Systems and methods for simulation prediction of targets for catheter ablation of left atrial flutter in patients with atrial structural remodeling

Patent metadata

Field	Value
Publication number	US-10842401-B2
Application number	US-201615573292-A
Country	US
Kind code	B2
Filing date	May 12, 2016
Priority date	May 12, 2015
Publication date	Nov 24, 2020
Grant date	Nov 24, 2020

Abstract

A computer-implemented method for non-invasively identifying ablation locations in atrial tissue, can include: receiving three-dimensional imaging data representing atrial tissue of a left atrial flutter (LAFL) subject; generating a subject-specific model of the at least one of the atrial tissue from the three-dimensional imaging data; estimating tissue fiber orientations in the atrial tissue; assigning the estimated tissue fiber orientations to the subject-specific model of the atrial tissue; conducting simulations of LAFL using the subject-specific model to identify regions of slow conduction of a propagating wave within an atrial tissue region of the atrial tissue; a critical isthmus of a rotational wavefront within the atrial tissue region; or a region based on a minimum cut in a flow network; and identifying at least one ablation location in the atrial tissue region based on the identified regions of slow conduction, the critical isthmus, or the minimum cut.

First claim

We claim:

1. A computer-implemented method for non-invasively identifying ablation locations in atrial tissue, comprising:
receiving three-dimensional imaging data representing atrial tissue of a left atrial flutter (LAFL) subject, wherein said atrial tissue includes at least one of a left atrium and a right atrium;
generating a subject-specific model of said at least one of said atrial tissue from said three-dimensional imaging data;
estimating tissue fiber orientations in said atrial tissue;
assigning said estimated tissue fiber orientations to said subject-specific model of said atrial tissue;
conducting simulations of LAFL using the subject-specific model to identify 1) regions of slow conduction of a propagating wave within an atrial tissue region of said atrial tissue; 2) a critical isthmus of a rotational wavefront within said atrial tissue region; or 3) a region based on a minimum cut in a flow network;
identifying at least one ablation location in the atrial tissue region based on at least one of said identified regions of slow conduction, said critical isthmus, or said minimum cut;
wherein identifying the at least one ablation location includes identifying one or more ablation lesion locations and at least one line connecting said one or more lesion locations with a nearest non-conductive anatomical barrier;
wherein the non-conductive anatomical barrier is a pulmonary vein or an ablation lesion from a pulmonary vein isolation procedure that encircled the pulmonary vein;
identifying connecting targets where transection lesion endpoints must extend so that a wave cannot propagate around the lesion; and
wherein said pulmonary vein isolation ablation is executed prior to extending said ablation lesion to said connecting targets.

2. The method of claim 1 , wherein said at least said atrial tissue includes both said left atrium and said right atrium.

3. The method of claim 1 , wherein said generating said subject-specific model further comprises identifying normal tissue regions and remodeled tissue regions of said three-dimensional imaging data and assigning tissue properties to said normal tissue regions and said remodeled tissue regions.

4. The method of claim 3 , wherein the remodeled tissue regions includes a plurality of degrees of fibrosis.

5. The method of claim 1 , wherein said identifying at least one ablation location in the atrial tissue region identifies at least one ablation location to render the subject non-inducible for LAFL.

6. The method of claim 1 , wherein said generating said subject-specific model of said atrial tissue region includes a representation of an ablation lesion in said subject from a previous procedure.

7. The method of claim 1 , wherein the non-conductive anatomical barrier is a mitral valve.

8. A non-transient computer-readable medium comprising computer-executable code that, when executed by a computer, causes the computer to perform:
receiving three-dimensional imaging data representing atrial tissue of a left atrial flutter (LAFL) subject, wherein said atrial tissue includes at least one of a left atrium and a right atrium;
generating a subject-specific model of said at least one of said atrial tissue from said three-dimensional imaging data;
estimating tissue fiber orientations in said atrial tissue;
assigning said estimated tissue fiber orientations to said subject-specific model of said atrial tissue;
conducting simulations of LAFL using the subject-specific model to identify 1) regions of slow conduction of a propagating wave within an atrial tissue region of said atrial tissue; 2) a critical isthmus of a rotational wavefront within said atrial tissue region; or 3) a region based on a minimum cut in a flow network;
identifying at least one ablation location in the atrial tissue region based on at least one of said identified regions of slow conduction, said critical isthmus, or said minimum cut;
wherein said generating said subject-specific model of said atrial tissue region includes a representation of an ablation lesion in said subject from a previous procedure;
wherein said identifying the at least one ablation location includes identifying one or more ablation lesion locations and at least one line connecting said one or more lesion locations with a nearest non-conductive anatomical barrier;
wherein the non-conductive anatomical barrier is a pulmonary vein or an ablation lesion from a pulmonary vein isolation procedure that encircled the pulmonary vein;
identifying connecting targets where transection lesion endpoints must extend so that a wave cannot propagate around the lesion; and
wherein said pulmonary vein isolation ablation is executed prior to extending said ablation lesion to said connecting targets.

9. The non-transient computer-readable medium of claim 8 , wherein said at least said atrial tissue includes both said left atrium and said right atrium.

10. The non-transient computer-readable medium of claim 8 , wherein said generating said subject-specific model further comprises identifying normal tissue regions and remodeled tissue regions of said three-dimensional imaging data and assigning tissue properties to said normal tissue regions and said remodeled tissue regions.

11. The non-transient computer-readable medium of claim 10 , wherein the remodeled tissue regions includes a plurality of degrees of fibrosis.

12. The non-transient computer-readable medium of claim 8 , wherein said identifying at least one ablation location in the atrial tissue region identifies at least one ablation location to render the subject non-inducible for LAFL.

13. The non-transient computer-readable medium of claim 8 , wherein the non-conductive anatomical barrier is a mitral valve.

14. A computer-implemented method for non-invasively identifying ablation locations in atrial tissue, comprising:
receiving three-dimensional imaging data representing atrial tissue of a left atrial flutter (LAFL) subject, wherein said atrial tissue includes at least one of a left atrium and a right atrium;
generating a subject-specific model of said at least one of said atrial tissue from said three-dimensional imaging data;
estimating tissue fiber orientations in said atrial tissue;
assigning said estimated tissue fiber orientations to said subject-specific model of said atrial tissue;
conducting simulations of LAFL using the subject-specific model to identify 1) regions of slow conduction of a propagating wave within an atrial tissue region of said atrial tissue; 2) a critical isthmus of a rotational wavefront within said atrial tissue region; or 3) a region based on a minimum cut in a flow network; and
identifying at least one ablation location in the atrial tissue region based on at least one of said identified regions of slow conduction, said critical isthmus, or said minimum cut;
wherein identifying the at least one ablation location includes identifying one or more ablation lesion locations and at least one line connecting said one or more lesion locations with a nearest non-conductive anatomical barrier; and
identifying connecting targets where transection lesion endpoints must extend so that a wave cannot propagate around the lesion.

Assignees

• Univ Johns Hopkins

Inventors

• Trayanova Natalia A
• Zahid Sohail
• Boyle Patrick

Classifications

• A61B5/361 Primary

  Detecting fibrillation · CPC title

• A61B5/0059 Primary

  using light, e.g. diagnosis by transillumination, diascopy, fluorescence (photoacoustic A61B5/0093; optical measurement of heart rate A61B5/02416; optical measurement of blood flow A61B5/0261; optical measurement of analytes A61B5/1455) · CPC title

• A61B2018/00839

  Bioelectrical parameters, e.g. ECG, EEG · CPC title

• A61B2018/00357

  Endocardium · CPC title

• A61B2018/00577

  Ablation · CPC title