阅读说明：本技术 心内心电图呈现 (Intracardiac electrocardiogram presentation ) 是由 S·欧柏 S·戈德堡 O·巴伦 于 2020-09-24 设计创作，主要内容包括：本发明题为“心内心电图呈现”。在一个实施方案中,提供了一种医疗系统,该医疗系统包括：导管,导管将被插入到活体受检者的心脏的腔室中并且包括用于在心脏的腔室内的相应位置处接触组织的导管电极；显示器；以及处理电路,处理电路用于从导管接收信号并且响应于信号：对信号在相应时序值处的相应电压值进行采样；以及将表示由导管电极在相应位置处感测的组织中的电活动的相应心内电描记图(IEGM)呈现条绘制到显示器,IEGM呈现条中的每个IEGM呈现条包括与时序值中的相应时序值相关并且以该时序值中的相应时序值的时间顺序布置的相应形状的线性阵列,相应形状的填充物响应于在时序值中的相应时序值处采样的信号中的相应信号的采样电压值中的相应采样电压值来进行格式化。(The invention is entitled "intracardiac electrocardiographic presentation". In one embodiment, a medical system is provided, the medical system comprising: a catheter to be inserted into a chamber of a heart of a living subject and including catheter electrodes for contacting tissue at respective locations within the chamber of the heart; a display; and processing circuitry for receiving the signal from the catheter and, in response to the signal: sampling respective voltage values of the signal at respective timing values; and plotting to a display respective Intracardiac Electrogram (IEGM) presentation bars representing electrical activity in tissue sensed by the catheter electrode at respective locations, each of the IEGM presentation bars comprising a linear array of respective shapes associated with and arranged in a temporal order of respective ones of the timing values, the fillers of the respective shapes formatted in response to respective ones of the sampled voltage values of the respective ones of the signals sampled at the respective ones of the timing values.)

1. A medical system, comprising:

a catheter configured to be inserted into a chamber of a heart of a living subject and comprising catheter electrodes configured to contact tissue at respective locations within the chamber of the heart;

a display; and

processing circuitry configured to receive a signal from the catheter and, in response to the signal:

sampling respective voltage values of the signal at respective timing values; and is

Drawing to the display respective Intracardiac Electrogram (IEGM) presentation bars representing electrical activity in the tissue sensed by the catheter electrode at the respective locations, each of the IEGM presentation bars comprising a linear array of respective shapes that are related to and arranged in a temporal order of respective ones of the timing values, the respective shaped fillers being formatted in response to respective ones of the sampled voltage values of the respective ones of the signals sampled at the respective ones of the timing values.

2. The system according to claim 1, wherein the processing circuitry is configured to draw the respective IEGM presentation bar to the display, wherein the respective shaped filler is at least partially colored in response to the respective one of the sampled voltage values of the respective one of the signals sampled at the respective one of the timing values.

3. The system according to claim 1, wherein the processing circuitry is configured to plot the respective IEGM presentation bar to the display, wherein a transparency of the filler of the respective shape is adjusted in response to the respective one of the sampled voltage values of the respective one of the signals sampled at the respective one of the timing values.

4. The system of claim 1, wherein the processing circuit is configured to:

deriving a value of an attribute of a respective one of the signals in response to a respective one of the sampled voltage values and a respective one of the timing values, and

drawing a respective IEGM presentation bar to the display, wherein:

the respective shaped fillings are formatted according to a first formatting in response to the respective ones of the sampled voltage values of the respective ones of the signals sampled at respective ones of the timing values, and

the fillings of respective ones of the shapes are also formatted according to a second formatting in response to the derived values.

5. The system of claim 4, wherein the attribute is a rate of change of the sampled voltage values.

6. The system of claim 4, wherein the attribute is a rank of a respective one of the signals.

7. The system of claim 4, wherein the first formatting comprises color formatting and the second formatting comprises transparency formatting.

8. The system of claim 4, wherein the first formatting comprises transparency formatting and the second formatting comprises color formatting.

9. The system according to claim 1, wherein the processing circuitry is configured to draw the respective IEGM presentation bar to the display with at least one additional marker selected from any one of: alphanumeric symbol, another symbol, line, point, time stamp, maximum in current data, pacing spike.

10. A medical method, comprising:

receiving a signal from a catheter configured to be inserted into a chamber of a heart of a living subject and comprising catheter electrodes configured to contact tissue at respective locations within the chamber of the heart;

sampling, in response to the signal, respective voltage values of the signal at respective timing values; and

drawing to a display respective Intracardiac Electrogram (IEGM) presentation bars representing electrical activity in the tissue sensed by the catheter electrode at the respective locations, each of the IEGM presentation bars comprising a linear array of respective shapes that are related to and arranged in a temporal order of respective ones of the timing values, the respective shaped fillers being formatted in response to respective ones of the sampled voltage values of the respective ones of the signals sampled at the respective ones of the timing values.

11. The method of claim 10, wherein the drawing comprises drawing the respective IEGM presentation bar to the display, wherein the respective shaped filler is at least partially colored in response to the respective one of the sampled voltage values of the respective one of the signals sampled at the respective one of the timing values.

12. The method of claim 10, wherein the drawing comprises drawing the respective IEGM presentation bar to the display, wherein transparency of the filler of the respective shape is adjusted in response to the respective one of the sampled voltage values of the respective one of the signals sampled at the respective one of the timing values.

13. The method of claim 10, further comprising deriving values of attributes of respective ones of the signals in response to respective ones of the sampled voltage values and respective ones of the timing values, and wherein the drawing comprises drawing the respective IEGM presentation bar to the display, wherein: the fillings of the respective shapes are formatted according to a first formatting in response to the respective ones of the sampled voltage values of the respective ones of the signals sampled at respective ones of the timing values, and the fillings of respective ones of the shapes are also formatted according to a second formatting in response to derived values.

14. The method of claim 13, wherein the attribute is a rate of change of the sampled voltage values.

15. The method of claim 13, wherein the attribute is a rank of a respective one of the signals.

16. The method of claim 13, wherein the first formatting comprises color formatting and the second formatting comprises transparency formatting.

17. The method of claim 13, wherein the first formatting comprises transparency formatting and the second formatting comprises color formatting.

18. The method according to claim 10, wherein the drawing comprises drawing the respective IEGM presentation bar to the display with at least one additional marker selected from any one of: alphanumeric symbol, another symbol, line, point, time stamp, maximum in current data, pacing spike.

19. A software product comprising a non-transitory computer readable medium having program instructions stored therein, which when read by a Central Processing Unit (CPU) causes the CPU to:

receiving a signal from a catheter configured to be inserted into a chamber of a heart of a living subject and comprising catheter electrodes configured to contact tissue at respective locations within the chamber of the heart;

sampling, in response to the signal, respective voltage values of the signal at respective timing values; and

drawing to a display respective Intracardiac Electrogram (IEGM) presentation bars representing electrical activity in the tissue sensed by the catheter electrode at the respective locations, each of the IEGM presentation bars comprising a linear array of respective shapes that are related to and arranged in a temporal order of respective ones of the timing values, the respective shaped fillers being formatted in response to respective ones of the sampled voltage values of the respective ones of the signals sampled at the respective ones of the timing values.

Technical Field

The present invention relates to medical systems and in particular, but not exclusively, to catheter-based systems.

Background

A number of medical procedures involve the placement of a probe, such as a catheter, within a patient. Position sensing systems have been developed to track such probes. Magnetic position sensing is one method known in the art. In magnetic position sensing, a magnetic field generator is typically placed at a known location outside the patient's body. Magnetic field sensors within the distal end of the probe generate electrical signals in response to these magnetic fields, which are processed to determine the coordinate position of the distal end of the probe. Such methods and systems are described in U.S. Pat. nos. 5,391,199, 6,690,963, 6,484,118, 6,239,724, 6,618,612, and 6,332,089, in PCT international patent publication WO 1996/005768, and in U.S. patent application publications 2002/006455, 2003/0120150, and 2004/0068178. Position may also be tracked using impedance or current based systems.

Arrhythmia treatment surgery is a medical procedure in which these types of probes or catheters have proven extremely useful. Cardiac arrhythmias and in particular atrial fibrillation have been a common and dangerous medical condition, especially in the elderly.

Diagnosis and treatment of cardiac arrhythmias includes mapping electrical properties of cardiac tissue (particularly the endocardium and cardiac volume) and selectively ablating cardiac tissue by applying energy. Such ablation may stop or alter the propagation of unwanted electrical signals from one portion of the heart to another. The ablation method breaks the unwanted electrical path by forming a non-conductive ablation lesion. Various forms of energy delivery for forming lesions have been disclosed and include the use of microwaves, lasers and more commonly radio frequency energy to form conduction blocks along the walls of cardiac tissue. In two-step surgery (mapping followed by ablation), electrical activity at various points within the heart is typically sensed and measured by advancing a catheter containing one or more electrical sensors into the heart and acquiring data at the points. These data are then used to select an endocardial target area to be ablated.

Electrode catheters have been commonly used in medical practice for many years. They are used to stimulate and map electrical activity in the heart, and to ablate sites of abnormal electrical activity. In use, an electrode catheter is inserted into a main vein or artery, such as the femoral artery, and then introduced into the heart chamber of interest. A typical ablation procedure involves inserting a catheter having one or more electrodes at its distal end into a heart chamber. A reference electrode may be provided, typically taped to the patient's skin, or may be provided using a second catheter positioned in or near the heart. RF (radio frequency) current is applied to the tip electrode of the ablation catheter, and the current flows through the surrounding medium (i.e., blood and tissue) to the reference electrode. The distribution of the current depends on the amount of contact of the electrode surface with the tissue compared to blood, which has a higher conductivity than the tissue. Heating of the tissue occurs due to the electrical resistance of the tissue. The tissue is heated sufficiently to cause cell destruction in the heart tissue, resulting in the formation of non-conductive foci within the heart tissue.

Disclosure of Invention

According to an embodiment of the present disclosure, there is provided a medical system including: a catheter configured to be inserted into a chamber of a heart of a living subject and including catheter electrodes configured to contact tissue at respective locations within the chamber of the heart; a display; and processing circuitry configured to receive the signal from the catheter and in response to the signal: sampling respective voltage values of the signal at respective timing values; and plotting to a display respective Intracardiac Electrogram (IEGM) presentation bars representing electrical activity in tissue sensed by the catheter electrode at respective locations, each of the IEGM presentation bars comprising a linear array of respective shapes associated with and arranged in a temporal order of respective ones of the timing values, the fillers of the respective shapes formatted in response to respective ones of the sampled voltage values of the respective ones of the signals sampled at the respective ones of the timing values.

Further, in accordance with an embodiment of the present disclosure, the processing circuit is configured to render the respective IEGM presentation bar to the display, wherein the respective shaped filler is at least partially colored in response to a respective one of the sampled voltage values of the respective one of the signals sampled at the respective one of the timing values.

Further, in accordance with an embodiment of the present disclosure, the processing circuit is configured to plot the respective IEGM presentation bars to the display, wherein the transparency of the respective shaped fillers is adjusted in response to respective ones of the sampled voltage values of the respective ones of the signals sampled at respective ones of the timing values.

Further, in accordance with an embodiment of the present disclosure, the processing circuit is configured to derive a value of the property of a respective one of the signals in response to a respective one of the sampled voltage values and a respective one of the timing values; and rendering the respective IEGM presentation bars to the display, wherein the respective shaped fills are formatted according to the first formatting in response to respective ones of the sampled voltage values of the respective ones of the signals sampled at respective ones of the timing values, and the respective ones of the shapes are also formatted according to the second formatting in response to the derived values.

Further, according to an embodiment of the present disclosure, the attribute is a rate of change of the sampled voltage value.

Further, according to an embodiment of the present disclosure, the attribute is a ranking of respective ones of the signals.

Additionally, according to an embodiment of the present disclosure, the first formatting includes color formatting and the second formatting includes transparency formatting.

Additionally, according to an embodiment of the present disclosure, the first formatting includes transparency formatting and the second formatting includes color formatting.

Further, in accordance with an embodiment of the present disclosure, the processing circuitry is configured to draw to the display a respective IEGM presentation bar having at least one additional indicia selected from any one of: alphanumeric symbol, another symbol, line, point, time stamp, maximum in current data, pacing spike.

There is also provided, in accordance with another embodiment of the present disclosure, a medical method, including receiving a signal from a catheter, the catheter configured to be inserted into a chamber of a heart of a living subject and including catheter electrodes configured to contact tissue at respective locations within the chamber of the heart; sampling, in response to the signal, respective voltage values of the signal at respective timing values; and plotting to a display respective Intracardiac Electrogram (IEGM) presentation bars representing electrical activity in tissue sensed by the catheter electrode at respective locations, each of the IEGM presentation bars comprising a linear array of respective shapes associated with and arranged in a temporal order of respective ones of the timing values, the fillers of the respective shapes formatted in response to respective ones of the sampled voltage values of the respective ones of the signals sampled at the respective ones of the timing values.

Further, in accordance with an embodiment of the present disclosure, the rendering includes rendering a respective IEGM presentation bar to the display, wherein the respective shaped filler is at least partially colored in response to a respective one of the sampled voltage values of the respective one of the signals sampled at the respective one of the timing values.

Additionally, in accordance with an embodiment of the present disclosure, the rendering includes rendering a respective IEGM presentation bar to the display, wherein the transparency of the respective shaped filler is adjusted in response to a respective one of the sampled voltage values of the respective one of the signals sampled at the respective one of the timing values.

Further, in accordance with an embodiment of the present disclosure, the method includes deriving values of attributes of respective ones of the signals in response to respective ones of the sampled voltage values and respective ones of the timing values, and wherein the drawing includes drawing respective IEGM presentation bars to the display, wherein the respective shaped fillers are formatted in accordance with a first formatting in response to respective ones of the sampled voltage values of the respective ones of the signals sampled at the respective ones of the timing values, and the respective ones of the shapes are also formatted in accordance with a second formatting in response to the derived values.

Further, according to an embodiment of the present disclosure, the attribute is a rate of change of the sampled voltage value.

Further, according to an embodiment of the present disclosure, the attribute is a ranking of respective ones of the signals.

Additionally, according to an embodiment of the present disclosure, the first formatting includes color formatting and the second formatting includes transparency formatting.

Additionally, according to an embodiment of the present disclosure, the first formatting includes transparency formatting and the second formatting includes color formatting.

Further, in accordance with an embodiment of the present disclosure, the drawing includes drawing to the display a respective IEGM presentation bar having at least one additional indicia selected from any one of: alphanumeric symbol, another symbol, line, point, time stamp, maximum in current data, pacing spike.

There is also provided, in accordance with another embodiment of the present disclosure, a software product including a non-transitory computer readable medium having program instructions stored therein, which when read by a Central Processing Unit (CPU) causes the CPU to: receiving a signal from a catheter, the catheter configured to be inserted into a chamber of a heart of a living subject and including catheter electrodes configured to contact tissue at respective locations within the chamber of the heart; sampling, in response to the signal, respective voltage values of the signal at respective timing values; and plotting to a display respective Intracardiac Electrogram (IEGM) presentation bars representing electrical activity in tissue sensed by the catheter electrode at respective locations, each of the IEGM presentation bars comprising a linear array of respective shapes associated with and arranged in a temporal order of respective ones of the timing values, the fillers of the respective shapes formatted in response to respective ones of the sampled voltage values of the respective ones of the signals sampled at the respective ones of the timing values.

Drawings

The present invention will be understood from the following detailed description taken in conjunction with the accompanying drawings, in which:

FIG. 1 is a schematic view of a medical surgical system constructed and operative in accordance with an embodiment of the present invention;

FIG. 2 is a schematic view of a catheter used in the system of FIG. 1;

fig. 3 is a schematic illustration of an IEGM trace and IEGM presentation bar prepared by the system of fig. 1;

fig. 4 is a schematic diagram of a plurality of IEGM presentation bars; and is

FIG. 5 is a flow chart including steps in a method of operation of the system of FIG. 1.

Detailed Description

SUMMARY

As mentioned previously, in two-step surgery (mapping followed by ablation), electrical activity at various points in the heart is typically sensed and measured by advancing a catheter containing one or more electrodes into the heart and acquiring data at the points. These data are then used to select a target region to be ablated.

In particular, electrical activity is typically displayed as Intracardiac Electrogram (IEGM) traces for analysis by a physician in order to find the source of the arrhythmia. Catheter electrodes that are not in contact with tissue in the heart typically measure some electrical signals and far-field signals from the heart tissue. When the catheter electrode is in contact with the heart tissue, the voltage value of the signal depends primarily on the tissue conductivity, while the far field is of secondary importance. Therefore, physicians are often interested in analyzing IEGM traces of electrodes in contact with tissue.

For focal catheters with one or two electrodes, a single IEGM trace is typically displayed for analysis by the physician. The physician can quickly determine whether the catheter-electrode providing the signal is in contact with the tissue based on the form of the signal. However, a multi-electrode catheter that simultaneously acquires electrical activity from different tissue locations may provide data for multiple IEGM traces to be simultaneously displayed on a single display. In some cases, the number of IEGM traces may be too large for a physician to easily determine which IEGM traces are provided by electrodes in contact with tissue and which traces are not.

An example of a multi-electrode catheter is produced by Biosense Webster inc. of Irvine, CA, USA having more than 48 electrodesA conduit. Octalay includes eight deflectable arms disposed at the distal end of the shaft, wherein each of the deflectable arms includes six electrodes. Some catheters may include more electrodes, such as, but not limited to, 120 electrodes.

In addition to the need to determine electrode contact during mapping as described above, the physician performing the ablation procedure also monitors the electrode-to-tissue contact, as effective ablation typically requires sufficient contact between the ablation electrode and the tissue. For a small number of electrodes, monitoring contact may be performed by presenting a measure of contact (such as the impedance observed by the electrode or the force on the electrode) in a numerical or even graphical manner. However, as the number of active electrodes used in ablation procedures increases, it becomes increasingly difficult for a physician to monitor any parameter of a single electrode. In terms of electrode contact, this problem is exacerbated by the fact that: in most cases, as the contact changes, the parameters of the measured contact also change.

Embodiments of the present invention address the above-described problems during medical procedures, such as mapping or ablation procedures, by presenting a multi-channel color formatted IEGM presentation bar to the physician instead of displaying an IEGM trace (a graph of voltage values versus time). Each IEGM presentation bar represents a sampling of IEGM voltage values of the signal (detected by the corresponding catheter electrode) with colored shapes (e.g., rectangles, ovals, or any suitable shape) arranged in a linear array in the bar. The shapes are colored according to the sampled voltage values and arranged in the presentation bar according to a temporal order of corresponding time sequence values associated with the sampled voltage values encoded in the colored shapes. For example, each subsequent shape in the bar may correspond to the next timing value at which the sample was taken, and each shape is color-coded according to the sampled voltage value sampled at the timing value associated with that shape.

In this way, the color coding of the linear array of shapes in the strip represents the voltage values in the signal detected by the respective catheter electrode.

The presentation bars may be displayed on the display in a contiguous manner with one another, thereby allowing multiple IEGM presentation bars associated with multiple catheter electrodes to be presented on a single screen. Prominent and other features of cardiac electrical activity may be collected from the strip, such as voltage values having maxima and minima, peak spacing, and rate of change of voltage values. For example, the rate of change of voltage is indicated by the width of the color bar in the bar. For example, a color change on a single shape represents a faster rate of change than a color change on several adjacent shapes.

In some embodiments, the shape may be formatted using another formatting method, for example, using different transparency levels for the shape's filler.

Additionally or alternatively, the shape of the IEGM presentation bar may be formatted to display another attribute of the signal, such as a rate of change of the respective signal or a ranking of the respective signal. When different attributes of a signal are displayed in a single IEGM presentation bar, one attribute may be represented using one formatting type (e.g., using different coloring) and another attribute may be represented using a different formatting type (e.g., using different transparency levels).

In some embodiments: IEGM traces may optionally be displayed in addition to IEGM presentation bars.

Some embodiments include a medical system including a catheter inserted into a chamber of a heart of a living subject. The catheter includes electrodes that contact tissue at respective locations within a chamber of the heart. The medical system may include a processing circuit that receives a signal from a catheter and samples respective voltage values of the signal at respective timing values in response to the signal.

The processing circuit optionally derives a value of an attribute of a respective one of the signals in response to a respective one of the sampled voltage values and a respective one of the timing values. The property may be a rate of change of the sampled voltage values, or a classification of a corresponding one of the signals.

The processing circuitry draws, in response to the signals, respective Intracardiac Electrogram (IEGM) presentation bars to the display that represent electrical activity in tissue sensed by the catheter electrodes at the respective locations. Each IEGM presentation bar includes a linear array of respective shapes that are associated with respective ones of the timing values and arranged in a temporal order of the respective ones of the timing values. The respective shaped filler is formatted in response to respective ones of the sampled voltage values of respective ones of the signals sampled at respective ones of the timing values. In some embodiments, the padding is formatted based on the sampled voltage value or based on another attribute (e.g., rate of change or gradation of voltage value) that depends on the sampled voltage value and the timing value. Thus, the formatting of the IEGM presentation bar may represent the sampling amplitude, rate of change of the sampling voltage values, and/or the gradation.

In some embodiments, the processing circuit renders the respective IEGM presentation bar to the display, wherein the respective shaped filler is at least partially colored in response to respective ones of the sampled voltage values of the respective ones of the signals sampled at respective ones of the timing values. In other embodiments, the processing circuit plots respective IEGM presentation bars to the display, wherein the transparency of the respective shaped fillers is adjusted in response to respective ones of the sampled voltage values of the respective ones of the signals sampled at respective ones of the timing values.

In some embodiments, the processing circuitry draws a respective IEGM presentation bar to the display, wherein: the respective shaped fills are formatted according to a first formatting in response to respective ones of the sampled voltage values of respective ones of the signals sampled at respective ones of the timing values, and the respective shaped fills are also formatted according to a second formatting in response to a derived value (e.g., representing another property of the signal, such as a rate of change or a ranking of the voltage values). Thus, at least some of the shapes may be formatted utilizing both the first formatting and the second formatting. For example, at least some of these shapes may be formatted with both color and transparency. The first formatting and the second formatting may be selected from any suitable formatting scheme, such as, but not limited to, color formatting or transparency formatting. In some embodiments, the first formatting includes color formatting and the second formatting includes transparency formatting. In other embodiments, the first formatting includes transparency formatting and the second formatting includes color formatting.

In some embodiments, the processing circuitry draws to the display a respective IEGM presentation bar having at least one additional marker selected, by way of example only, from any one of: alphanumeric symbol, another symbol, line, point, time stamp, maximum in current data, pacing spike.

Description of the System

Reference is now made to fig. 1, which is a schematic illustration of a medical surgical system 20, constructed and operative in accordance with an embodiment of the invention. Reference is now made to fig. 2, which is a schematic illustration of a catheter 40 for use in the system 20 of fig. 1.

The medical procedure system 20 is used to determine the position of the catheter 40, as seen in inset 25 of fig. 1 and in more detail in fig. 2. Catheter 40 includes a shaft 22 and a plurality of deflectable arms 54 (only some labeled for simplicity) for insertion into a body part of a living subject, such as a chamber of heart 26. The flexible arms 54 have respective proximal ends connected to the distal end of the shaft 22.

Catheter 40 includes a position sensor 53 disposed on shaft 22 in a predefined spatial relationship with respect to the proximal ends of flexible arms 54. The orientation sensor 53 may include the magnetic sensor 50 and/or at least one axis electrode 52. The magnetic sensor 50 may include at least one coil, such as but not limited to a two-axis or three-axis coil arrangement, to provide position data of position and orientation (including yaw). Catheter 40 includes a plurality of catheter electrodes 55 (only some labeled in fig. 2 for simplicity) disposed at different respective locations along each of the deflectable arms 54. In general, catheter 40 may be used to map electrical activity in the heart of a living subject using electrodes 55, or may be used to perform any other suitable function in a body part of a living subject. The electrodes 55 are configured to contact tissue of the body part at respective locations within the body part (e.g., within a chamber of the heart).

The medical-surgical system 20 may determine the position and orientation of the shaft 22 of the catheter 40 based on signals provided by the magnetic sensor 50 and/or shaft electrodes 52 (proximal electrode 52a and distal electrode 52b) mounted on the shaft 22 on either side of the magnetic sensor 50. At least some of proximal electrode 52a, distal electrode 52b, magnetic sensor 50, and electrodes 55 are connected to various driver circuits in console 24 by wires extending through shaft 22 via catheter connector 35. In some embodiments, at least two of the electrode 55, the shaft electrode 52, and the magnetic sensor 50 of each of the deflectable arms 54 are connected to drive circuitry in the console 24 via the catheter connector 35. In some embodiments, distal electrode 52b and/or proximal electrode 52a may be omitted.

The illustration shown in fig. 2 was chosen purely for the sake of conceptual clarity. Other configurations of the shaft electrode 52 and the electrode 55 are also possible. Additional functions may be included in the orientation sensor 53. Elements not relevant to the disclosed embodiments of the invention, such as the flush port, are omitted for clarity.

Physician 30 navigates catheter 40 to a target location in a body part (e.g., heart 26) of patient 28 by manipulating shaft 22 and/or deflection from sheath 23 using manipulator 32 near the proximal end of catheter 40. The catheter 40 is inserted through the sheath 23 with the deflectable arms 54 brought together and only after the catheter 40 is retracted from the sheath 23, the deflectable arms 54 are able to expand and resume their intended functional shape. By housing the deflectable arms 54 together, the sheath 23 also serves to minimize vascular trauma on its way to the target site.

The console 24 includes processing circuitry 41 (typically a general purpose computer) and suitable front end and interface circuitry 44 for generating signals in and/or receiving signals from body surface electrodes 49 attached to the chest and back, or any other suitable skin surface of the patient 28 by leads passing through the cable 39.

The console 24 also includes a magnetic induction subsystem. The patient 28 is placed in a magnetic field generated by a pad containing at least one magnetic field radiator 42 driven by a unit 43 arranged in the console 24. The magnetic field radiator 42 is configured to emit an alternating magnetic field into an area in which a body part (e.g., the heart 26) is located. The magnetic field generated by the magnetic field radiator 42 generates a directional signal in the magnetic sensor 50. The magnetic sensor 50 is configured to detect at least a portion of the emitted alternating magnetic field and provide the directional signal as a corresponding electrical input to the processing circuit 41.

In some embodiments, processing circuitry 41 uses the position signals received from shaft electrode 52, magnetic sensor 50, and electrode 55 to estimate the position of catheter 40 within an organ (such as a heart chamber). In some embodiments, processing circuitry 41 correlates the position signals received from electrodes 52, 55 with previously acquired magnetic position-calibration position signals to estimate the position of catheter 40 within the heart chamber. The azimuthal coordinates of the axial electrodes 52 and electrodes 55 may be determined by the processing circuitry 41 based on (among other inputs) the measured impedance between the electrodes 52, 55 and the body surface electrodes 49, or the proportion of the current distribution. Console 24 drives a display 27 that shows the distal end of catheter 40 within heart 26.

Methods of orientation sensing using current distribution measurements and/or external magnetic fields are implemented in various medical applications, for example, as produced by Biosense Webster IncImplemented in systems and described in detail in U.S. Pat. nos. 5,391,199, 6,690,963, 6,484,118, 6,239,724, 6,618,612, 6,332,089, 7,756,576, 7,869,865, and 7,848,787, PCT patent publication WO 96/05768, and U.S. patent application publications 2002/0065455 a1, 2003/0120150 a1, and 2004/0068178 a 1.

The 3-system applies an Active Current Location (ACL) impedance based position tracking method. In some embodiments, the processing circuitry 41 is configured to use an ACL method to generate a mapping (e.g., a current-orientation matrix (CPM)) between the indication of electrical impedance and orientation in the magnetic coordinate system of the magnetic field radiator 42. Processing circuitry 41 estimates the orientation of axis electrode 52 and electrode 55 by performing a lookup in CPM.

The processing circuitry 41 is typically programmed with software to perform the functions described herein. The software may be downloaded to the computer in electronic form over a network, for example, or it may alternatively or additionally be provided and/or stored on non-transitory tangible media, such as magnetic, optical, or electronic memory.

For simplicity and clarity, FIG. 1 only shows the elements relevant to the disclosed technology. System 20 generally includes additional modules and elements that are not directly related to the disclosed technology and, therefore, are intentionally omitted from fig. 1 and the corresponding description.

The catheter 40 described above includes eight flexible arms 54, with each arm 54 having six electrodes. By way of example only, any suitable catheter may be used in place of catheter 40, for example, a catheter having a different number of flexible arms and/or a different number of electrodes on each arm, or a catheter having a different stylet shape such as a balloon catheter, basket catheter, or lasso catheter.

The medical procedure system 20 may also perform ablation of cardiac tissue using any suitable catheter, for example, using the catheter 40 or a different catheter and any suitable ablation method. Console 24 may include an RF signal generator 34 configured to generate RF power that is applied by one or more electrodes of a catheter connected to console 24 and one or more of body surface electrodes 49 to ablate the myocardium of heart 26. Console 24 may include a pump (not shown) that pumps irrigation fluid into the irrigation channel to the distal end of the catheter where ablation is performed. The catheter performing the ablation may further comprise a temperature sensor (not shown) for measuring the temperature of the myocardium during the ablation and adjusting the ablation power and/or the irrigation rate of the pumping of the irrigation fluid in dependence of the measured temperature.

Reference is now made to fig. 3, which is a schematic illustration of an IEGM trace 60 and IEGM presentation bar 62 prepared by the system 20 of fig. 1. The IEGM trace 60 shows the change in voltage value with respect to time using a line plot of the signal received from one of the electrodes 55 of the catheter 40 (fig. 2).

To generate the IEGM presentation bar 62, the voltage values of the received signals are sampled at appropriate time intervals. The voltage value at the sampling time may be a positive value or a negative value. The time interval between samples may be any suitable value, for example, but not limited to, in the range of 1 millisecond to 50 milliseconds. The voltage values sampled at the corresponding time series values are then converted into color values. The color value may be derived based on looking up the color value in a table that maps a range of voltage values to color values. Alternatively, the color value may be calculated using a function that receives the voltage value as an input and outputs the color value. The color values may be defined using known color models such as RGB or custom based color models. The respective shapes 64 of the IEGM presentation bar 62 are assigned to the respective timing values at which the signal is sampled. The respective shape 64 is then colored according to respective color values derived from respective sampled voltage values sampled at respective time series values.

For example, the shapes 64-1 to 64-7 shown in the inset 66 are assigned timing values of 3900 milliseconds, 3910 milliseconds, 3920 milliseconds, 3930 milliseconds, 3940 milliseconds, 3950 milliseconds, and 3960 milliseconds, respectively. The voltages sampled at 3900 milliseconds, 3910 milliseconds, 3920 milliseconds, 3930 milliseconds, 3940 milliseconds, 3950 milliseconds, and 3960 milliseconds derived from the signal are equal to 1.2, 1.24, 1.3, 1.33, 1.31, 1.15, and 1.1, respectively. The color values corresponding to red, crimson, orange and orange are derived from the voltages 1.2, 1.24, 1.3, 1.33, 1.31, 1.15 and 1.1, respectively. The shapes 64-1 to 64-7 are then colored with the following colors, respectively: red, crimson, orange and orange. Note that two or more different voltages may be mapped to the same color. For example, voltages of 1.2 and 1.24 are both mapped to red.

Shape 64 may be selected from any suitable shape, such as a rectangle or an ellipse. The shape 64 may have any suitable height, such as 1mm to 100mm, or even higher, depending on the size of the display 27 (fig. 1) and the number of IEGM presentation bars 62 being displayed simultaneously. The shape 64 may have any suitable width, for example, a single pixel to 5mm, depending on the size of the display 27 and the distance of the display from the physician 30 (FIG. 1) and the timing interval between samples.

Although IEGM presentation bar 62 shown in fig. 3 is shown in grayscale due to the limitations of the patent drawing, by way of example IEGM presentation bar 62 may be displayed on the display using colors, with peaks displayed using red (arrow 68) and magenta (arrow 69), and valleys displayed using cyan (arrow 70). Any suitable color coding may be employed to represent voltage values by any suitable color.

Salient and other features of cardiac electrical activity, such as voltage values having maxima and minima, peak spacing, and rate of change of voltage values, may be collected from IEGM presentation bar 62. For example, the rate of change of voltage is indicated by the width of the color bar in the bar. For example, a color change on a single shape 64 represents a faster rate of change than a color change on several adjacent shapes 64.

In some embodiments, another formatting method (instead of using different colors) may be used to format the shape 64, e.g., using different transparency levels for the filler of the shape 64. The fill of shape 64 may be a solid or patterned fill having a transparency level that is adjusted according to the voltage value associated with the shape.

Reference is now made to fig. 4, which presents a schematic view of a plurality of IEGM bars 62. IEGM presentation bars 62 represent the signals received from the nineteen electrodes 55 of catheter 40 (fig. 1), respectively. The IEGM presentation bars 62 of lanes 8, 11, 17, and 18 show more activity in the negative voltage range than the IEGM presentation bars 62 of the other lanes.

Fig. 4 also shows a legend 72 that provides the physician 30 (fig. 1) with a look-up table between the various colors and corresponding voltage values in the IEGM presentation bar 62. By way of example only, the top of the legend may be colored with a dark red color and the bottom of the legend may be colored with a dark blue color.

The IEGM presentation bars 62 are displayed on the display in a contiguous manner with one another, allowing multiple IEGM presentation bars 62 to be presented on a single display screen.

In some embodiments, instead of displaying a voltage value that varies over time, the IEGM presentation bar 62 may display other attributes of the signal, such as a rate of change of the corresponding signal or a ranking of the corresponding signal, by formatting the shape 64 according to the value of the other attribute.

In other embodiments, in addition to displaying time-varying voltage values, the IEGM presentation bar 62 may display other attributes of the signal, such as a rate of change of the corresponding signal or a ranking of the corresponding signal, by formatting the shape 64 using one formatting type (e.g., using different levels of transparency) according to the value of the other attribute, or by formatting the shape 64 using a different formatting type (e.g., using different coloring) according to the voltage value.

Reference is now made to fig. 5, which is a flow chart 74 including steps in a method of operation of the system 20 of fig. 1.

The catheter 40 (fig. 1) is configured to be inserted (block 76) into a chamber of a heart 26 (fig. 1) of a living subject and includes catheter electrodes 55 (fig. 2) configured to contact tissue at respective locations within the chamber of the heart 26.

Processing circuitry 41 (fig. 1) is configured to receive the signal from conduit 40 and, in response to the signal, sample a respective voltage value of the signal at a respective timing value (block 78).

Processing circuitry 41 (fig. 1) is optionally configured to derive (block 80) values of properties of respective ones of the signals responsive to respective ones of the sampled voltage values and respective ones of the timing values. The property may be, for example, a rate of change of the sampled voltage values, or a classification of a corresponding one of the signals.

The processing circuitry 41 (fig. 1) is configured to plot (block 82) a respective Intracardiac Electrogram (IEGM) presentation bar 62 (fig. 3) representative of electrical activity in tissue sensed by the catheter electrode 55 at the respective location to the display 27 (fig. 1) in response to the signal. Each IEGM presentation bar 62 includes a linear array of respective shapes 64 (fig. 3) that are associated with and arranged in a temporal order of corresponding ones of the timing values. The fillings of the respective shapes 64 are formatted in response to respective ones of the sampled voltage values of respective ones of the signals sampled at respective ones of the timing values.

The formatting may depend on the sampled voltage values or be based on the values of at least some of the sampled values. For example, the formatting may be based on a rate of change of the sampled voltage values, or a ranking of respective ones of the signals. Thus, the IEGM presentation bar 62 may display the rate of change or the gradation of the sampled voltage values.

In some embodiments, the processing circuitry 41 (fig. 1) is configured to plot the respective IEGM presentation bars 62 to the display 27 (fig. 1), wherein the fillings of the respective shapes 64 are at least partially colored in response to respective ones of the sampled voltage values of the respective ones of the signals sampled at respective ones of the timing values. In other embodiments, the processing circuitry 41 (fig. 1) is configured to plot the respective IEGM presentation bars 62 to the display 27 (fig. 1), wherein the transparency of the fillings of the respective shapes 64 are adjusted in response to respective ones of the sampled voltage values of the respective ones of the signals sampled at respective ones of the timing values.

In some embodiments, the processing circuitry 41 (fig. 1) is configured to render the respective IEGM presentation bars 62 to the display 27 (fig. 1), wherein the fillings of the respective shapes 64 are formatted according to a first formatting in response to respective ones of the sampled voltage values of the respective ones of the signals sampled at respective ones of the timing values, and the fillings of the respective shapes 64 are also formatted according to a second formatting in response to the derived values (derived in the step of block 80). The first formatting and the second formatting may be selected from any suitable formatting scheme, such as, but not limited to, color formatting or transparency formatting. In some embodiments, the first formatting includes color formatting and the second formatting includes transparency formatting. In other embodiments, the first formatting includes transparency formatting and the second formatting includes color formatting.

In some embodiments, the processing circuitry 41 (fig. 1) is configured to render to the display 27 (fig. 1) a respective IEGM presentation bar having at least one additional indicia selected from any one of: an alphanumeric symbol (e.g., channel number of fig. 4), another symbol (e.g., legend 72 of fig. 4), a line (not shown), a point (not shown), a time stamp (timing value of fig. 4), a maximum in current data (not shown), a pacing spike (not shown).

As used herein, the term "about" or "approximately" for any numerical value or range indicates a suitable dimensional tolerance that allows the component or collection of elements to achieve its intended purpose as described herein. More specifically, "about" or "approximately" may refer to a range of values ± 20% of the recited value, e.g., "about 90%" may refer to a range of values from 71% to 99%.

Various features of the invention which are, for clarity, described in the context of separate embodiments, may also be provided in combination in a single embodiment. Conversely, various features of the invention which are, for brevity, described in the context of a single embodiment, may also be provided separately or in any suitable subcombination.

The embodiments described above are cited by way of example, and the present invention is not limited to what has been particularly shown and described hereinabove. Rather, the scope of the present invention includes both combinations and subcombinations of the various features described hereinabove, as well as variations and modifications thereof which would occur to persons skilled in the art upon reading the foregoing description and which are not disclosed in the prior art.