the 3D mapping data consists of the automatic adjustment of the surfaces formed on the basis of this data. In the case of the segmentation of the cardiac chamber that is going to be subjected to the treatment, an automatic adjustment of the extracted 3D surface contour of the cardiac chamber can be made to the superficial contour obtained by means of the 3D mapping data. In the case of variations in the shape of the surface contours obtained from the 3D image data and the 3D mapping data, to improve the mutual adjustment, deforming adjustment algorithms on the surface contour can be used from the data of 3D image or on the surface contour from the 3D mapping data. The surface adjustment can be done, for example, by minimizing the point distances between the surface points of the mapping data and the surface points of the 3D surface contour extracted from the 3D image data (point-to-point adjustment). Alternatively, the adjustment can also be carried out by means of the minimization of point distances between surface points of the mapping data and the interpolated surface points of the 3D image data (point-to-surface adjustment). In order to perform the surface adjustment, a good surface representation of the cardiac chamber that is going to receive the treatment, or 3D mapping data, is required. Since these data are usually collected regularly over a long period of time, this is at the beginning of catheter ablation, only few 3D mapping data are available, preferably a multi-stage registration process is performed. Here it is carried out in a first initial stage, the registration through markers. The accuracy of the registration is then improved in the profile of the process by means of the adjustment of surfaces in a second stage. Obviously, also by means of the increasing number of mapping points, other steps of the surface adjustment can be carried out, whereby a further improvement of the accuracy is eventually possible. This multistage recording is advantageous since the registration by means of the adjustment of surfaces with a correspondingly good surface representation is more accurate than the registration by means of anatomical marker points or by means of synthetic markers, however a good surface representation however, it is obtained only afterwards in the subsequent profile of the procedure. In the first initial stage, a combination of the registration by means of markers and the registration by means of surface adjustment can also be performed. For example, the registration of the left atrium can be carried out by means of the superficial adjustment of a vascular surface, for example of the pulmonary artery, and additionally with the help of right anatomical marker points of the atrium, for example the coronary sinus or the orifice of the atrium. vena cava inferior or vena cava superior. Another possibility for recording by means of the surface adjustment consists of using for the adjustment the surface of the chamber to be treated, but the surface of another chamber, which was already measured electroanalytically before the beginning of the use of the catheter. This can be, for example, the right atrium, which was previously measured with an isolation of the pulmonary vein (PVI) from the left atrium. The measurement here obviously must be done with a sufficient number of surface points. The resulting adjustment parameters for those chambers can then be used for the data obtained during ablation with the catheter. In the previous exemplary embodiments, the surface adjustment was carried out as a point-to-point or point-to-surface adjustment, since the catheter ablation procedure is performed in certain smaller areas of the chamber to be treated, the superficial adjustment in these areas of interest due to the high density of the mapping points produces more precise results than in the case of the other areas of the chamber that will be treated. By means of a greater weighting of the superficial points, which are within the areas of interest, for example around the pulmonary veins in the case of a PVI, a better spatial adjustment is obtained in that area than in the other areas of the cardiac chamber. The area of interest can be determined, for example, by means of a corresponding entry given by the operator in a graphical user interface. In addition to these anatomically interesting areas, superficial points can also be taken into account in the immediate areas of the moving catheter or its known position, in order to carry out the local superficial adjustment. The higher weight of these points results in a better local fit around the tip of the catheter than in the other areas of the chamber to be treated. This procedure, however, requires a real-time recording during the use of the catheter, in order to continuously update the surface fit during the movement of the catheter.

After recording between the 3D mapping data and the 3D image data in step 5 in the display module 13, the overlap with correct position and dimension for displaying the superimposed data is performed. With the dotted arrow it is shown in figure 1 the possibility of refining the registration or overlap during ablation with the catheter by means of a multi-stage process, as previously indicated. For superimposed visualization, which for example can be performed on a monitor 6, different techniques can be used. Thus, in one embodiment, the 3D image data or the cardiac chamber to be treated can be visualized by means of a volume transformation technique (VRT).

The image data displayed with the volume transformation technique can be superimposed on the 3D mapping data set, which shows both the electrical activity exerted locally and also the momentary position of the catheter. The transparency of both partial images, that is the partial image of the 3D image data and the partial image of the 3D mapping data, can be modified by an operator as well as the attenuation factor of the superposition, to obtain the visualization adequate anatomy, electrophysiology or simultaneously both properties. Since the visualization of the 3D mapping data contains the visualization of the position and orientation of the mapping catheter, it is also possible to superimpose the 3D image data temporally on the representation of the position and orientation of the mapping catheter. In another embodiment, the surface extracted from the 3D image data can be displayed as a shaded surface or by means of a triangulation in the form of a polygonal network. The polygonal network is represented together with the 3D mapping data, to simultaneously visualize the anatomy represented by the polygonal network and the electrophysiology represented by the 3D mapping data. Also in this case it is possible to temporarily represent only the position and orientation of the mapping catheter together with the surface of the polygonal network represented. In another modality, with the obtained data an endoscopic perspective can be calculated and visualized by means of the superposition of the anatomical image data and the electrophysiological 3D mapping data. By means of this endoscopic perspective, from the angle of view of the tip of the catheter, the catheter can be guided by the operator equally to the corresponding anatomical or electrophysiological positions, for example in the orifice of the pulmonary vein. In addition, the obtained data can be used to visualize the distance of the tip of the catheter to predetermined areas. Since during the registration between the 3D mapping data and the 3D image data or when recording the position of the mapping catheter and the 3D image data a spatial relationship between the mapping catheter and the 3D image data is obtained, calculate the distance from the tip of the catheter to the predetermined image points of the 3D image at any time. By means of this registration it is possible to show the mapping catheter during the representation of the 3D image data, also without showing the electrophysiological data, and simultaneously to indicate the aforementioned distance. Thus, for example, the distance from the tip of the catheter to the target tissue can be visualized in real time, for example. The visualization can be carried out, for example, by color representation of the catheter with a color code for the distance. This possibility of the representation of the catheter can be used for the planning and control of ablation processes. In addition, due to the registration between the mapping catheter and the 3D images it is also possible to store the position of the stitched points together with the image data. The stored positions can be used for documentation purposes as well as for the planning and control of the subsequent ablation processes.

Claims (16)

1. NOVELTY OF THE INVENTION Having described the invention as above, property is claimed as contained in the following: CLAIMS 1. A procedure for the visual assistance of the use of an electrophysiological catheter in the heart, in which during the use of the catheter are visualized the electroanatomical 3D mapping data already obtained from an area of the heart that is going to receive the treatment, with a tomographic 3D imaging procedure before the use of the catheter, 3D image data of a body region containing the area that goes to receive the treatment, with the 3D image data then by means of segmentation the 3D surface profile of the objects in the area to be treated is extracted and the 3D mapping data and the selected 3D image data are assigned to the position and the correct dimension, and are displayed simultaneously superimposed on each other, characterized in that in a stage of the registration it is automatically performs the assignment of the correct position and dimension by means of surface adjustment, for which the 3D surface profile of the 3D image data is coincided at least partially with the 3D surface profile of the 3D mapping data.
2. 2. The method according to claim 1, characterized in that the 3D image data of the area to be treated are obtained with a computed tomography procedure by X-ray or magnetic resonance tomography.
3. 3. The method according to claim 1, characterized in that the 3D image data of the body region are obtained with a 3D ultrasound procedure.
4. 4. The method according to claims 1 to 3, characterized in that the assignment of the correct position and dimension is performed automatically in a first stage during the use of the catheter with the aid of anatomical marker points or synthetic markers and in a second stage. Later stage is refined by means of surface adjustment. The method according to one of claims 1 to 4, characterized in that the visualization of the 3D image data is carried out by means of a volume transformation technique. The method according to one of claims 1 to 4, characterized in that the visualization of the 3D surface profile of the 3D image data takes place in the form of a polygonal network. The method according to one of claims 1 to 6, characterized in that the overlap is carried out with an adjustable transparency and attenuation factor. The method according to one of claims 1 to 7, characterized in that a registration is made between a used catheter and the "3D image data and at least in the representation of at least the 3D image data forming the profile. of the 3D surface at least one part of the catheter is visualized in real time 9. The method according to claim 8, characterized in that the visualization of at least one part of the catheter is performed temporarily without overlaying the 3D mapping data. The method according to claim 8 or 9, characterized in that the momentary distance of a catheter tip to a predetermined image point of the 3D image data is calculated and the distance is represented coded in the display. The method according to claim 10, characterized in that the distance is represented by means of color coding of the display of the catheter 12. A device for performing the method according to one of the preceding claims, characterized in that it has - one or several input interfaces for the electroanatomical 3D mapping data and for the 3D image data, - a segmentation module which is formed for segmentation of the 3D image data, to extract a 3D surface profile of the objects that are inside a volume obtained with the 3D image data, - a registration module linked to the segmentation module which is formed for the automatic assignment of the correct position and dimension of the electroanatomical 3D mapping data and of the 3D image data forming the 3D surface profile, by means of the adjustment Surface 3D surface profile of the 3D image data with a 3D surface profile of the 3D mapping data in at least one stage of the registration, and - a display module attached to the registration module, which overlaps with the correct position and dimension , the 3D mapping data with at least the 3D image data forming the 3D surface profile with and processed for viewing in an apparatus for the presentation of images. The device according to claim 12, characterized in that the registration module is formed for the automatic assignment with the correct position and dimension in a multi-stage process, in which in the first stage the allocation of the correct position and dimension with the help of anatomical marker points or artificial markers and in a subsequent second stage is refined by means of surface adjustment in which the 3D surface profile of the 3D data images fits the 3D surface profile of the data of 3D mapping. The device according to claim 12 or 13, characterized in that the display module is shaped to display in real time a part of the catheter used within the representation of the 3D image data forming the 3D surface profile. The device according to claim 14, characterized in that a calculation module is provided which calculates the momentary distance of the tip of a catheter to a predetermined image point of the 3D image data, and the display module is conformed for the real-time coded representation of the calculated distance. The device according to claim 15, characterized in that the display module is shaped for color visualization of a catheter part, wherein the colors vary depending on the calculated distance.