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WO2017001912A1 - Système et procédé pour fournir une représentation d'état de charge de cellule cardiaque - Google Patents

Système et procédé pour fournir une représentation d'état de charge de cellule cardiaque Download PDF

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Publication number
WO2017001912A1
WO2017001912A1 PCT/IB2016/000929 IB2016000929W WO2017001912A1 WO 2017001912 A1 WO2017001912 A1 WO 2017001912A1 IB 2016000929 W IB2016000929 W IB 2016000929W WO 2017001912 A1 WO2017001912 A1 WO 2017001912A1
Authority
WO
WIPO (PCT)
Prior art keywords
catheter
cardiac
charge state
electrodes
cell charge
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/IB2016/000929
Other languages
English (en)
Inventor
Reto WILDHABER
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Swissnovation GmbH
Original Assignee
Swissnovation GmbH
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Swissnovation GmbH filed Critical Swissnovation GmbH
Publication of WO2017001912A1 publication Critical patent/WO2017001912A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/06—Devices, other than using radiation, for detecting or locating foreign bodies ; Determining position of diagnostic devices within or on the body of the patient
    • A61B5/061—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
    • A61B5/063—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 using impedance measurements
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H50/00—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics
    • G16H50/50—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics for simulation or modelling of medical disorders
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/25—Bioelectric electrodes therefor
    • A61B5/279—Bioelectric electrodes therefor specially adapted for particular uses
    • A61B5/28—Bioelectric electrodes therefor specially adapted for particular uses for electrocardiography [ECG]
    • A61B5/283—Invasive
    • A61B5/285—Endotracheal, oesophageal or gastric probes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/68—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient
    • A61B5/6846—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive
    • A61B5/6847—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive mounted on an invasive device
    • A61B5/6852—Catheters
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B2560/00—Constructional details of operational features of apparatus; Accessories for medical measuring apparatus
    • A61B2560/02—Operational features
    • A61B2560/0223—Operational features of calibration, e.g. protocols for calibrating sensors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B2562/00—Details of sensors; Constructional details of sensor housings or probes; Accessories for sensors
    • A61B2562/04—Arrangements of multiple sensors of the same type
    • A61B2562/043—Arrangements of multiple sensors of the same type in a linear array
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/316—Modalities, i.e. specific diagnostic methods
    • A61B5/318—Heart-related electrical modalities, e.g. electrocardiography [ECG]
    • A61B5/327—Generation of artificial ECG signals based on measured signals, e.g. to compensate for missing leads
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/316—Modalities, i.e. specific diagnostic methods
    • A61B5/318—Heart-related electrical modalities, e.g. electrocardiography [ECG]
    • A61B5/346—Analysis of electrocardiograms
    • A61B5/349—Detecting specific parameters of the electrocardiograph cycle
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/74—Details of notification to user or communication with user or patient; User input means
    • A61B5/742—Details of notification to user or communication with user or patient; User input means using visual displays
    • A61B5/743—Displaying an image simultaneously with additional graphical information, e.g. symbols, charts, function plots

Definitions

  • This invention relates generally to the field of heart rhythm disorders and more specifically to a system and method thereof for providing a representation of cardiac cell charge state.
  • An accurate registration of a cardiac de-/repolarization sequence often does simplify and speed up the diagnostics in human medicine.
  • By visually comparing ECG signals based on a patient's heart electrical activity correlations can be drawn with cardiac de- /repolarization sequence representing that electrical activity. Having such physiological data from patient, it is a common method to detect known diseases or irregularities of the patients heart.
  • the standard ECG is a very simple, ubiquitous method and hence a very widely spread system or tool. It gives a good, but very compressed overview of the cardiac depolarization and repolarization sequence.
  • Gold Standard is set by the transcutaneous measurement with an intracardiac catheter directly placed on the myocardium of interest, which is a complex, costly and invasive method and is often related to risks, e.g. such as bleeding, thromboembolism, stroke, etc. to name a few.
  • an ECG of the heart comprising said tissue, obtaining a model of the heart geometry, obtaining a model of the torso geometry and relating the measurements per electrode or sensor of the ECG to the heart and torso geometry and estimating the distribution, fluctuation and/or movement of electrical activity through heart tissue based upon a fastest route algorithm, shortest path algorithm and/or fast marching algorithm.
  • a system for providing a representation of dynamic cardiac cell charge state comprises a sensor unit for receiving cardiac potential data, further comprises a sensor data acquisition module for acquiring and providing saidj ardiac potential data to a cardiac cell charge state estimation module of the system, wherein said estimation module generates an estimation of the cardiac cell charge state, and wherein that sensor unit is realised as an esophageal ECG catheter.
  • An esophageal catheter generally is comprising multiple electrodes with a known geometry and alignment.
  • Such a catheter is placed in the esophagus and used to record the electrical cardiac signal potentials observable in the esophagus. Inserting an esophageal catheter is a very minimally invasive and very low risk method, comparable to the insertion of a common feeding tube. With a subsequent model based processing, a representative of the current charge state is gained. This obtained current charge state is then either presented as is or further mapped to anatomical cardiac structures and displayed graphically.
  • Esophageal electrodes are much closer to the myocardium, and in particular to the atrium, than standard skin electrodes and therefore the influence, attenuation and distortion due to the various tissues and tissue borders (such as lungs, fat and others) is reduced. Thereby the influence of the inter-individual differences in torso and cardiac anatomy and geometry are reduced and the analysis with predefined models is sufficient to already provide useful information about the dynamic cardiac charge state to the physician.
  • the estimation module continuously applies estimation data sets from a cardiac cell charge state model.
  • an esophageal catheter electrode arrangement for an ECG catheter wherein said catheter has two or more electrodes, wherein at least one electrode is configured as ring electrode and at that the catheter further comprises a set arrangement of electrodes, preferably realised as rings or ring segments, more preferably realised as point- or pinhead-shaped electrodes, wherein said set arrangement of electrodes is spatial, to receive spatial cardiac potential data.
  • One of the advantages of the invention is, that the configuration of all electrodes (ring and non-ring electrodes) must be arranged on the catheter in such a way, that the vectors of the cardiac potentials, which are measured between any two electrodes, are covering all three dimensions of the space.
  • Fig. 1 shows schematic block diagram of the cardiac cell polarization-state analysing system
  • Fig. 2 shows a detail of an insertion member of an ECG catheter with a ring-formed electrode and with a triple-segment electrode configuration
  • Fig. 3 shows yet another detail of an electrode configuration for an ECG catheter with a set of multiple ring and triple-segment electrodes
  • Fig. 4 showing the placement of surface electrodes for rotation tracking.
  • Figure 1 illustrates a schematic block diagram of the cardiac cell polarization-state analysing system.
  • an electro-catheter 107 of the system 1 is inserted into the esophagus of a patient.
  • Said catheter 107 has one or more electrodes 109 in an electrode arrangement 108.
  • the electrodes can not only be configured as rings, but also as spatial arranged electrode contacts or plates.
  • the electrodes 109 are arranged on an insertion member 1070 of the catheter 107.
  • the placement of the catheter into the esophagus is a well-known procedure and can be performed a low risks.
  • the insertion member 1070 is preferably configured as thin tube and can be inserted through the mouth or nose without causing bleeding and partly even without anaesthesia (anaesthetic or narcosis).
  • cardiac potential data needs to be obtained by means of an sensor unit 107, 109 of a representation system 1.
  • Said sensor unit 107, 109 preferably is an esophageal electrode ECG catheter 107.
  • ECG catheter 107 For providing a multi-dimensional representation of dynamic cardiac cell charge state, e.g. a triple-segment electrode configuration (reference numeral 1091 in figure 2) is required. Two or three dimensions representation are possible. These electrodes need to be configured in a spatial arranged.
  • said probed cardiac potential data will be further processed using a cardiac cell charge state estimation module 20 of the system 1.
  • Said estimation module acts as filter by and walking through a set of cardiac cell charge states and by trying to best-fit them to said cardiac potential data.
  • Said estimated or mapped best-fit data will be generated as an estimation data set or estimation of cardiac cell charge state 200.
  • the estimation data set is also understood as estimation of myocardial cell charge state.
  • Reference numeral 21 indicates model parameters.
  • a cardiac cell charge state model 22 or cardiac cell charge state dataset can be used as knowledge base to perform the estimation using said cardiac cell charge state estimation module 20.
  • An anatomical mapping module 40 and a graphical representation module 41 will perform a graphical representation recording 400 according to the estimation-data set 200.
  • a charge state change indicator (arrow) 401 shows the depolarisation-front, or any surrogate for it, currently represented in the graphical representation recording 400.
  • a time index indicator or arrow 402 shows the current position in the cardiac potential waveform resp. eECG.
  • a multichannel esophageal electrocardiogram (eECG) recording, plot or waveform is referenced with numeral 110.
  • a first, second and third cardiac potential waveform are referenced with numerals 1101, 1102 and 1103. These waveforms correspond with the respective cardiac potentials measured using the eECG catheter.
  • the system consists of a calibration unit to provide a modulated electrical current to external skin electrodes, whereby said current is being measured on the esophageal catheter electrodes and provided to the data acquisition module, wherein said data acquisition module generates an electrode position data set using said measured current, while based on said electrode position data set the position and orientation of the catheter in relation to the torso can be identified.
  • Said calibration unit is an optional configuration.
  • FIG. 2 illustrates a detailed view of an insertion member 1070 of an esophageal ECG catheter with a ring-formed electrode 1090 and with a triple-segment electrode configuration 1091.
  • said novel electrode arrangement allows data acquisition based on which cardiac potential data a three-dimensional reconstruction of representation of dynamic cardiac cell charge state is possible.
  • Figure 3 illustrates an electrode configuration where electrodes are arranged as single 1090 or grouped ring- or non-ring electrodes 1091 along and around the insertion member of the catheter. Said insertion member is not visualised in figure 3.
  • Non-ring electrodes only cover a well-defined angle of the circumference of the catheter.
  • the total of all electrodes (ring and non-ring electrodes) must be arranged on the catheter in such a way, that the vectors of the cardiac potentials, which are measured between any two electrodes, are covering all three dimensions of the space.
  • esophageal catheters enable to retrieve cardiac potentials via the esophageal mucosa.
  • eECG signals reveal a local view of the cardiac electrical activity and enable to perform a spatial and temporal analysis.
  • multiple ring electrodes or non-ring electrodes or both are lined-up onto a catheter tube.
  • eECG signals reveal an improved resolution, particularly in the atrial signal parts compared to a standard surface ECG.
  • the anatomical proximity of esophagus and myocardium allows to record local myocardial fields and opens the field for analysis of local cardiac activity with a limited number of electrodes.
  • esophageal catheter with multiple either ring or non-ring electrodes or any combination of both. Recording the electrical potential at each electrode simultaneously and with an appropriate sampling frequency and time resolution, temporal and spatial localization of myocardial electrical activity, or any surrogate of it, becomes reachable.
  • the localization preciseness depends among others on the quantity and arrangement of the electrodes, the recording quality and sampling rate. In contrast to standard ECG signals recorded with surface (skin) electrodes, eECG signals do not or only marginally have to pass (or bypass) lung, fat or other high impedance tissues.
  • Reference numeral 107 indicates the esophageal electrode catheter or sensor unit.
  • a catheter electrodes or electrode arrangement is numerated with 108.
  • a single catheter electrode is referenced with numeral 109.
  • a group of electrodes is referenced with numeral 108.
  • Typical ring electrodes are referenced with 1090.
  • non-ring electrodes, ring segment, point- or pinhead-shaped electrodes are indicated with reference numeral 1091.
  • the esophageal catheter electrode arrangement for an ECG catheter 107 has two or more electrodes 109, wherein the catheter comprises a set arrangement of electrodes 1091, wherein said set arrangement of electrodes 1091 is spatial, to receive spatial cardiac potential data.
  • said set arrangement of electrodes 1091 is preferably realised as ring segments, more preferably realised as point- or pinhead-shaped electrodes ruviiwu fe o / u u u j * -
  • At least one electrode is configured as ring electrode 1090.
  • Figure 4 illustrates the placement of surface electrodes for rotation tracking.
  • the positive electrode centrally on the sternum (+), the negative electrode on thoracic vertebra Th6 (-).
  • the angle coding herein is defined as follows using position and angle: ventral (0°), left (90°), dorsal (180°) and right (270°).
  • the described system consists of a calibration unit to provide a modulated electrical current to external skin electrodes, whereby said current is being measured on the esophageal catheter electrodes and provided to the data acquisition module, wherein said data acquisition module generates an electrode position data set using said measured current, while based on said electrode position data set the position and orientation of the catheter in relation to the torso T can be identified.
  • a tracking signal is injected via two surface Ag/AgCI electrodes, the positive electrode - identified with the character "+" - centrally on the sternum, the negative on the spine on vertebra Th6 - identified with the character Both lines of the electrodes are protected with resistors, limiting the injection current.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Medical Informatics (AREA)
  • Public Health (AREA)
  • General Health & Medical Sciences (AREA)
  • Biomedical Technology (AREA)
  • Pathology (AREA)
  • Molecular Biology (AREA)
  • Surgery (AREA)
  • Veterinary Medicine (AREA)
  • Physics & Mathematics (AREA)
  • Animal Behavior & Ethology (AREA)
  • Biophysics (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Databases & Information Systems (AREA)
  • Data Mining & Analysis (AREA)
  • Epidemiology (AREA)
  • Primary Health Care (AREA)
  • Pulmonology (AREA)
  • Cardiology (AREA)
  • Human Computer Interaction (AREA)
  • Measurement And Recording Of Electrical Phenomena And Electrical Characteristics Of The Living Body (AREA)

Abstract

L'invention concerne un système (1) pour fournir une représentation d'état de charge de cellule cardiaque dynamique, comprenant une unité capteur (107, 109) pour recevoir des données de potentiel cardiaque, comprenant en outre un module d'acquisition de données de capteur (10) pour acquérir et fournir lesdites données de potentiel cardiaque à un module d'estimation d'état de charge de cellule cardiaque (20) du système (1), ledit module d'estimation (20) générant une estimation (200) de l'état de charge de cellule cardiaque, ladite unité capteur (107) étant réalisée sous la forme d'un cathéter ECG œsophagien.
PCT/IB2016/000929 2015-07-02 2016-06-30 Système et procédé pour fournir une représentation d'état de charge de cellule cardiaque Ceased WO2017001912A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
CH9612015 2015-07-02
CH00961/15 2015-07-02

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WO2017001912A1 true WO2017001912A1 (fr) 2017-01-05

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Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP3476286A1 (fr) 2017-10-24 2019-05-01 Berner Fachhochschule Appareil permettant de fournir des informations électrocardiographiques et en particulier sur l'arythmie

Citations (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2000003637A1 (fr) * 1998-07-16 2000-01-27 Universite De Montreal Sonde electromyographique depourvue de perturbations
US20020038093A1 (en) * 2000-03-15 2002-03-28 Mark Potse Continuous localization and guided treatment of cardiac arrhythmias
US20040059237A1 (en) * 2002-09-19 2004-03-25 Narayan Sanjiv Mathur Method and apparatus for classifying and localizing heart arrhythmias
US20060229594A1 (en) * 2000-01-19 2006-10-12 Medtronic, Inc. Method for guiding a medical device
EP1897490A2 (fr) * 2006-09-06 2008-03-12 Biosense Webster, Inc. Corrélation de cartes électriques cardiaques avec des mesures de la surface corporelle
WO2010151130A1 (fr) 2009-06-24 2010-12-29 Cortius Holding B.V. Imagerie inverse de l'activité électrique d'un muscle cardiaque
US20110276046A1 (en) * 2010-05-05 2011-11-10 Heimbecher Reed R Monitoring, Managing and/or Protecting System and Method for Non-Targeted Tissue
US20130066193A1 (en) * 2011-09-13 2013-03-14 Eric S. Olson Catheter navigation using impedance and magnetic field measurements

Patent Citations (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2000003637A1 (fr) * 1998-07-16 2000-01-27 Universite De Montreal Sonde electromyographique depourvue de perturbations
US20060229594A1 (en) * 2000-01-19 2006-10-12 Medtronic, Inc. Method for guiding a medical device
US20020038093A1 (en) * 2000-03-15 2002-03-28 Mark Potse Continuous localization and guided treatment of cardiac arrhythmias
US20040059237A1 (en) * 2002-09-19 2004-03-25 Narayan Sanjiv Mathur Method and apparatus for classifying and localizing heart arrhythmias
EP1897490A2 (fr) * 2006-09-06 2008-03-12 Biosense Webster, Inc. Corrélation de cartes électriques cardiaques avec des mesures de la surface corporelle
WO2010151130A1 (fr) 2009-06-24 2010-12-29 Cortius Holding B.V. Imagerie inverse de l'activité électrique d'un muscle cardiaque
US20110276046A1 (en) * 2010-05-05 2011-11-10 Heimbecher Reed R Monitoring, Managing and/or Protecting System and Method for Non-Targeted Tissue
US20130066193A1 (en) * 2011-09-13 2013-03-14 Eric S. Olson Catheter navigation using impedance and magnetic field measurements

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP3476286A1 (fr) 2017-10-24 2019-05-01 Berner Fachhochschule Appareil permettant de fournir des informations électrocardiographiques et en particulier sur l'arythmie
US12016693B2 (en) 2017-10-24 2024-06-25 Berner Fachhochschule, Technik Und Informatik Apparatus for providing electrocardiogramand arrhythmia information

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