CN106691438B - Whole-heart three-dimensional mapping system for complex arrhythmias - Google Patents

Abstract

The present application provides an overall cardiac three-dimensional mapping system for complex arrhythmias, including an epicardial three-dimensional mapping module, an endocardial three-dimensional magnetic localization mapping module, an endocardium-epicardial combined mapping module, a three-dimensional Mapping common base modules. Among them, the 3D mapping public basic module provides the whole system with the construction of a 3D anatomical model of the heart and the fusion of electrophysiological information and anatomical models; the endocardial 3D magnetic localization and mapping module has built-in magnetic field generation and positioning software and hardware to provide magnetic field positioning for the entire system; The epicardium mapping module has built-in epicardial partition software; the endocardium-epicardial combined mapping module has a built-in endocardial-epicardial combined mapping algorithm to achieve overall cardiac mapping. The system can obtain and organically fuse the three-dimensional electroanatomical information jointly mapped by the endocardium and the corresponding epicardium, and realize accurate mapping under dynamic conditions such as cardiac shape, relatively fixed position and thoracotomy, and meet the requirements of complex arrhythmias. Special needs for clinical diagnosis and treatment and mechanism research.

Description

Whole-heart three-dimensional mapping system for complex arrhythmias

technical field

The present application is an overall cardiac three-dimensional mapping system used for clinical diagnosis and treatment of complex arrhythmia and mechanism research. The system can obtain the three-dimensional electroanatomical mapping information of the endocardium and its corresponding epicardium, and can organically fuse the two to achieve endocardial mapping when the position and shape of the heart are relatively fixed. It can perform accurate epicardial mapping when the position and shape of the heart change, such as open thoracic vision, to complete the overall three-dimensional mapping of the heart, and meet the unique needs of complex arrhythmias. It belongs to the technical field of medical devices.

Background technique

Arrhythmia is a common clinical cardiovascular disease. Complex arrhythmias such as atrial fibrillation, ventricular tachycardia, and ventricular fibrillation seriously endanger human health and have become the focus of cardiovascular disease research. Mapping is an important link in the diagnosis, treatment and research of complex arrhythmia. Through mapping, the identification, judgment and localization of arrhythmia can be realized. In clinical diagnosis, treatment and mechanism research, there are two main types of complex arrhythmia mapping: endocardial mapping and epicardial mapping. However, in recent years, some studies have found that for a considerable proportion of complex arrhythmias, in the process of occurrence and maintenance, the effect of epicardial lesions is often more serious and extensive than that of endocardium. Only endocardial mapping cannot reveal complex arrhythmias. The exact electrophysiological mechanism of the abnormality is not conducive to the determination of clinical diagnosis and treatment plans. Therefore, co-mapping of endocardium and epicardium to obtain more comprehensive electrophysiological information is a unique need for clinical diagnosis, treatment and mechanism research of complex arrhythmias.

At present, in complex arrhythmia research, three-dimensional mapping technology is mainly used to obtain electrophysiological information. The technology is based on the needs of endocardial mapping, and can display the electrophysiological information of the anatomical parts of the heart and the corresponding parts in three dimensions. There are two main systems for the application of this mapping technology in the world: one is the Carto system based on magnetic field positioning or magnetoelectric dual positioning, and the other is the Ensite system based on electric field positioning. When the membrane is mapped, nothing can be done. The main reason is that epicardial mapping is generally performed under open heart. At this time, the electric field medium changes due to air filling. At the same time, the shape and position of the heart will also change due to the surgical operation. Ensite system, Carto system Neither can be used in this situation.

Two-dimensional mapping technology under traditional X-ray fluoroscopy can be used for open-chest epicardial mapping. However, due to the unintuitive spatial display, this method has defects such as difficulty in accurate positioning, long X-ray exposure time, and no positioning. , memory function, it is difficult to meet the research needs of complex arrhythmia.

In the 1990s, the multi-channel electrophysiological mapping technology was applied to the clinic. With the assistance of computers, by placing multiple electrodes on the epicardial surface at the same time, the ECG signals of multiple sites can be obtained synchronously, with high accuracy. However, it is still two-dimensional mapping, lacking intuitiveness, and it is difficult to combine with intracardiac mapping to analyze the corresponding area, and most of them adopt offline analysis, and the analysis results cannot be obtained in real time, so the clinical application is limited.

Optical mapping technology is a functional imaging technology to study cardiac electrical excitation conduction at the cellular level. Toxicity, etc., this technology is currently mainly used for in vitro mapping of animals, and it is difficult to use in humans.

Therefore, the existing two-dimensional and three-dimensional mapping systems cannot well meet the needs of clinical diagnosis, treatment and mechanism research specific to complex arrhythmias.

SUMMARY OF THE INVENTION

In order to achieve the above purpose, the present application provides the following technical solutions.

An integral cardiac three-dimensional mapping system for complex arrhythmias, comprising: a common basic module for three-dimensional mapping, an endocardial three-dimensional magnetic localization mapping module, an epicardial three-dimensional mapping module, and an endocardium-epicardial combined standard module. test module.

The three-dimensional mapping public basic module is used to construct a three-dimensional anatomical model of the heart for each mapping module of the system, and fuse the electrophysiological information of the points of the mapping catheter into the three-dimensional anatomical model.

The endocardial three-dimensional magnetic positioning and mapping module is used to generate the spatial magnetic field required by the system, determine the position and direction of the magnetic induction catheter in the magnetic field, determine the mutual positional relationship between the catheter and the cardiac anatomical structure at its location, and realize the magnetic positioning function; and The three-dimensional mapping public basic module is combined for electrical mapping of the entire endocardium, and combined with the three-dimensional cardiac image to obtain a three-dimensional electroanatomical mapping of the endocardium.

The epicardium three-dimensional mapping module is used to divide and refine the characteristic functional area on the three-dimensional anatomical model of the epicardium of the measured object; the topological mapping method is used, combined with the three-dimensional mapping public basic module, and is used for cardiac mapping. The entire epicardium is electrically mapped and combined with the three-dimensional cardiac image to obtain a three-dimensional epicardial electroanatomical map to achieve accurate epicardial mapping under dynamic conditions such as thoracotomy. Combined with the stimulator, pacing, dragging, recording and analysis are performed.

The endocardium-epicardial combined mapping module has a built-in endocardial-epicardial combined mapping algorithm, which is used to realize the organic fusion of the electrophysiological information of the endocardium and epicardium obtained from the selected mapping points. Endocardial 3D magnetic localization and mapping module, epicardial mapping module, and 3D mapping public basic module, respectively fuse the endocardial and epicardial electrophysiological information with the three-dimensional anatomical graphics of the heart to realize the endocardial and cardiac The electrophysiological information of the adventitia corresponds to a three-dimensional electroanatomical map of the whole heart.

The three-dimensional mapping public basic module includes a heart three-dimensional anatomical model construction technology research unit, a heart model and electrophysiological information fusion technology research unit, and is used to realize the construction of the three-dimensional heart anatomical model and the fusion of the heart model and electrophysiological information.

The technical research unit for constructing a three-dimensional anatomical model of the heart is used to construct a simulated anatomical model of the heart based on CT/MRI data.

The heart model and electrophysiological information fusion technology research unit is used to realize the fusion of the three-dimensional anatomical model of the heart and the electrophysiological information.

Wherein, the endocardial three-dimensional magnetic positioning and mapping module includes a magnetic field generator, a magnetic positioning and mapping catheter, a signal processing device, and a first workstation.

The magnetic field generator is used to generate the space magnetic field required by the system. The space magnetic field strength and magnetic field frequency conform to the safety range of the measured object.

The magnetic positioning and mapping catheter is used to sense the signal of the spatial magnetic field, and is used to take points on the cardiac anatomy to obtain electrophysiological information.

The signal processing device is used to process the cardiac electrophysiological information and spatial orientation information transmitted by the mapping electrodes and magnetic sensors, realize digital signal processing and communication with the workstation, and control the magnetic field generation module to ensure that the signals of the mapping electrodes and the magnetic field are generated. Module synchronization.

The first workstation has built-in magnetic positioning software, three-dimensional composition software, and electrocardiographic analysis software of magnetic positioning system. It is used to realize three-dimensional magnetic localization and endocardial three-dimensional mapping.

Magnetic positioning software is used to determine the spatial position and attitude of the mapping electrode and catheter tip; in addition, it is used to simultaneously receive and process positioning information such as the magnetic field strength and magnetic field direction of dozens of magnetic sensors to achieve multi-point synchronous and accurate magnetic positioning. To meet the needs of multi-point synchronous mapping and high-precision three-dimensional magnetic positioning, the three-dimensional mapping positioning accuracy of the system is less than or equal to 1mm.

The three-dimensional composition software is used to construct the three-dimensional geometric configuration of the heart in real time according to the spatial position coordinates of the mapping electrodes calculated by the positioning software. The three-dimensional configuration deviation of the system is less than or equal to 2mm.

The electrocardiographic analysis software of the magnetic positioning system is used to realize the real-time storage of the electrocardiographic information of the heart over time. Through the algorithm analysis, the dynamic waveform display of the electrocardiographic information is carried out with the help of the computer.

The epicardium three-dimensional mapping module includes epicardium partition software, epicardial three-dimensional composition and electroanatomical map display unit, epicardial pacing and dragging unit, and epicardial three-dimensional mapping hardware unit.

The epicardium partitioning software is used to realize the interactive and automatic partitioning according to the characteristic points on the simulated epicardium 3D anatomical model, and guide the operator to take points on the actual epicardium; through the human-computer interaction interface of the partitioning software, the It is necessary to add and delete feature points and refine the partition.

The epicardium three-dimensional composition and electroanatomical map display unit is used to realize the point-taking on the heart of the measured object based on the mapping catheter or the mapping electrode. The triangular patch method is used to construct a real-time three-dimensional geometric model of the heart for the three-dimensional epicardium. For mapping; call the public basic module of 3D mapping to match the ECG information with the spatial position of the mapping points to realize the fusion of the ECG information and the cardiac anatomy model; using the topology mapping method, the data collected on the actual epicardium are The mapping points are mapped to the three-dimensional anatomical model of the simulated heart epicardium, and the electrophysiological information is attached to construct the electroanatomical map of the epicardium under the dynamic situation of thoracotomy; it is used to store and display the electroanatomical map of the epicardium for three-dimensional mapping. .

The epicardial pacing dragging unit is used to realize pacing, dragging and recording analysis in combination with traditional electrophysiological recorders and program-controlled stimulators, to complete the precise positioning of the bypass channel position, the pacing verification of complete conduction block, different Partial tachycardia pacing or dragging, etc., assist in judging the arrhythmia mechanism and verifying the effect of treatment.

The epicardium 3D mapping hardware unit is used to provide hardware support for epicardial 3D mapping.

Wherein, the epicardial three-dimensional mapping hardware unit is composed of a multipolar mapping catheter, a signal processing device, and a second workstation.

The multi-pole mapping catheter is used to realize the synchronous acquisition of cardiac multi-point electrophysiological signals and realize the needs of cardiac multi-point synchronous mapping. In order to achieve this function, the catheter is equipped with multiple magnetic sensors and multiple electrodes at the same time.

The multiple magnetic sensors embedded in the catheter are subject to constant magnetic force, and there is no attraction or repulsion between each other. For accurate positioning in magnetic field environments.

The catheter is equipped with multiple electrodes, which are made of platinum metal rings, and the metal materials used in the catheter are all non-magnetic. During the operation, the mapping electrodes need to be placed into the positioning magnetic field to sense the magnetic field signal. The ability of the electrode to induce the magnetic field directly affects the positioning accuracy.

The signal processing device is used to process the cardiac electrophysiological information transmitted by the mapping electrodes, realize digital signal processing and communication with the workstation, and this part can be borrowed from mature modules on the market.

The second workstation has built-in epicardial partitioning software, epicardial 3D composition and electroanatomical map display unit, and is connected to the epicardial pacing tow unit and epicardial 3D mapping hardware unit through the data interface to transmit data information .

The endocardial epicardial combined mapping algorithm is based on the principle of topology mapping, combined with the three-dimensional mapping public basic module, endocardial three-dimensional mapping, and epicardial three-dimensional mapping functions, in the dynamic deformation of the open heart. Then, the co-mapping of the endocardium and the epicardium of the corresponding region is realized.

The magnetic field generator is composed of a magnetic field generating circuit, a single-chip microcomputer, a coil, and a positioning plate, and is used to generate an external space magnetic field.

There are 9 coils in 3 groups, and they receive the current sent by the magnetic field generating circuit and generate a magnetic field.

The positioning plate is used to fix the coil that generates the magnetic field.

The magnetic field generating circuit is used to send the shock wave to the coil to form a magnetic field.

The single-chip microcomputer is used to control the operation of the magnetic field generating circuit and synchronize data with the single-chip microcomputer of the signal processing module.

It can be seen from the above technical solutions that the present application provides an overall cardiac 3D mapping system for complex arrhythmias, including a 3D mapping common basic module, an endocardial 3D magnetic localization mapping module, and an epicardial 3D mapping module , Endocardial epicardial combined mapping module. Among them, the 3D mapping public basic module provides the whole system with the construction of a 3D anatomical model of the heart and the fusion of electrophysiological information and anatomical models; the endocardial 3D magnetic localization and mapping module has built-in magnetic field generation and positioning software and hardware to provide magnetic field positioning for the entire system; The epicardium mapping module has built-in epicardial partition software; the endocardium-epicardial combined mapping module has a built-in endocardial-epicardial combined mapping algorithm to achieve overall cardiac mapping. The system can obtain and organically fuse the three-dimensional electroanatomical information jointly mapped by the endocardium and the corresponding epicardium, and realize accurate mapping under dynamic conditions such as cardiac shape, relatively fixed position and thoracotomy, and meet the requirements of complex arrhythmias. Special needs for clinical diagnosis and treatment and mechanism research.

Description of drawings

In order to more clearly illustrate the embodiments of the present application or the technical solutions in the prior art, the accompanying drawings used in the description of the embodiments and the prior art are briefly introduced below. Obviously, the described drawings are only some embodiments of the present application, and for those of ordinary skill in the art, other drawings can also be obtained based on these drawings without any creative effort.

FIG. 1 is a structural block diagram of an overall cardiac three-dimensional mapping system for complex arrhythmia provided by the present application.

FIG. 2 is a schematic diagram of the composition of an endocardial three-dimensional magnetic localization mapping module provided by the present application.

Fig. 2a is a schematic diagram of the composition of a magnetic field generator provided by the present application.

Fig. 2b is a schematic diagram of the built-in software of a workstation for endocardial three-dimensional magnetic localization mapping provided by the present application.

FIG. 3 is a schematic flow chart of a magnetic field positioning process provided by the present application.

FIG. 4 is a schematic diagram of an epicardial partition provided in this application.

FIG. 5 is a schematic diagram of an epicardial three-dimensional mapping process provided in the present application.

FIG. 6 is a schematic diagram of the principle of combined endocardial and epicardial mapping provided by the present application.

FIG. 7 is a schematic diagram of the composition of an overall cardiac three-dimensional mapping system for complex arrhythmia provided by the present application.

Detailed ways

The specific embodiments of the present application will be described in detail below with reference to the accompanying drawings. Obviously, the described embodiments are only a part of the embodiments of the present application, but not all of the embodiments. Based on the embodiments in the present application, all other embodiments obtained by those of ordinary skill in the art without creative efforts shall fall within the protection scope of the present application.

Example 1

FIG. 1 is a structural block diagram of an overall cardiac three-dimensional mapping system for complex arrhythmia provided by the present application.

As shown in FIG. 1 , the overall cardiac three-dimensional mapping system for complex arrhythmias includes a three-dimensional mapping public basic module 10, an endocardial three-dimensional magnetic localization mapping module 20, an epicardial three-dimensional mapping module 30, an intracardiac three-dimensional mapping module Membrane epicardium joint mapping module 40 .

The three-dimensional mapping public basic module 10 receives the input CT/MRI data, and is constructed of an endocardial three-dimensional magnetic localization mapping module 20, an epicardial three-dimensional mapping module 30, and an endocardial epicardial combined mapping module 40. The three-dimensional anatomical model of the heart is received, and the electrophysiological information of the mapping points taken by the endocardium and epicardial mapping electrodes is received and fused into the three-dimensional anatomical model.

The endocardial three-dimensional magnetic positioning and mapping module 20 is used to generate the spatial magnetic field required by the system, determine the position and direction of the magnetic induction catheter/mapping electrode in the magnetic field, and determine the mutual positional relationship between the catheter and the cardiac anatomical structure where it is located, and the obtained space The orientation data are respectively input into the endocardial three-dimensional magnetic mapping module 20, the epicardial three-dimensional mapping module 30, and the endocardial epicardial combined mapping module 40 to realize the magnetic positioning function; it is combined with the three-dimensional mapping public basic module 10 , used for electrical mapping of the whole endocardium, and combined with the three-dimensional image of the heart to obtain a three-dimensional electroanatomical map of the endocardium.

The three-dimensional epicardium mapping module 30 receives the data of the three-dimensional anatomical model of the epicardium of the measured object constructed by the three-dimensional mapping public basic module 10, and divides and refines the characteristic functional areas on the constructed model; Take a point on the epicardium, and obtain the ECG information and spatial position information of the point at the same time; the three-dimensional composition software uses the spatial position information of the selected mapping point to perform three-dimensional composition in real time; the electrophysiological information of the epicardial mapping electrode points, It is received by the three-dimensional mapping public basic module 10; through topological mapping, the mapping points taken in the actual epicardium are corresponding to the simulated heart model, and the electrophysiological information of the mapping points is fused to the three-dimensional anatomical model of the epicardium. ; The fusion data is output to the epicardium three-dimensional mapping module 30 to obtain a three-dimensional electroanatomical map of the epicardium, so as to realize the accurate mapping of the epicardium under dynamic conditions such as thoracotomy; the epicardium three-dimensional mapping module 30 is used for and The traditional electrophysiological recorder and the program-controlled stimulator are combined to perform pacing, dragging, recording and analysis.

The endocardium-epicardial combined mapping module 40 is used to realize the organic fusion of the electrophysiological information of the endocardium and epicardium obtained from the selected mapping points, combined with the endocardial three-dimensional magnetic localization and mapping module 20, the epicardial The membrane three-dimensional mapping module 30 and the three-dimensional mapping public basic module 10 respectively fuse the electrophysiological information of the endocardium and the epicardium with the three-dimensional anatomical graphics of the heart, and use the endocardium-epicardial joint mapping algorithm to obtain the overall Electroanatomical map of the heart.

It can be seen from the above technical solutions that the present application provides an overall cardiac 3D mapping system for complex arrhythmias, including a 3D mapping common basic module, an endocardial 3D magnetic localization mapping module, and an epicardial 3D mapping module , Endocardial epicardial combined mapping module. The public basic module of 3D mapping provides the construction of 3D anatomical model of the heart and the fusion of electrophysiological information and anatomical model for endocardial mapping, epicardial mapping and combined endocardial epicardial mapping; The measurement module has built-in magnetic field generation and positioning software and hardware, which provides magnetic field positioning for the entire system and realizes three-dimensional mapping of the endocardium; the epicardial mapping module has a built-in epicardial partition software, which realizes epicardial segmentation under dynamic conditions such as thoracotomy. Accurate mapping; the endocardium and epicardium combined mapping module has a built-in endocardium and epicardium combined mapping algorithm to realize the joint mapping of the endocardium and the corresponding epicardium. Cardiac global mapping meets the unique needs of complex arrhythmias to obtain more comprehensive cardiac electrophysiological information for clinical diagnosis, treatment and mechanism research.

The three-dimensional mapping public basic module 10 includes a heart three-dimensional anatomical model construction technology research unit 11 and a heart model and electrophysiological information fusion technology research unit 12. As shown in FIG. 7, the heart three-dimensional anatomical model construction technology research unit 11 receives the measured object Based on the CT/MRI data from the database, a three-dimensional anatomical model of the endocardium and epicardium based on the medical image data is constructed according to the anatomical structure and physiological characteristics. The measurement module 30 and the endocardium-epicardial combined mapping module 40 are respectively called to output the data to the heart model and electrophysiological information fusion technology research unit 12 to realize the fusion of the three-dimensional anatomical model of the heart and the electrophysiological information, and the fusion data are respectively output to The endocardium three-dimensional magnetic localization mapping module 20 , the epicardium three-dimensional mapping module 30 , and the endocardium-epicardial joint mapping module 40 .

The endocardial three-dimensional magnetic localization and mapping module 20 includes a magnetic field generator 21 , a magnetic localization and mapping catheter 22 , a signal processing device 23 and a first workstation 24 , as shown in FIG. 2 . It is used to provide 3D magnetic localization function and 3D mapping function of endocardium for the whole system.

The magnetic field generator 21 is used to generate the spatial positioning magnetic field required by the system, and each location in the magnetic field space has a unique magnetic field strength and magnetic field polarity. Set the space zero point in the magnetic field space as the origin of the three-dimensional coordinate. The space magnetic field strength and magnetic field frequency are within the allowable safety range of the measured object.

The magnetic field generator includes a coil 210, a magnetic field generating circuit 211, a single-chip microcomputer 212, and a positioning plate 213, as shown in Fig. 2a. The coil 210 is used to receive the current sent by the magnetic field generating circuit to generate a magnetic field. There are 3 sets of 9 coils. The positioning plate 213 is used to fix the coil for generating the magnetic field. The magnetic field generating circuit 211 is used for sending an oscillating wave to the coil to form a magnetic field. The single-chip microcomputer 212 is used to control the operation of the magnetic field generating circuit and synchronize data with the single-chip microcomputer of the signal processing module.

The magnetic positioning and mapping catheter 22 is equipped with a plurality of magnetic sensors and mapping electrodes, which are used for sensing the signals of the spatial magnetic field, and are used for taking points on the anatomical structure of the heart to obtain electrophysiological information.

The signal processing device 23 receives information from the magnetic positioning and mapping catheter 22, and is used to process the spatial orientation information of the mapping electrodes and the cardiac electrophysiological information transmitted by the magnetic positioning sensor, realize digital signal processing and communication with the workstation, and at the same time Control the magnetic field generation module to ensure that the signal of the mapping catheter is synchronized with the magnetic field generation module. The processing result is output to the first workstation 24 .

The first workstation 24 receives the spatial orientation and electrophysiological information output by the signal processing device 23, and realizes the three-dimensional magnetic positioning of the mapping catheter and the mapping electrodes and the three-dimensional mapping of the heart. The first workstation 24 has built-in magnetic positioning software 241 , three-dimensional composition software 242 , magnetic positioning system electrocardiographic analysis software 243 , and a graphic output and display unit 244 , as shown in FIG. 2 b .

The magnetic positioning software 241 receives the spatial orientation information of the mapping electrode collection point output by the signal processing device 23 through the data interface, and calculates the corresponding spatial three-dimensional coordinates and directions to determine the position and attitude of the mapping electrode and the catheter tip. The spatial three-dimensional coordinates and orientation data are output to the three-dimensional composition software 242 . Magnetic positioning software 241 is used to receive and process positioning information such as the magnetic field strength and direction of dozens of magnetic sensors. In terms of algorithms, it improves the existing three-dimensional magnetic positioning technology based on three magnetic sensors. With the help of parallel algorithms Real-time data processing is performed to achieve multi-point synchronous and accurate magnetic positioning to meet the needs of multi-point synchronous mapping and high-precision three-dimensional magnetic positioning. Magnetic positioning software 241, three-dimensional calibration positioning accuracy≤1mm.

The three-dimensional composition software 242 receives the three-dimensional spatial orientation information of the mapping points taken by the catheter or the mapping electrodes input by the magnetic positioning software 241, and uses the triangular patch generation method and the smoothing algorithm to establish a three-dimensional anatomical structure model of the heart in real time. The established three-dimensional model It can be observed from any angle, and the 3D model composition deviation is less than or equal to 2mm. At the same time, on the established 3D structure model, the position and attitude of the magnetic positioning mapping electrode or mapping catheter are displayed in real time, and the data output by the 3D composition software 242 is sent to the 3D structure The mapping common base module 10 is used as a geometric model for three-dimensional mapping.

The core of the real-time 3D composition of the heart involves the cardiac cavity reconstruction algorithm. The cardiac cavity reconstruction algorithms that are more suitable for magnetic field positioning mainly include the spherical contraction method, the radial basis function solution method, and the real-time construction method. The real-time construction method can quickly reconstruct the cardiac cavity and Pulmonary veins are more suitable for use here, and the three-dimensional configuration deviation of the system is less than or equal to 2mm.

The electrocardiographic analysis software 243 of the magnetic positioning system receives the electrocardiographic information of the mapping electrode collection point output by the signal processing device 23 through the data interface, and realizes the real-time storage of the electrocardiographic information of the cardiac mapping point dynamic change with time and the waveform display on the computer. . The ECG information collected by the mapping electrodes, after being processed by the signal processing module 23, is input to the ECG analysis software 243, processed by the ECG analysis algorithm, and the ECG analysis software 243 obtains the ECG data sampling points of each mapping point on the computer screen. The abscissa and ordinate on the computer screen can display the ECG waveform of the ECG information of the mapping point dynamically changing with time.

The graphic output and display unit 244 calls the heart model and electrophysiological information fusion technology research unit 12 of the three-dimensional mapping public basic module 10 to realize the matching and fusion of the endocardial three-dimensional anatomical model and the electrophysiological information of the collection point, and obtain the endocardial three-dimensional Electroanatomical map, realize the storage and display of 3D anatomical graph, ECG waveform, 3D electroanatomical graph on the screen.

The epicardial 3D mapping module 30 includes epicardial partition software 31 , an epicardial 3D mapping and electroanatomical map display unit 32 , an epicardial pacing and dragging unit 33 , and an epicardial 3D mapping hardware unit 34 .

The epicardium partition software 31 receives the data of the simulated three-dimensional anatomical model of the epicardium, and communicates the data with the three-dimensional mapping common basic module 10 . The epicardium partitioning software 31 is used to realize interactive and automatic partitioning according to the characteristic points on the simulated three-dimensional anatomical model of the epicardium, and instruct the operator to take points on the actual epicardium. A schematic representation of the epicardial subdivision is shown in Figure 4.

The epicardium 3D mapping and electroanatomical map display unit 32 receives the spatial position information and ECG information of the mapping electrode collection point on the mapping catheter, and communicates with the signal processing device 341 in the epicardial 3D mapping hardware unit 34 through data. interface for data transfer. It is used to realize the acquisition of points on the epicardium of the measured object based on the mapping catheter, and use the triangular patch method to construct a three-dimensional geometric model of the epicardium in real time; the ECG information and spatial position information processed by the signal processing device 341 are input into the three-dimensional marker. The measurement public basic module 10 is used to match the ECG information with the spatial position, so as to realize the fusion of the ECG information and the cardiac anatomical model. Using the mathematical method of topological mapping, the mapping points collected on the actual epicardium are mapped to the three-dimensional anatomical model of the simulated epicardium, and the electrophysiological information is attached to realize the construction of the electroanatomical map of the epicardium under dynamic conditions such as thoracotomy. With the help of computer, the storage and display of epicardial three-dimensional electroanatomical map can be realized.

The epicardial pacing dragging unit 33 is used to realize pacing, dragging and recording analysis in combination with traditional electrophysiological recorders and program-controlled stimulators, to complete the precise positioning of the bypass channel position, the pacing verification of complete conduction block, The pacing or dragging of tachycardia in different parts can assist in judging the arrhythmia mechanism and verifying the effect of treatment.

The epicardium 3D mapping hardware unit 34 is used to provide hardware support for epicardial 3D mapping. The epicardial three-dimensional mapping hardware unit 34 includes a multipolar mapping catheter 340 , a signal processing device 341 , and a second workstation 342 .

The multi-pole mapping catheter 340 is used to realize the synchronous acquisition of cardiac multi-point electrophysiological signals and realize the needs of cardiac multi-point synchronous mapping. In order to achieve this function, the catheter is equipped with multiple magnetic sensors and multiple electrodes at the same time. Magnetic positioning software 241, three-dimensional composition software 32, etc., are used to take points in a magnetic field environment to achieve accurate positioning and simultaneous mapping of multiple points of the heart.

The multiple magnetic sensors embedded in the catheter are subject to constant magnetic force, and there is no attraction or repulsion between each other. For accurate positioning in magnetic field environments.

The catheter is equipped with multiple electrodes, which are made of platinum metal rings, and the metal materials used in the catheter are all non-magnetic. During the operation, the mapping electrodes need to be placed into the positioning magnetic field to sense the magnetic field signal. The ability of the electrode to induce the magnetic field directly affects the positioning accuracy.

The signal processing device 341 is used to process the cardiac spatial position and electrophysiological information transmitted by the magnetic sensor and the mapping electrode, and realize digital signal processing and communication with the computer.

The second workstation 342 has built-in epicardial partitioning software, epicardial three-dimensional mapping and electroanatomical map display units, and is connected to the signal processing device, the multi-polar mapping catheter and the epicardial pacing tow unit through the interface to perform data information transfer. It is used to realize graph construction, display, algorithm analysis, human-computer interaction, data transfer, etc.

The endocardial epicardial joint mapping module 40 communicates with the endocardial three-dimensional magnetic localization mapping module 20, the epicardial three-dimensional mapping module 30, and the three-dimensional mapping common basic module 10 through the data interface, and transmits data to the intracardiac three-dimensional mapping module 20. The electrophysiological information of the membrane and epicardium is correspondingly fused with the three-dimensional anatomical graphics of the heart, and the endocardium and epicardial electrophysiological information obtained by taking points is organically fused with the help of the endocardium-epicardial joint mapping algorithm. Electroanatomical map of the whole heart.

Embodiment 2

This embodiment specifically illustrates that the overall cardiac three-dimensional mapping system for complex arrhythmias provided by the present application realizes accurate epicardial mapping and overall cardiac mapping under dynamic conditions of open chest in clinical diagnosis and treatment and mechanism research. The process of 3D mapping.

FIG. 7 is a schematic diagram of the composition of an overall cardiac three-dimensional mapping system for complex arrhythmia provided by the present application.

As shown in Figure 7, if a subject with complex arrhythmia needs to perform the whole cardiac three-dimensional electroanatomical mapping operation, three-dimensional magnetic localization, endocardial three-dimensional mapping, epicardial three-dimensional mapping, cardiac Endocardium and epicardium combined mapping, the specific steps are as follows.

The realization process of 3D magnetic positioning is carried out according to the following steps.

1. As shown in Figure 3, the magnetic field generator 21 generates the space magnetic field required for three-dimensional magnetic positioning. Each location in the magnetic field space has a unique magnetic field strength and magnetic field polarity, and a space zero point is set in the magnetic field space, which is used as a three-dimensional coordinate. origin.

2. When the mapping catheter 22 equipped with the magnetic sensor moves in the magnetic field, the magnetic sensor can measure the magnetic field strength and magnetic field direction information at the location.

3. The magnetic field information is subjected to signal processing such as amplification, filtering, and analog-to-digital conversion through the signal processing device 23, and is input to the computer 24 with built-in magnetic positioning and mapping software through the communication data interface.

4. Determine the coordinate position and attitude of the mapping catheter in space through the built-in magnetic positioning software of the computer 24, and realize the positioning of the magnetic catheter and the mapping electrode in combination with the relative spatial position relationship of the mapping electrodes on the mapping catheter.

The realization process of 3D endocardial mapping is carried out according to the following steps.

1. The mapping electrodes are taken on the endocardium of the heart, and each point is accompanied by spatial information and ECG information.

2. The spatial information is input into the magnetic positioning software built in the first workstation 24 to obtain the three-dimensional coordinates of the mapping point and the direction data of the mapping electrode and the catheter, so as to realize the magnetic positioning of the mapping electrode and the catheter.

3. Input the three-dimensional coordinates of the mapping point and the direction data of the mapping electrodes and the catheter into the three-dimensional composition software in the first workstation 24 to construct an anatomical map for cardiac mapping.

4. The ECG information is input to the signal processing module 23 for signal processing such as amplification and analog-to-digital conversion.

5. The processed information is received by the communication interface of the first workstation 24, and the three-dimensional mapping public basic module 10 is invoked to realize the fusion and registration of the ECG information and the cardiac mapping anatomical graphics, and obtain a three-dimensional electroanatomical map of the cardiac endocardium. Complete endocardial 3D mapping.

The realization process of epicardial partition is as follows.

1. Input the CT/MRI image data to the computer through the data interface, and receive it by the three-dimensional mapping public basic module 10. According to the anatomical structure and physiological characteristics, a three-dimensional simulated cardiac anatomy model including endocardium and epicardium is constructed.

2. Compiling the epicardium partition software 31, according to the needs of electrophysiological mapping, different feature points can be selected on the epicardium, and different regions can be divided according to the feature points.

3. Through the human-computer interaction interface of the partition software, feature points can be added and deleted as required, and the partition can be refined to ensure the accuracy of the epicardial mapping of the thoracotomy deformed heart.

The realization process of the three-dimensional mapping of the epicardium of the thoracotomy deformed heart is carried out according to the following steps.

1. As shown in FIG. 5 , the three-dimensional reconstruction of the heart is performed by the three-dimensional mapping public basic module 10 based on the CT/MRI data to obtain a three-dimensional anatomical model of the simulated heart.

2. The operator sets the epicardium partition on the three-dimensional anatomical model of the simulated heart and selects the feature points. On the epicardium of the actual heart, the corresponding region to be selected is set, and the corresponding feature points are found.

3. Select a feature point to obtain the ECG information of the point.

4. After being processed by the signal processing module, it is received by the three-dimensional mapping public basic module 10, and the ECG information is matched with the spatial position to realize the fusion of the ECG information and the three-dimensional anatomical model of the heart.

5. According to the topological mapping relationship, the points taken on the real model are mapped to the simulated heart model, and the electrophysiological information is attached to obtain the basic three-dimensional electroanatomical model.

6. According to needs, new points can be added around the feature points, or inappropriate feature points can be deleted, so as to obtain a three-dimensional electrophysiological model of the epicardium that meets the requirements, and realize the three-dimensional mapping of the epicardium of the open chest deformed heart.

Implementation of combined endocardial epicardial mapping:

FIG. 6 is a schematic diagram of the principle of combined endocardial and epicardial mapping provided by the present application. With reference to FIG. 6 , the principle of combined endocardial epicardial mapping and its realization process are described. Among them, the feature points A, B, A', B' are the endocardium, the epicardium and their corresponding points, representing any point that meets the requirements.

As shown in FIG. 6 , the implementation process of the combined endocardial and epicardial mapping is carried out as follows.

1. The three-dimensional mapping public basic module 10 receives the CT/MRI image data input from the data interface, and constructs a three-dimensional simulated cardiac anatomy model according to the anatomical structure and physiological characteristics.

2. Call the 3D simulated cardiac anatomy model established by the 3D mapping public basic module 10, select appropriate feature points, and use the epicardial zoning software 31 to perform epicardial zoning based on the feature points.

3. Take point A' on the actual endocardium, construct an actual three-dimensional composition of the heart including the endocardium, and obtain the electrophysiological information of the selected mapping point A', and perform endocardial mapping;

4. According to the topology mapping, the endocardium mapping point A' is corresponding to the endocardium of the three-dimensional simulated heart model, and the endocardial virtual mapping point A is obtained;

5. On the three-dimensional virtual model of the heart, the corresponding virtual corresponding points B of the epicardium are obtained according to the virtual mapping point A of the endocardium. These points are used as basic points to guide the operation in combination with the epicardial partitions and feature points on the virtual model. The person purposefully takes points on the actual epicardium.

6. On the epicardium of the actual heart, set the area to be taken, find the corresponding basic point B', take the point, and obtain the ECG information. After processing by the signal processing module, the spatial information of the selected mapping point is obtained. The positioning software is input for positioning processing, and the output information is input into the three-dimensional composition software for real-time three-dimensional composition; the spatial information and ECG information of the selected mapping points are received by the three-dimensional mapping public basic module 10, and the ECG information is matched with the spatial position. Realize the fusion of ECG information and cardiac anatomical model.

7. According to the topological mapping relationship, the point B' taken on the real model is mapped to the simulated heart model, and the electrophysiological information is attached to obtain the basic overall three-dimensional electroanatomical model of the heart including the endocardium and the corresponding epicardium. .

8. According to needs, more points can be taken around the basic point, and inappropriate points can be deleted to obtain a three-dimensional electroanatomical model of the whole heart that meets the requirements, and complete the three-dimensional mapping of the whole heart.

It can be seen from the realization process of each function of the system disclosed above that the system provided by the present application can obtain and organically fuse the three-dimensional electroanatomical information jointly mapped by the endocardium and the epicardium of the corresponding region, and realize the relative fixedness of the heart shape, position and location. It can accurately map under dynamic conditions such as thoracotomy, meeting the special needs of complex arrhythmia to obtain more comprehensive electrophysiological information for clinical diagnosis and treatment and mechanism research.

The two embodiments in this specification have their own emphases. The first embodiment mainly describes the system composition and the functions of each component, and the second embodiment mainly describes the process of realizing each function of the system. The same or similar parts between the two embodiments can be referred to each other. The above description of the disclosed embodiments enables those skilled in the art to implement the present application. Various modifications to the above embodiments, as long as they do not depart from the spirit or scope of the present application, fall within the protection scope of the present application. Therefore, the present application is not to be limited by the examples provided herein, but is to be accorded the widest scope consistent with the principles and novel features disclosed herein.

Claims (10)

1. a whole heart three-dimensional mapping system for complex arrhythmia, is characterized in that, comprises: The three-dimensional mapping public basic module is used to construct a three-dimensional anatomical model of the heart for each mapping module of the system, and fuse the electrophysiological information of the points of the mapping catheter into the three-dimensional anatomical model; The endocardial three-dimensional magnetic positioning and mapping module is used to generate the spatial magnetic field required by the system, determine the position and direction of the magnetic induction catheter in the magnetic field, determine the mutual positional relationship between the catheter and the cardiac anatomical structure where it is located, and realize the magnetic positioning function; Combined with the common basic module for measurement, it is used to conduct electrical mapping of the entire endocardium, and combine it with the three-dimensional cardiac image to obtain a three-dimensional electroanatomical map of the endocardium; The epicardium 3D mapping module is used to divide and refine the characteristic functional area on the 3D anatomical model of the epicardium of the measured object; the topological mapping method is used, combined with the common basic module of 3D mapping, for epicardial mapping The overall electrical mapping is carried out and combined with the three-dimensional cardiac image to obtain a three-dimensional epicardial electroanatomical map to achieve accurate epicardial mapping under dynamic conditions of thoracotomy; it is used to combine with traditional electrophysiological recorders and programmable stimulators , for pacing, dragging, recording and analysis; The endocardium-epicardium joint mapping module is used to realize the corresponding fusion of the endocardium and epicardium electrophysiological information with the three-dimensional anatomical graphics of the heart, and with the help of the endocardium-epicardium joint mapping algorithm, organic fusion The endocardium and epicardium electrophysiological information obtained from the mapping points are used to obtain the electroanatomical mapping map of the whole heart; The realization of the combined endocardial and epicardial mapping is carried out according to the following steps: (a) The public basic module of three-dimensional mapping receives the CT/MRI image data input from the data interface, and constructs a three-dimensional simulated cardiac anatomy model according to the anatomical structure and physiological characteristics (b) The 3D simulated cardiac anatomical model established by the public basic module of 3D mapping is called, and the appropriate feature points are selected, and the epicardial segmentation software is used to perform epicardial segmentation based on the feature points; (c) In the actual endocardium Take point A' above to construct the actual three-dimensional composition of the heart including the endocardium, and obtain the electrophysiological information of the selected mapping point A' to perform endocardial mapping; (d) According to the topological map, the endocardium is mapped. The mapped point A' corresponds to the endocardium of the three-dimensional simulated heart model, and the endocardial virtual mapping point A is obtained; (e) On the three-dimensional virtual model of the heart, the corresponding endocardial virtual mapping point A is obtained. The virtual corresponding point B of the epicardium, these points are used as basic points, combined with the epicardial partition and feature points on the virtual model, to guide the operator to take points on the actual epicardium; (f) in the heart of the actual heart. On the adventitia, set the area to be taken, find the corresponding basic point B', take the point, and obtain the ECG information. After being processed by the signal processing module, the spatial information of the selected mapping point is input into the positioning software for positioning processing. The output information is input into the 3D composition software for real-time 3D composition; the spatial information and ECG information of the selected mapping points are received by the 3D mapping public basic module, and the ECG information and the spatial position are matched to realize the ECG information and the heart anatomy model. (g) According to the topological mapping relationship, the point B' taken on the real model is mapped to the simulated heart model, and the electrophysiological information is attached to obtain the basic overall heart including the endocardium and the corresponding epicardium. Three-dimensional electroanatomical model. 2. The overall cardiac three-dimensional mapping system for complex arrhythmias according to claim 1, wherein the three-dimensional mapping common basic module comprises: a heart three-dimensional anatomical model construction technology research unit, which is used to realize CT-based /MRI data to build a simulated cardiac anatomical model; the research unit of cardiac model and electrophysiological information fusion technology is used to realize the fusion of three-dimensional cardiac anatomical model and electrophysiological information. 3. The overall cardiac three-dimensional mapping system for complex arrhythmias as claimed in claim 2, wherein the three-dimensional anatomical model construction technology research unit of the heart constructs a medical imaging data-based cardiac imaging system according to anatomical structure and physiological characteristics. The three-dimensional anatomical model of endocardium and epicardium serves as the model basis for endocardial mapping, epicardial mapping, and combined endocardial and epicardial mapping. 4. The overall cardiac three-dimensional mapping system for complex arrhythmias as claimed in claim 2, wherein the endocardial three-dimensional magnetic positioning and mapping module has built-in magnetic field generation and positioning software and hardware to provide the entire system with Magnetic field positioning, mainly including: The magnetic field generator is used to generate the space magnetic field required by the system, and the space magnetic field strength and magnetic field frequency conform to the safety range of the measured object; The magnetic positioning software is used to determine the spatial position and attitude of the mapping electrode and the catheter tip; in addition, it is used to simultaneously receive and process the magnetic field strength and magnetic field direction positioning information of dozens of magnetic sensors to achieve multi-point synchronous and accurate magnetic positioning. The positioning accuracy of the three-dimensional standard is less than or equal to 1mm; Magnetic positioning three-dimensional composition software is used to construct the three-dimensional geometric configuration of the heart in real time according to the spatial position or direction coordinates of the mapping electrodes and the mapping catheter calculated by the positioning software, and at the same time, on the anatomical configuration of the heart, real-time construction of the mapping catheter. Position and attitude, the system requires three-dimensional configuration deviation ≤ 2mm; The ECG analysis software of the magnetic positioning system is used to realize the real-time storage of cardiac electrophysiological information over time and the dynamic waveform display on the computer; through the processing of the ECG analysis algorithm, the ECG data sampling points of each mapping point are obtained on the computer screen. The horizontal and vertical coordinates on the . 5 . The overall cardiac three-dimensional mapping system for complex arrhythmias according to claim 4 , wherein the endocardium three-dimensional magnetic localization mapping module can be combined with a three-dimensional mapping public basic module to obtain endocardium. 6 . Three-dimensional electroanatomical map, endocardial three-dimensional mapping. 6. The overall cardiac three-dimensional mapping system for complex arrhythmias according to claim 5, wherein the magnetic field generator is composed of a magnetic field generating circuit, a single-chip microcomputer, a coil, and a positioning plate, and is used to generate an extracorporeal space magnetic field; The magnetic field generating circuit is used to send the shock wave to the coil to form a magnetic field; The single-chip microcomputer is used to control the operation of the magnetic field generating circuit and synchronize data with the single-chip microcomputer of the signal processing module; There are 9 coils in 3 groups, which receive the current sent by the magnetic field generating circuit and generate the space magnetic field required by the system; The positioning plate is used to fix the coil that generates the magnetic field. 7. The overall cardiac three-dimensional mapping system for complex arrhythmias according to claim 5, wherein the epicardium three-dimensional mapping module mainly comprises: The epicardium partitioning software is used to realize the interactive and automatic partitioning according to the characteristic points on the simulated epicardium 3D anatomical model, and guide the operator to take points on the actual epicardium; through the human-computer interaction interface of the partitioning software, the It is necessary to add and delete feature points and refine the partition; The epicardium three-dimensional composition and electroanatomical map display unit is used to realize the point-taking on the heart of the measured object based on the mapping catheter or the mapping electrode. The triangular patch method is used to construct a real-time three-dimensional geometric model of the heart for the three-dimensional epicardium. For mapping; call the public basic module of 3D mapping to match the ECG information with the spatial position of the mapping points to realize the fusion of the ECG information and the cardiac anatomy model; using the topology mapping method, the data collected on the actual epicardium are The mapping points are mapped to the three-dimensional anatomical model of the simulated heart epicardium, and the electrophysiological information is attached to construct the electroanatomical map of the epicardium under the dynamic situation of thoracotomy; it is used to store and display the electroanatomical map of the epicardium for three-dimensional mapping. ; The epicardial pacing dragging unit is used to realize pacing, dragging and recording analysis in combination with traditional electrophysiological recorders and program-controlled stimulators, to complete the precise positioning of the bypass channel position, the pacing verification of complete conduction block, different Pacing or dragging of local tachycardia to assist in judging the arrhythmia mechanism and verifying the effect of treatment; The epicardium 3D mapping hardware unit is used to provide hardware support for epicardial 3D mapping. 8. The overall cardiac three-dimensional mapping system for complex arrhythmias according to claim 7, wherein the epicardium three-dimensional mapping hardware unit mainly comprises: Multi-polar mapping catheter, used to realize the synchronous acquisition of cardiac multi-point electrophysiological signals, to meet the needs of cardiac multi-point synchronous mapping; the catheter is equipped with multiple magnetic sensors and multiple electrodes at the same time; multiple embedded in the catheter The magnetic sensor has a constant magnetic force, and there is no attraction or repulsion between each other, which is used for accurate positioning in a magnetic field environment; the catheter is equipped with multiple electrodes, which are made of platinum metal rings, and the metal materials used in the catheter are all non-magnetic; during surgery It is necessary to put the mapping electrodes into the positioning magnetic field to sense the magnetic field signal. 9 . The overall cardiac three-dimensional mapping system for complex arrhythmias according to claim 8 , wherein the endocardium-epicardial joint mapping module has a built-in endocardium-epicardial joint mapping algorithm. 10 . , which is used to fuse the electrophysiological information of the endocardium and epicardium with the three-dimensional anatomical graphics of the heart respectively, so as to realize the organic fusion of the electrophysiological information of the endocardium and epicardium obtained from the selected mapping points, and obtain the electrophysiological information of the whole heart. Anatomical map. 10 . The overall cardiac three-dimensional mapping system for complex arrhythmias according to claim 9 , wherein the combined endocardial and epicardial mapping algorithm is based on the principle of topology mapping, combined with three-dimensional mapping. 11 . The common basic module, endocardium 3D mapping module, and epicardium 3D mapping module realize the common mapping of the endocardium and the corresponding epicardium in the case of dynamic deformation of the open heart.

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