178 results about "Endocardium" patented technology

A system that interfaces with a workstation endocardial mapping system allows for the rapid and successful ablation of cardiac tissue. The system allows a physician to see a representation of the physical location of a catheter in a representation of an anatomic model of the patient's heart. The workstation is the primary interface with the physician. A servo catheter having pull wires and pull rings for guidance and a servo catheter control system are interfaced with the workstation. Servo catheter control software may run on the workstation. The servo catheter is coupled to an RF generator. The physician locates a site for ablation therapy and confirms the location of the catheter. Once the catheter is located at the desired ablation site, the physician activates the RF generator to deliver the therapy.

A mapping catheter is positioned in a heart chamber, and active electrode sites are activated to impose an electric field within the chamber. The blood volume and wall motion modulates the electric field, which is detected by passive electrode sites on the preferred catheter. Electrophysiology measurements, as well as geometry measurements, are taken from the passive electrodes and used to display a map of intrinsic heart activity.

A leadless cardiac pacemaker having a radial fixation mechanism is provided. The cardiac pacemaker can include fixation mechanism separate from a pacing electrode and having a diameter equal to or less than the outer diameter of the pacemaker. The fixation mechanism can allow the pacemaker to be inserted into tissue with less than 2 rotations of the pacemaker to place the pacing electrode in contact with the tissue. In some embodiments, the fixation mechanism can comprise a plurality of hooks or protrusions positioned near a distal portion of the pacemaker. The fixation mechanism(s) can be configured to penetrate the endocardium of the patient and reside mostly within the myocardium. Methods of delivering the leadless cardiac pacemaker into the heart are also provided.

A method and a device for improving cardiac function are provided. The device is packaged in a collapsed state in an end of a catheter. Portions of a frame construction of the device spring outwardly when the catheter is withdrawn from the device. Anchoring formations on the frame construction secure the frame construction to a myocardium of the heart. A membrane secured to the frame construction then forms a division between volumes of an endocardial cavity of the heart on opposing sides of the membrane.

A system (10) for determining electrical potentials on an endocardial surface of a heart is provided. The system includes a non-contact, non-expandable, miniature, multi-electrode catheter probe (12), a plurality of electrodes (32) disposed on an end portion (30) thereof, means for determining endocardial potentials (14) based on electrical potentials measured by the catheter probe, a matrix of coefficients that is generated based on a geometric relationship between the probe surface, and the endocardial surface. A method is also provided.

A method and system for generating a patient specific anatomical heart model is disclosed. Volumetric image data, such as computed tomography (CT) or echocardiography image data, of a patient's cardiac region is received. Individual models for multiple heart components, such as the left ventricle (LV) endocardium, LV epicardium, right ventricle (RV), left atrium (LA), right atrium (RA), mitral valve, aortic valve, aorta, and pulmonary trunk, are estimated in said volumetric cardiac image data. A patient specific anatomical heart model is generated by integrating the individual models for each of the heart components.

A leadless cardiac pacemaker having a radial fixation mechanism is provided. The cardiac pacemaker can include fixation mechanism separate from a pacing electrode and having a diameter equal to or less than the outer diameter of the pacemaker. The fixation mechanism can allow the pacemaker to be inserted into tissue with less than 2 rotations of the pacemaker to place the pacing electrode in contact with the tissue. In some embodiments, the fixation mechanism can comprise a plurality of hooks or protrusions positioned near a distal portion of the pacemaker. The fixation mechanism(s) can be configured to penetrate the endocardium of the patient and reside mostly within the myocardium. Methods of delivering the leadless cardiac pacemaker into the heart are also provided.

A mapping catheter is described to map electric field activity in a heart chamber. The catheter has a first grouping of electrodes positioned so that they are not in contact with the patient's heart. The catheter also having a second set of electrodes positioned in contact with the patient's heart.

Systems and methods for automated segmentation of anatomical structures (e.g., heart). Convolutional neural networks (CNNs) may be employed to autonomously segment parts of an anatomical structure represented by image data, such as 3D MRI data. The CNN utilizes two paths, a contracting path and an expanding path. In at least some implementations, the expanding path includes fewer convolution operations than the contracting path. Systems and methods also autonomously calculate an image intensity threshold that differentiates blood from papillary and trabeculae muscles in the interior of an endocardium contour, and autonomously apply the image intensity threshold to define a contour or mask that describes the boundary of the papillary and trabeculae muscles. Systems and methods also calculate contours or masks delineating the endocardium and epicardium using the trained CNN model, and anatomically localize pathologies or functional characteristics of the myocardial muscle using the calculated contours or masks.

A method for automatic left ventricle segmentation of cine short-axis magnetic resonance (MR) images that does not require manually drawn initial contours, trained statistical shape models, or gray-level appearance models is provided. More specifically, the method employs a roundness metric to automatically locate the left ventricle. Epicardial contour segmentation is simplified by mapping the pixels from Cartesian to approximately polar coordinates. Furthermore, region growing is utilized by distributing seed points around the endocardial contour to find the LV myocardium and, thus, the epicardial contour. This is a robust technique for images where the epicardial edge has poor contrast. A fast Fourier transform (FFT) is utilized to smooth both the determined endocardial and epicardial contours. In addition to determining endocardial and epicardial contours, the method also determines the contours of papillary muscles and trabeculations.

Percutaneous transmyocardial revascularizaton systems are disclosed for creating thin, linear incisions through the endocardium and partially into the myocardium. The systems mitigate the deficiencies of current approaches that position a distal tip channeling mechanism against the endocardial surface. The systems position a catheter body lengthwise along the endocardial surface and incorporate a cutting mechanism movable radially relative to the catheter body to create one or more elongate thin, linear incisions along one or more windows through the catheter body. Flexible support strands are used to urge each window into intimate contact with the endocardial surface. Each cutting element is adapted to protrude radially outward from the catheter body to contact tissue adjacent each window. The cutting mechanism incorporates a mechanical cutting element or an electrode designed to transmit direct current or radiofrequency energy into tissue to simultaneously cut and coagulate tissue. The catheter also can infuse a therapeutic agent directly into the incisions to encourage angiogenesis. The catheter also cuts thin, linear incisions capable of ablating arrhythmia substrates by disrupting electrical propagation through the affected myocardium.

An arrangement for introducing and implanting the electrode(s) of an endocardial implantable cardiac lead at a cardiac implantation site within a heart chamber or vessel. An elongated guide body formed of flexible material and extending between a guide body proximal end and a guide body distal end is advanced transvenously to position the guide body distal end in relation to the cardiac implantation site. Guide body tracking means is coupled with the lead distal end for receiving and slidingly engaging the guide body to allow the cardiac lead to be advanced along the guide body until the electrode is positioned at the cardiac implantation site. Pusher means formed of an elongated pusher body of flexible material extends between a pusher body proximal end and a pusher body distal end and has a cardiac lead engaging means for engaging the cardiac lead at or adjacent the distal lead end. The pusher body has sufficient column strength to be advanced alongside the guide body and lead body with the cardiac lead engaging means engaging and slidingly advancing the guide body tracking means and the cardiac lead distally along the guide body to thereby allow the cardiac lead to be advanced along the guide body until the electrode is positioned at the cardiac implantation site. The lead body is released from the lead engaging means and fixed, if the lead includes a fixation mechanism. The pusher means is retracted by retraction of the pusher body.

Systems and methods for automated segmentation of anatomical structures (e.g., heart). Convolutional neural networks (CNNs) may be employed to autonomously segment parts of an anatomical structure represented by image data, such as 3D MRI data. The CNN utilizes two paths, a contracting path and an expanding path. In at least some implementations, the expanding path includes fewer convolution operations than the contracting path. Systems and methods also autonomously calculate an image intensity threshold that differentiates blood from papillary and trabeculae muscles in the interior of an endocardium contour, and autonomously apply the image intensity threshold to define a contour or mask that describes the boundary of the papillary and trabeculae muscles. Systems and methods also calculate contours or masks delineating the endocardium and epicardium using the trained CNN model, and anatomically localize pathologies or functional characteristics of the myocardial muscle using the calculated contours or masks.

A method and system for simulating patient-specific cardiac electrophysiology including the effect of the electrical conduction system of the heart is disclosed. A patient-specific anatomical heart model is generated from cardiac image data of a patient. The electrical conduction system of the heart of the patient is modeled by determining electrical diffusivity values of cardiac tissue based on a distance of the cardiac tissue from the endocardium. A distance field from the endocardium surface is calculated with sub-grid accuracy using a nested-level set approach. Cardiac electrophysiology for the patient is simulated using a cardiac electrophysiology model with the electrical diffusivity values determined to model the Purkinje network of the patient.

A medical device for characterizing the cardiac status of a patient equipped with a bi-ventricular pacing active implant device. The implant collects an endocardiac acceleration signal and searches for an optimal pacing configuration. This latter tests a plurality of different pacing configurations and delivers for each tested configuration parameters derived from the endocardiac acceleration peak (PEA). The device derives a patient clinical status from those parameters, the indication being representative of the patient's response to the cardiac resynchronization therapy. Those parameters include: the possibility to automatically get or not a valid optimal AV Delay among all the biventricular pacing configurations; a factor indicating the character sigmoid of the PEA / AVD characteristic; the average value of the PEA for the various configurations; and the PEA signal / noise ratio. The active implantable medical device includes control software and processes for executing the characterizing functionality described.

A surgical ablation probe assembly particularly suitable for ablating tissue on a surface of a patient's heart having an ablation member and a stabilizing member for guiding the probe assembly to an intracorporeal location such as a surface of the patient's heart. The elongated ablation member generally has at least one ablation electrode on a distal shaft section. The stabilizing member has a vacuum lumen which applies a vacuum to the inner chamber of the stabilizing member to aspirate fluid from within the chamber or about the stabilizing member and can aid in holding the stabilizing member to an intracorporeal surface such as the epicardial or endocardial surface of the patient's heart. The probe assembly may also have a removable stylet to help retain the shape of the distal portion. The assembly is suitable for treating a patient for atrial arrhythmia, by forming linear or curvilinear lesions and preferably a continuous lesion on the surface of the patient's heart.

Some embodiments of the invention provide a system for occluding a left atrial appendage of a patient. Some embodiments of the system can include a ring occluder that can be positioned around the left atrial appendage and a ring applicator to position the ring occluder with respect to the left atrial appendage. One embodiment discloses a method of accessing endocardial surfaces of the heart through the atrial appendage. Additional embodiments of the invention provide a clip occluder that can be positioned around the left atrial appendage. A clip applicator can position the clip occluder with respect to the left atrial appendage.

To control cardiac arrhythmias, various conduction-modifying agents include biopolymers, fibroblasts, neurotoxins, and growth factors are introduced either epicardially or endocardially to the fat pads in proximity to the ganglia therein. Any desired technique may be used for injection, including injection from a catheter inserted percutaneously, or direct injection through the epicardial during open heart surgery. Preferably the patient's heart is beating throughout the Injection.

The present invention discloses an endocardial three-dimensional guide system and guide method. Said system includes excitation device, three pairs of excitation electrodes, catheter position signal obtaining device, respiratory impedance regulating device and cardiac chambers mechanical external form synchronization device. Said excitation device contains digital control logic and constant-current generation module. The above-mentioned catheter position signal obtaining device includes catheter, positioning amplifier, A / D converter, digital demodulator and coordinate converter. Said respiratory impedance regulating device includes body surface electric field signal collecting circuit, positioning amplifier, A / D converter, respiratory data extraction module and respiratory correction module.

An injector apparatus and associated methods for safely and repeatedly delivering an injectate at a predefined depth into the myocardium of the heart may be catheter-based or implemented in a handheld unit for use in open chest procedures. The injector includes a body, a stabilizer secured to a distal end of the body for stabilizing the distal end of the body relative to the myocardium, and a needle that may be controllably advanced from the distal end of the body into the myocardium. The stabilizer employs any suitable technique for stabilizing the distal end of the catheter body relative to the myocardium while the heart is beating. An enlarged region disposed along the needle functions as a stop to prevent the needle from being advanced into the myocardium beyond a desired penetration depth. To make an injection, the physician brings the distal end of the body in proximity to the endocardium or the epicardium using any suitable technique, actuates the stabilizer to stabilize the distal end relative to the myocardium; and advances the needle into the myocardium. Advancement of the needle into the myocardium is impeded by the enlarged region, thereby placing the needle tip at the desired penetration depth and avoiding puncturing of the heart. The injection is then made, and the needle and catheter are removed.

A method and apparatus for improving blood flow to an ischemic region (e.g., myocardial ischemia) a patient is provided. An ultrasonic transducer is positioned proximate to the ischemic region. Ultrasonic energy is applied at a frequency at or above 1 MHz to create one or more thermal lesions in the ischemic region of the myocardium. The thermal lesions can have a gradient of sizes. The ultrasound transducer can have a curved shape so that ultrasound energy emitted by the transducer converges to a site within the myocardium, to create a thermal lesion without injuring the epicardium or endocardium.

A method is provided for segmenting an image of interest of a left ventricle. The method includes determining a myocardium contour according to a graph cut of candidate endocardium contours, and a spline fitting to candidate epicardium contours in the absence of shape propagation. The method further includes applying a plurality of shape constraints to candidate endocardium contours and candidate epicardium contours to determine the myocardium contour, wherein a template is determined by shape propagation of a plurality of images in a sequence including the image of interest in the presence of shape propagation.

A method and system for generating a patient specific anatomical heart model is disclosed. Volumetric image data, such as computed tomography (CT) or echocardiography image data, of a patient's cardiac region is received. Individual models for multiple heart components, such as the left ventricle (LV) endocardium, LV epicardium, right ventricle (RV), left atrium (LA), right atrium (RA), mitral valve, aortic valve, aorta, and pulmonary trunk, are estimated in said volumetric cardiac image data. A patient specific anatomical heart model is generated by integrating the individual models for each of the heart components.

A method for assessing cardiac function using an ultrasound imaging catheter system includes positioning an ultrasound catheter so the ultrasound transducer can image a ventricle, obtaining images of the ventricle at two or more times within the cardiac cycle, recognizing an edge of the endocardium, measuring dimensions of the ventricle, calculating a volume or area of the ventricle at the two or more points in the cardiac cycle, and calculating the ejection fraction based upon the difference in volume or area at the two or more times in the cardiac cycle. The method can be used to determine a location for an intervention, such as placement of a pacemaker pacing lead, and may be performed before and after an intervention to assess the impact of the treatment on cardiac function.

Methods and process for detection of myocardial ischemia involve detection and analysis of changes in electrical conduction velocity within the heart to monitor changes in the condition of the cardiac muscle and indicate possible ischemia. Conduction velocity slows considerably when oxygen supply to the heart is reduced. Analysis of electrical conduction velocity can be used to verify the occurrence of myocardial ischemia in a more reliable manner. Changes in conduction velocity may be monitored based on conduction time between electrodes positioned in the left and right ventricles of the heart. The electrodes may be endocardial or epicardial electrodes. In general, the techniques may involve launching a stimulation waveform at one electrode and sensing a local cardiac depolarization at another electrode to assess conduction time.

Myocardial tissue tracking techniques are used to project or guide a single manually-defined set of myocardial contours through time. Displacement encoding with stimulated echoes (DENSE), harmonic phase (HARP) and speckle tracking is used to encode tissue displacement into the phase of complex MRI images, providing a time series of these images, and facilitating the non-invasive study of myocardial kinematics. Epicardial and endocardial contours need to be defined at each frame on cine DENSE images for the quantification of regional displacement and strain as a function of time. The disclosed method presents a novel and effective two dimensional semi-automated segmentation technique that uses the encoded motion to project a manually defined region of interest through time. Contours can then easily be extracted for each cardiac phase.