# US 10,765,336 B2 · System and method for planning a patient-specific cardiac procedure > Agents: this data is available as JSON from the patentgrep API and MCP server — see https://patentgrep.com/llms.txt - Number: US 10,765,336 B2 - Document ID: US10765336B2 - Status: Granted - Kind: B2 - Application number: 13/984,741 - Filed: 2012-02-10 - Published: 2014-03-27 - Granted: 2020-09-08 - Earliest claimed: 2011-02-11 - Assignees: The Johns Hopkins University - Applicants: Natalia A. Trayanova; Henry R. Halperin; Hermenegild Arevalo; Jason Constantino - Inventors: Natalia A. Trayanova; Henry R. Halperin; Hermenegild Arevalo; Jason Constantino - Web page: https://patentgrep.com/patent/US10765336B2 ## CPC - A61B 5/28: for electrocardiography [ECG] - A61B 5/055: involving electronic [EMR] or nuclear [NMR] magnetic resonance, e.g. magnetic resonance imaging - A61B 5/319: Circuits for simulating ECG signals - A61B 6/503: {for diagnosis of the heart} - A61B 34/10: Computer-aided planning, simulation or modelling of surgical operations - G06T 19/00: Manipulating three-dimensional [3D] models or images for computer graphics - G16H 50/50: for simulation or modelling of medical disorders - A61B 6/032: {Transmission computed tomography [CT]} - A61B 6/037: {Emission tomography} - A61B 6/466: {adapted to display 3D data} - A61B 6/5223: {generating planar views from image data, e.g. extracting a coronal view from a 3D image} - A61B 8/0883: {for diagnosis of the heart} - A61B 8/13: Tomography (A61B8/10, A61B8/12 take precedence) - A61B 2505/05: Surgical care - A61B 2576/023: for the heart - G06T 2210/41: Medical - A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D) - G06T: IMAGE DATA PROCESSING OR GENERATION, IN GENERAL - G16H: HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA ## Abstract A method of planning a patient-specific cardiac procedure according to an embodiment of the current invention includes receiving three-dimensional imaging data of a patient's heart, simulating at least one of electrophysiological or electromechanical activity of at least a portion of the patient's heart using the three-dimensional imaging data, and planning the patient-specific cardiac procedure based on the simulating. The cardiac procedure is for providing a preselected alteration of at least one of electrophysiological or electromechanical behavior of the patient's heart. ## Claims ### Claim 1 A non-invasive computer-implemented method of producing a personalized set of cardiac ablation targets to treat ventricular tachycardia in a living patient's heart, comprising: receiving contrast-enhanced three-dimensional MRI or CT data of at least a portion of said living patient's heart; segmenting said contrast-enhanced three-dimensional MRI or CT data to obtain three-dimensional heart image data; segmenting said three-dimensional heart image data into at least three different tissue types of said heart based on said contrast-enhanced three-dimensional MRI or CT data, said at least three different tissue types including a normal tissue region, a scar tissue region and a transition zone region, said transition zone region including an infarct border zone tissue region and being characterized as having electrophysiological properties bounded by the properties of the normal and scar tissue regions; constructing a model of at least a portion of said living patient's heart, said constructing said model comprising: creating a finite element mesh using the segmented three-dimensional data, to provide a geometrical representation of said patient's heart, the finite element mesh comprising a plurality of volume elements, wherein the volume elements each represent a volume having an edge length in a range of about 300-400 microns; determining a fiber orientation in each of the volume elements based on calculations executed on a patient-specific geometry of the patient's heart; and assigning electrophysiological parameters to each of the volume elements taking into account the determined fiber orientations and the type of tissue where the corresponding volume element is located; simulating, using a computer, at least one of electrophysiological or electromechanical activity of at least a portion of said living patient's heart using said model, said simulating inducing an arrhythmia in said model of said living patient's heart; producing, using said model, a personalized set of cardiac ablation targets representing locations in the heart critical to sustaining simulated ventricular tachycardia, such that when the targets are ablated, all simulated ventricular tachycardia is eliminated with a minimal ablation lesion size, wherein said producing a personalized set of cardiac ablation targets comprises simulating an initial target ablation, and upon the initial target ablation not eliminating all the simulated ventricular tachycardia re-calculating the personalized set of cardiac ablation targets; and exporting said personalized set of ablation targets for use during the ablation procedure to treat ventricular tachycardia. ### Claim 2 (depends on 1) The method of claim 1, further comprising: receiving additional patient-specific data that includes at least one of biopsy data, electrocardiogram data, recorded data from an implantable device, or invasive electrical mapping data, wherein said simulating uses said additional patient-specific data. ### Claim 3 (depends on 1) The method of claim 1, wherein said model of said at least said portion of said patient's heart includes at least a model of right and left ventricles of said patient's heart, wherein said simulating at least one of electrophysiological or electromechanical activity is simulating electrophysiological activity of at least said right and left ventricles of said living patient's heart, and wherein said producing said personalized set of ablation targets is providing a personalized set of cardiac ablation targets to alleviate a ventricular arrhythmia. ### Claim 4 (depends on 3) The method of claim 3, wherein said ventricular arrhythmia is a ventricular tachycardia. ### Claim 5 (depends on 3) The method of claim 3, wherein said producing said personalized set of cardiac ablation targets comprises identifying organizing centers of ventricular tachycardia from said simulating electrophysiological activity of at least said right and left ventricles of said living patient's heart. ### Claim 6 (depends on 5) The method of claim 5, wherein said producing said personalized set of cardiac ablation targets comprises identifying a critical pathway for ventricular tachycardia corresponding to said organizing centers as well as other slow conducting pathways through and around areas of scar tissue that are a part of a ventricular tachycardia circuit, and wherein said producing said personalized set of cardiac ablation targets further comprises providing said personalized set of cardiac ablation targets to coincide with at least a portion of said critical pathways for said ventricular tachycardia. ### Claim 7 A non-transitory computer-readable medium comprising computer-executable code for producing a personalized set of cardiac ablation targets to treat ventricular tachycardia in a living patient's heart, said computer-executable code comprising instructions that, when executed by said computer, causes said computer to: receive contrast-enhanced three-dimensional MRI or CT imaging data of at least a portion of said living patient's heart, said living patient's heart comprising normal tissue regions and remodeled tissue regions; segment said contrast-enhanced three-dimensional MRI or CT data to obtain three-dimensional heart image data; segment said three-dimensional heart image data into at least three different tissue types of said heart based on said contrast-enhanced three-dimensional MRI or CT data, said at least three different tissue types including a normal tissue region, a scar tissue region and a transition zone region, said transition zone region including an infarct border zone tissue region and being characterized as having electrophysiological properties bounded by the properties of the normal and scar tissue regions; construct a model of at least a portion of said living patient's heart, said constructing said model comprising: creating a finite element mesh using the segmented three-dimensional data, to provide a geometrical representation of said patient's heart, the finite element mesh comprising a plurality of volume elements, wherein the volume elements each represent a volume having an edge length in a range of about 300-400 microns; determining a fiber orientation in each of the volume elements based on calculations executed on a patient-specific geometry of the patient's heart; and assigning electrophysiological parameters to each of the volume elements taking into account the determined fiber orientations and the type of tissue where the corresponding volume element is located; simulate at least one of electrophysiological or electromechanical activity of at least a portion of said living patient's heart using said model, said simulating inducing an arrhythmia in said model of said living patient's heart; produce, using said model, a personalized set of cardiac ablation targets representing locations in the heart critical to sustaining simulated ventricular tachycardia, such that when the targets are ablated, all simulated ventricular tachycardia is eliminated with a minimal ablation lesion size, wherein said producing a personalized set of cardiac ablation targets comprises simulating an initial target ablation, and upon the initial target ablation not eliminating all the simulated ventricular tachycardia re-calculating the personalized set of cardiac ablation targets; and export said personalized set of ablation targets for use in during the ablation procedure to treat ventricular tachycardia. ### Claim 8 (depends on 7) The computer-readable medium according to claim 7, said computer-executable code further comprising instructions that, when executed by said computer, causes said computer to: receive additional patient-specific data that includes at least one of biopsy data, electrocardiogram data, recorded data from an implantable device, or invasive electrical mapping data, wherein said simulation uses said additional patient-specific data. ### Claim 9 (depends on 7) The computer-readable medium according to claim 7, wherein said ventricular arrhythmia is a ventricular tachycardia. ### Claim 10 (depends on 7) The computer-readable medium according to claim 7, wherein said producing said personalized set of ablation targets comprises identifying organizing centers of ventricular tachycardia from said simulating electrophysiological activity of at least said right and left ventricles of said living patient's heart. ### Claim 11 (depends on 7) The computer-readable medium according to claim 7, wherein said model of said at least said portion of said patient's heart includes at least a model of right and left atria of said living patient's heart, wherein said remodeled tissue regions are fibrotic tissue regions, wherein said simulating at least one of electrophysiological or electromechanical activity is simulating electrophysiological activity of at least said right and left atria of said living patient's heart, and wherein said producing said personalized set of ablation targets includes providing an ablation target to alleviate atrial fibrillation. ### Claim 12 A system for producing a personalized set of cardiac ablation targets to treat ventricular tachycardia in a living patient's heart comprising a data processor configured with computer-executable code, said computer-executable code comprising instructions that, when executed by said data processor, causes said data processor to: receive contrast-enhanced magnetic resonance or CT three-dimensional imaging data of at least a portion of said living patient's heart, said patient's heart comprising normal tissue regions and remodeled tissue regions; segment said contrast-enhanced magnetic resonance or CT three-dimensional imaging data to obtain three-dimensional heart image data; segment said three-dimensional heart image data into at least three different tissue types of said heart based on said contrast-enhanced magnetic resonance or CT three-dimensional imaging data, said at least three different tissue types including a normal tissue region, a scar tissue region and a transition zone region, said transition zone region including an infarct border zone tissue region and being characterized as having electrophysiological properties bounded by the properties of the normal and scar tissue regions; construct a model of at least a portion of said living patient's heart, said constructing said model comprising: creating a finite element mesh using the segmented three-dimensional data, to provide a geometrical representation of said patient's heart, the finite element mesh comprising a plurality of volume elements, wherein the volume elements each represent a volume having an edge length in a range of about 300-400 microns; determining a fiber orientation in each of the volume elements based on calculations executed on a patient-specific geometry of the patient's heart; and assigning electrophysiological parameters to each of the volume elements taking into account the determined fiber orientations and the type of tissue where the corresponding volume element is located; simulate at least one of electrophysiological or electromechanical activity of at least a portion of said living patient's heart using said model, said simulating inducing an arrhythmia in said model of said living patient's heart; and produce, using said model, a personalized set of cardiac ablation targets representing locations in the heart critical to sustaining simulated ventricular tachycardia, such that when the targets are ablated, all simulated ventricular tachycardia is eliminated with a minimal ablation lesion size, wherein said producing a personalized set of cardiac ablation targets comprises simulating an initial target ablation, and upon the initial target ablation not eliminating all the simulated ventricular tachycardia re-calculating the personalized set of cardiac ablation targets; and export said personalized set of ablation targets for use during the ablation procedure to treat ventricular tachycardia. ### Claim 13 (depends on 12) The system according to claim 12, said computer-executable code further comprising instructions that, when executed by said data processor, causes said data processor to: receive additional patient-specific data that includes at least one of biopsy data, electrocardiogram data, recorded data from an implantable device, or invasive electrical mapping data, wherein said simulation uses said additional patient-specific data. ### Claim 14 (depends on 12) The system according to claim 12, wherein said ventricular arrhythmia is a ventricular tachycardia. ### Claim 15 (depends on 12) The system according to claim 12, wherein said producing said personalized set of ablation targets comprises identifying organizing centers of ventricular tachycardia from said simulating electrophysiological activity of at least said right and left ventricles of said living patient's heart. ### Claim 16 (depends on 12) The system according to claim 12, wherein said model of said at least said portion of said patient's heart includes at least a model of right and left atria of said patient's heart, wherein said remodeled tissue regions are fibrotic tissue regions, wherein said simulating at least one of electrophysiological or electromechanical activity is simulating electrophysiological activity of at least said right and left atria of said patient's heart, and wherein said producing said personalized set of ablation targets includes providing an ablation target to alleviate atrial fibrillation. ### Claim 17 (depends on 1) The method of claim 1, further comprising segmenting said living patient's heart of said three-dimensional imaging data by demarcating epicardial and endocardial surfaces of said living patient's heart, wherein said constructing said model is based on said segmenting. ### Claim 18 (depends on 1) The method of claim 1, wherein the determining fiber orientations comprises defining transmural and apicobasal directions of entire myocardium tissue of said living patient's heart. ### Claim 19 (depends on 18) The method of claim 18, wherein the determining fiber orientations comprises using bi-directional spherical linear interpolation to interpolate fiber orientations within the myocardium. ### Claim 20 (depends on 1) The method according to claim 1, further comprising: generating a map of electrical activity of said living patient's heart registered to a geometrical representation of said living patient's heart, wherein said producing said personalized set of ablation targets is based on said generating said map. ### Claim 21 (depends on 7) The computer-readable medium according to claim 7, wherein said instructions, when executed by said computer, further causes said computer to perform segmenting said living patient's heart of said three-dimensional imaging data by demarcating epicardial and endocardial surfaces of said living patient's heart, wherein said constructing said model is based on said segmenting. ### Claim 22 (depends on 7) The computer-readable medium according to claim 7, wherein the determining fiber orientations comprises defining transmural and apicobasal directions of entire myocardium tissue of said living patient's heart. ### Claim 23 (depends on 22) The computer-readable medium according to claim 22, wherein the determining fiber orientations comprises using bi-directional spherical linear interpolation to interpolate fiber orientations within the myocardium. ### Claim 24 (depends on 7) The computer-readable medium according to claim 7, wherein said instructions, when executed by said computer, further causes said computer to perform: generating a map of electrical activity of said living patient's heart registered to a geometrical representation of said living patient's heart, wherein said producing said personalized set of ablation targets is based on said generating said map. ### Claim 25 (depends on 12) The system according to claim 12, wherein said computer-executable code further comprising instructions that, when executed by said data processor, causes said data processor to perform segmenting said living patient's heart of said three-dimensional imaging data by demarcating epicardial and endocardial surfaces of said living patient's heart, wherein said constructing said model is based on said segmenting. ### Claim 26 (depends on 12) The system according to claim 12, wherein the determining fiber orientations comprises defining transmural and apicobasal directions of entire myocardium tissue of said living patient's heart. ### Claim 27 (depends on 26) The system according to claim 26, wherein the determining fiber orientations comprises using bi-directional spherical linear interpolation to interpolate fiber orientations within the myocardium. ### Claim 28 (depends on 12) The system according to claim 12, wherein said computer-executable code further comprising instructions that, when executed by said data processor, causes said data processor to perform generating a map of electrical activity of said living patient's heart registered to a geometrical representation of said living patient's heart, wherein said producing said personalized set of ablation targets is based on said generating said map. ### Claim 29 (depends on 1) The method of claim 1, wherein the volume elements are tetrahedra-shaped. ### Claim 30 (depends on 1) The method of claim 1, further comprising: stimulating left and right ventricles of the constructed model of the patient's heart to induce an arrhythmia, wherein said simulating includes using said determined patient-specific ablation target at a plurality of locations in the left and right ventricles. ### Claim 31 (depends on 7) The computer-readable medium according to claim 7, wherein the volume elements are tetrahedra-shaped. ### Claim 32 (depends on 7) The computer-readable medium according to claim 7, wherein said computer-executable code further comprising instructions that, when executed by said computer, causes said computer to perform: stimulating left and right ventricles of the constructed model of the patient's heart to induce an arrhythmia, wherein said simulating includes using said determined personalized set of ablation targets at a plurality of locations in the left and right ventricles. ### Claim 33 (depends on 12) The system according to claim 12, wherein the volume elements are tetrahedra-shaped. ### Claim 34 (depends on 12) The system according to claim 12, wherein said computer-executable code further comprising instructions that, when executed by said data processor, causes said data processor to perform: stimulating left and right ventricles of the constructed model of the patient's heart to induce an arrhythmia, wherein said simulating includes using said determined personalized set of ablation targets at a plurality of locations in the left and right ventricles.