CA2445360A1 - Real-time monitoring and mapping of ablation lesion formation in the heart - Google Patents

Real-time monitoring and mapping of ablation lesion formation in the heart Download PDF

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CA2445360A1
CA2445360A1 CA002445360A CA2445360A CA2445360A1 CA 2445360 A1 CA2445360 A1 CA 2445360A1 CA 002445360 A CA002445360 A CA 002445360A CA 2445360 A CA2445360 A CA 2445360A CA 2445360 A1 CA2445360 A1 CA 2445360A1
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ablation
computer
sites
map
site
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CA2445360C (en
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Yaron Keidar
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Biosense Webster Inc
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Biosense Inc
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1492—Probes or electrodes therefor having a flexible, catheter-like structure, e.g. for heart ablation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
    • A61B18/22—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor
    • A61B18/24—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor with a catheter
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00017—Electrical control of surgical instruments
    • A61B2017/00022—Sensing or detecting at the treatment site
    • A61B2017/00039—Electric or electromagnetic phenomena other than conductivity, e.g. capacity, inductivity, Hall effect
    • A61B2017/00044—Sensing electrocardiography, i.e. ECG
    • A61B2017/00048—Spectral analysis
    • A61B2017/00053—Mapping
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00017—Electrical control of surgical instruments
    • A61B2017/00022—Sensing or detecting at the treatment site
    • A61B2017/00084—Temperature
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00238—Type of minimally invasive operation
    • A61B2017/00243—Type of minimally invasive operation cardiac
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00238—Type of minimally invasive operation
    • A61B2017/00274—Prostate operation, e.g. prostatectomy, turp, bhp treatment
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00345—Vascular system
    • A61B2018/00351—Heart
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00547—Prostate
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00773—Sensed parameters
    • A61B2018/00839—Bioelectrical parameters, e.g. ECG, EEG
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
    • A61B2034/101—Computer-aided simulation of surgical operations
    • A61B2034/105—Modelling of the patient, e.g. for ligaments or bones
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
    • A61B2034/107—Visualisation of planned trajectories or target regions
    • A—HUMAN NECESSITIES
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    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • A61B2034/2046—Tracking techniques
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • A61B2034/2072—Reference field transducer attached to an instrument or patient
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
    • A61B2090/397—Markers, e.g. radio-opaque or breast lesions markers electromagnetic other than visible, e.g. microwave
    • A61B2090/3975—Markers, e.g. radio-opaque or breast lesions markers electromagnetic other than visible, e.g. microwave active
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/25—User interfaces for surgical systems

Abstract

A method is provided for ablating tissue in a heart of a subject during an ablation procedure. The method includes applying a local treatment to the heart at a plurality of sites designated for ablation. At each respective site, a parameter is sensed that is indicative of a level of ablation at the site. The method preferably includes displaying a map of the heart, and designating, on the map, during the ablation procedure, indications of the respective levels of ablation at the sites, responsive to the respective sensed parameters.

Claims (111)

1. A method for ablating tissue in a heart of a subject during an ablation procedure, comprising:
applying a local treatment to the heart at a plurality of sites designated for ablation;
sensing at each respective site a parameter that is indicative of a level of ablation at the site;
displaying a map of the heart; and designating, on the map, during the ablation procedure, indications of the respective levels of ablation at the sites, responsive to the respective sensed parameters.
2. A method according to claim 1, comprising determining a location of each respective site, wherein designating the indications of the respective levels of ablation comprises designating the indications of respective levels of ablation at the sites, responsive to the respective sensed parameters and to the respective determined locations.
3. A method according to claim 1, wherein applying the local treatment comprises applying a cryogenic source to induce ablation.
4. A method according to claim 1, wherein applying the local treatment comprises applying a radioactive source to induce ablation.
5. A method according to claim 1, wherein applying the local treatment comprises applying a chemical to induce ablation.
6. A method according to claim 1, wherein designating the indications of the respective levels of ablation at the sites comprises translating each indication into a color on a color scale.
7. A method according to claim 1, wherein displaying the map comprises displaying an electroanatomical activation map.
8. A method according to claim 1, wherein displaying the map comprises displaying an electroanatomical voltage amplitude map.
9. A method according to claim 1, wherein displaying the map comprises displaying a map generated using a modality selected from the list consisting of CT
scanning, magnetic resonance imaging, fluoroscopy, echocardiography, single-photon computed tomography, and positron emission tomography.
10. A method according to claim 1, wherein sensing at each respective site the parameter that is indicative of the level of ablation at the site comprises calculating a weighted average of levels of ablation at the site and at secondary sites in a vicinity of the site, wherein the weighting of each secondary site decreases as the distance of the secondary site from the site increases.
11. A method according to claim 1, comprising segmenting a mapping volume including the sites into voxels, wherein designating the indications of the respective levels of ablation at the sites comprises designating the indications with respect to respective voxels of the mapping volume.
12. A method according to claim 1, wherein sensing the parameter comprises sensing a measure of electrical impedance at the site.
13. A method according to claim 1, comprising segmenting a surface area including the sites into planar segments, wherein designating the indications of the respective levels of ablation at the sites comprises designating the indications with respect to respective planar segments of the surface area.
14. A method according to claim 13, wherein segmenting the surface area comprises segmenting the surface area into triangular segments.
15. A method according to claim 1, wherein applying the local treatment comprises applying energy to the heart.
16. A method according to claim 15, wherein applying the energy comprises applying radiofrequency energy.
17. A method according to claim 15, wherein applying the energy comprises applying energy generated by a laser.
18. A method according to claim 15, wherein applying the energy comprises applying ultrasound energy.
19. A method according to claim 15, wherein sensing the parameter comprises sensing a measure of the energy applied at the site.
20. A method according to claim 19, wherein sensing the parameter comprises calculating a measure of a total amount of energy applied at the site.
21. A method according to claim 1, wherein sensing the parameter comprises sensing a temperature of the site.
22. A method according to claim 21, wherein sensing the parameter comprises determining a maximum temperature sensed at the site.
23. A method according to claim 21, wherein sensing the parameter comprises determining a maximal temperature time-gradient at the site.
24. A method for ablating tissue in an organ of a subject, comprising:
applying a local treatment to the organ at a plurality of sites designated for ablation;
sensing at each respective site a parameter that is indicative of a level of ablation at the site;
displaying a map of the organ; and designating, on the map, during the ablation procedure, indications of the respective levels of ablation at the sites, responsive to the respective sensed parameters.
25. A. method according to claim 24, wherein the organ includes a liver of the subject, and wherein applying the local treatment comprises applying the treatment to the liver.
26. A method according to claim 24, wherein the organ includes a prostate of the subject, and wherein applying the local treatment comprises applying the treatment to the prostate.
27. A method according to claim 24, wherein the organ includes a breast of the subject, and wherein applying the local treatment comprises applying the treatment to the breast.
28 28. Apparatus for ablating tissue in a heart of a subject during an ablation procedure, comprising:
a probe, adapted to be inserted into the heart;
an ablation device, adapted to apply a local treatment to the heart so as to ablate tissue of the heart;
at least one sensor, adapted to sense a parameter that is indicative of a level of ablation;
a display monitor; and a computer, adapted to:
drive the ablation device to apply the local treatment to the heart at a plurality of sites designated for ablation, receive respective sensed parameters from the sensor, sensed when the sensor is located at or adjacent to the plurality of sites designated for ablation, display on the display monitor a map of the heart, and designate, on the map, during the ablation procedure, indications of the respective levels of ablation at the sites, responsive to the respective sensed parameters.
29. Apparatus according to claim 28, wherein the sensor is adapted to be fixed to the probe.
30. Apparatus according to claim 28, wherein the probe comprises a catheter.
31. Apparatus according to claim 28, comprising an ablation power generator, coupled to the ablation device, adapted to generate power for use by the ablation device for performing ablation.
32. Apparatus according to claim 28, comprising one or more body surface electrodes, adapted to be coupled to a surface of a body of the subject, and an electrocardiogram (ECG) monitor, adapted to receive signals from the body surface electrodes and to provide an ECG synchronization signal to the computer.
33. Apparatus according to claim 28, comprising a position sensor, adapted to be fixed to the probe and to generate respective position sensor signals responsive to respective locations of the sites, wherein the computer is adapted to:
receive the respective position sensor signals and, responsive thereto, determine respective locations of the sites, when the position sensor is respectively located at or adjacent to the plurality of sites designated for ablation, and designate the indications of respective levels of ablation at the sites, responsive to the respective sensed parameters and to the respective determined locations.
34. Apparatus according to claim 28, wherein the ablation device comprises a cryogenic element.
35. Apparatus according to claim 28, wherein the ablation device is adapted to apply radioactivity to induce ablation of the tissue.
36. Apparatus according to claim 28, wherein the ablation device comprises a chemical applicator, adapted to apply a chemical to induce ablation of the tissue.
37. Apparatus according to claim 28, wherein the computer is adapted to translate each indication into a color on a color scale, and to designate the translated indications on the map.
38. Apparatus according to claim 28, wherein the map comprises an electroanatomical activation map, and wherein the computer is adapted to display the electroanatomical activation map on the display monitor.
39. Apparatus according to claim 28, wherein the map comprises an electroanatomical voltage amplitude map, and wherein the computer is adapted to display the electroanatomical voltage amplitude map on the display monitor.
40. Apparatus according to claim 28, wherein the map comprises a map generated using a modality selected from the list consisting of: CT scanning, magnetic resonance imaging, fluoroscopy, echocardiography, single-photon computed tomography, and positron emission tomography, and wherein the computer is adapted to display the map on the display monitor.
41. Apparatus according to claim 28, wherein the computer is adapted to calculate a weighted average of levels of ablation at each site and at secondary sites in a vicinity of the site, wherein the weighting of each secondary site decreases as the distance of the secondary site from the site increases.
42. Apparatus according to claim 28, wherein the computer is adapted to segment a mapping volume including the sites into voxels, and wherein the computer is adapted to designate, on the map, the indications of the respective levels of ablation at the sites with respect to respective voxels of the mapping volume.
43. Apparatus according to claim 28, wherein the parameter comprises a measure of electrical impedance, and wherein the sensor comprises an electrode, adapted to sense the measure of electrical impedance.
44. Apparatus according to claim 28, wherein the computer is adapted to segment a surface area including the sites into planar segments, and to designate the indications of the respective levels of ablation with respect to respective planar segments of the surface area.
45. Apparatus according to claim 44, wherein the computer is adapted to segment the surface area into triangular segments.
46. Apparatus according to claim 28, wherein the sensor comprises a temperature sensor.
47. Apparatus according to claim 46, wherein the computer is adapted to receive, from the temperature sensor, a sequence of sensed temperatures at one of the sites, and to determine responsive thereto a maximum temperature sensed at the site.
48. Apparatus according to claim 46, wherein the computer is adapted to receive, from the temperature sensor, a sequence of sensed temperatures at one of the sites, and to determine responsive thereto a maximal temperature time-gradient at the site.
49. Apparatus according to claim 28, wherein the ablation device is adapted to apply energy to the heart so as to ablate tissue of the heart.
50. Apparatus according to claim 49, wherein the ablation device comprises a laser.
51. Apparatus according to claim 49, wherein the ablation device comprises an ultrasound transducer, adapted to apply ultrasound energy to the heart so as to ablate tissue of the heart.
52. Apparatus according to claim 49, wherein the ablation device comprises an ablation electrode, adapted to apply RF energy to the heart so as to ablate tissue of the heart.
53. Apparatus according to claim 52, wherein the ablation electrode comprises a monopolar ablation electrode, and wherein the apparatus comprises a return electrode, adapted to be placed against skin of the subject and to complete an electrical circuit with the monopolar ablation electrode.
54. Apparatus according to claim 52, wherein the ablation electrode comprises a bipolar electrode.
55. Apparatus according to claim 52, wherein the sensor comprises the ablation electrode, and wherein the ablation electrode is adapted to sense the parameter indicative of the level of ablation.
56. Apparatus according to claim 49, wherein the sensor comprises an energy sensor, adapted to sense a measure of the energy applied by the ablation device.
57. Apparatus according to claim 56, wherein the computer is adapted to receive, from the sensor, respective sensed measures of energy applied at each of the sites, and to calculate for each site a measure of a total amount of energy applied.
58. Apparatus for ablating tissue in an organ of a subject during an ablation procedure, comprising:
a probe, adapted to be inserted into the organ;
an ablation device, adapted to apply a local treatment to the organ so as to ablate tissue of the organ;

at least one sensor, adapted to sense a parameter that is indicative of a level of ablation;
a display monitor; and a computer, adapted to:
drive the ablation device to apply the local treatment to the organ at a plurality of sites designated for ablation, receive respective sensed parameters from the sensor, sensed when the sensor is located at or adjacent to the plurality of sites designated for ablation, display on the display monitor a map of the organ, and designate, on the map, during the ablation procedure, indications of the respective levels of ablation at the sites, responsive to the respective sensed parameters.
59. Apparatus according to claim 58, wherein the organ includes a liver of the subject, and wherein the ablation device is adapted to apply the local treatment to the liver.
60. Apparatus according to claim 58, wherein the organ includes a prostate of the subject, and wherein the ablation device is adapted to apply the local treatment to the prostate.
61. Apparatus according to claim 58, wherein the organ includes a breast of the subject, and wherein the ablation device is adapted to apply the local treatment to the breast.
62. A computer software product for mapping an ablation procedure performed on tissue in a heart of a subject, the product comprising a computer-readable medium, in which program instructions are stored, which instructions, when read by a computer, cause the computer to:
receive a plurality of sensed parameters generated by a sensor, which senses the respective parameters when located at or adjacent to a plurality of sites designated for ablation, each sensed parameter being indicative of a level of ablation, and designate, on a map of the heart, during the ablation procedure, indications of the level of ablation at each respective site, responsive to the respective sensed parameters.
63. A product according to claim 62, wherein the instructions cause the computer to cause an ablation device to apply a local treatment to the heart so as to ablate tissue of the heart.
64. A product according to claim 62, wherein the instructions cause the computer to display the map on a display monitor.
65. A product according to claim 62, wherein the instructions cause the computer to determine a location of each of the respective sites, and to designate the indications of respective levels of ablation at the sites, responsive to the respective sensed parameters and to the respective determined locations.
66. A product according to claim 62, wherein the instructions cause the computer to translate each indication into a color on a color scale, and to designate the translated indications on the map.
67. A product according to claim 62, wherein the map includes an electroanatomical activation map, and wherein the instructions cause the computer to designate the indications on the electroanatomical activation map.
68. A product according to claim 62, wherein the map includes an electroanatomical voltage amplitude map, and wherein the instructions cause the computer to designate the indications on the electroanatomical voltage amplitude map.
69. A product according to claim 62, wherein the map includes a map generated using a modality selected from the list consisting of: CT scanning, magnetic resonance imaging, fluoroscopy, echocardiography, single-photon computed tomography, and positron emission tomography, and wherein the instructions cause the computer to designate the indications on the map.
70. A product according to claim 62, wherein the instructions cause the computer to calculate a weighted average of levels of ablation at each of the respective sites and at respective secondary sites in a vicinity of each of the sites, wherein the respective weightings of each secondary site decrease as the distance of the respective secondary sites from the respective sites increases.
71. A product according to claim 62, wherein the instructions cause the computer to segment a mapping volume including the sites into voxels, and to designate the indications with respect to respective voxels of the mapping volume.
72. A product according to claim 62, wherein the sensed parameters include respective measures of electrical impedance, and wherein the instructions cause the computer to receive the respective measures of electrical impedance.
73. A product according to claim 62, wherein the instructions cause the computer to segment a surface area including the sites into planar segments, and to designate the indications with respect to respective planar segments of the surface area.
74. A product according to claim 73, wherein the instructions cause the computer to segment the surface area into triangular segments.
75. A product according to claim 62, wherein the sensed parameters include respective measures of energy applied at each of the sites, and wherein the instructions cause the computer to receive the respective measures of energy applied at each site.
76. A product according to claim 75, wherein the instructions cause the computer to calculate for each site a measure of a total amount of energy applied.
77. A product according to claim 62, wherein the sensed parameters include a sequence of sensed temperatures at one of the sites, and wherein the instructions cause the computer to receive the sequence of sensed temperatures.
78. A product according to claim 77, wherein the instructions cause the computer to determine a maximum temperature sensed at the site, responsive to the sequence of sensed temperatures.
79. A product according to claim 77, wherein the instructions cause the computer to determine a maximal temperature time-gradient at the site, responsive to the sequence of sensed temperatures.
80. A computer software product for mapping an ablation procedure performed on tissue in a organ of a subject, the product comprising a computer-readable medium, in which program instructions are stored, which instructions, when read by a computer, cause the computer to:
receive a plurality of sensed parameters generated by a sensor, which senses the respective parameters when located at or adjacent to a plurality of sites designated for ablation, each sensed parameter being indicative of a level of ablation, and designate, on a map of the organ, during the ablation procedure, indications of the level of ablation at each respective site, responsive to the respective sensed parameters.
81. A product according to claim 80, wherein the organ includes a liver of the subject, and wherein the instructions cause the computer to designate the indications on a map of the liver.
82. A product according to claim 80, wherein the organ includes a prostate of the subject, and wherein the instructions cause the computer to designate the indications on a map of the prostate.
83. A product according to claim 80, wherein the organ includes a breast of the subject, and wherein the instructions cause the computer to designate the indications on a map of the breast.
84. Apparatus for ablating tissue in a heart of a subject during an ablation procedure, comprising:
a probe, adapted to be inserted into the heart;
an ablation device, adapted to apply a local treatment to the heart so as to ablate tissue of the heart;
at least one ablation sensor, adapted to be fixed to the probe and to sense a parameter that is indicative of a level of ablation;
a position sensor, adapted to be fixed to the probe and to generate position sensor signals;
a display monitor; and a computer, adapted to:

drive the ablation device to apply the local treatment to the heart at a plurality of sites designated for ablation, receive respective sensed parameters from the ablation sensor, sensed when the ablation sensor is located at or adjacent to the plurality of sites designated for ablation, receive respective position sensor signals from the position sensor and, responsive thereto, determine respective locations of the sites, when the position sensor is respectively located at or adjacent to the plurality of sites designated for ablation, display on the display monitor a map of the heart, and designate, on the map, during the ablation procedure, indications of the respective levels of ablation at the sites, responsive to the respective sensed parameters and to the respective determined locations.
85. Apparatus according to claim 84, wherein the probe comprises a catheter.
86. Apparatus according to claim 84, comprising an ablation power generator, coupled to the ablation device, adapted to generate power for use by the ablation device for performing ablation.
87. Apparatus according to claim 84, comprising one or more body surface electrodes, adapted to be coupled to a surface of a body of the subject, and an electrocardiogram (ECG) monitor, adapted to receive signals from the body surface electrodes and to provide an ECG synchronization signal to the computer.
88. Apparatus according to claim 84, wherein the ablation device comprises a cryogenic element.
89. Apparatus according to claim 84, wherein the ablation device is adapted to apply radioactivity to induce ablation of the tissue.
90. Apparatus according to claim 84, wherein the ablation device comprises a chemical applicator, adapted to apply a chemical to induce ablation of the tissue.
91. Apparatus according to claim 84, wherein the computer is adapted to translate each indication into a color on a color scale, and to designate the translated indications on the map.
92. Apparatus according to claim 84, wherein the map comprises an electroanatomical activation map, and wherein the computer is adapted to display the electroanatomical activation map on the display monitor.
93. Apparatus according to claim 84, wherein the map comprises an electroanatomical voltage amplitude map, and wherein the computer is adapted to display the electroanatomical voltage amplitude map on the display monitor.
94. Apparatus according to claim 84, wherein the map comprises a map generated using a modality selected from the list consisting of: CT scanning, magnetic resonance imaging, fluoroscopy, echocardiography, single-photon computed tomography, and positron emission tomography, and wherein the computer is adapted to display the map on the display monitor.
95. Apparatus according to claim 84, wherein the computer is adapted to calculate a weighted average of levels of ablation at each site and at secondary sites in a vicinity of the site, wherein the weighting of each secondary site decreases as the distance of the secondary site from the site increases.
96. Apparatus according to claim 84, wherein the computer is adapted to segment a mapping volume including the sites into voxels, and wherein the computer is adapted to designate, on the map, the indications of the respective levels of ablation at the sites with respect to respective voxels of the mapping volume.
97. Apparatus according to claim 84, wherein the parameter comprises a measure of electrical impedance, and wherein the ablation sensor comprises an electrode, adapted to sense the measure of electrical impedance.
98. Apparatus according to claim 84, wherein the computer is adapted to segment a surface area including the sites into planar segments, and to designate the indications of the respective levels of ablation with respect to respective planar segments of the surface area.
99. Apparatus according to claim 98, wherein the computer is adapted to segment the surface area into triangular segments.
100. Apparatus according to claim 84, wherein the ablation sensor comprises a temperature sensor.
101. Apparatus according to claim 100, wherein the computer is adapted to receive;
from the temperature sensor, a sequence of sensed temperatures at one of the sites, and to determine responsive thereto a maximum temperature sensed at the site.
102. Apparatus according to claim 100, wherein the computer is adapted to receive, from the temperature sensor, a sequence of sensed temperatures at one of the sites, and to determine responsive thereto a maximal temperature time-gradient at the site.
103. Apparatus according to claim 84, wherein the ablation device is adapted to apply energy to the heart so as to ablate tissue of the heart.
104. Apparatus according to claim 103, wherein the ablation device comprises a laser.
105. Apparatus according to claim 103, wherein the ablation device comprises an ultrasound transducer, adapted to apply ultrasound energy to the heart so as to ablate tissue of the heart.
106. Apparatus according to claim 103, wherein the ablation device comprises an ablation electrode, adapted to apply RF energy to the heart so as to ablate tissue of the heart.
107. Apparatus according to claim 106, wherein the ablation electrode comprises a monopolar ablation electrode, and wherein the apparatus comprises a return electrode, adapted to be placed against skin of the subject and to complete an electrical circuit with the monopolar ablation electrode.
108. Apparatus according to claim 106, wherein the ablation electrode comprises a bipolar electrode.
109. Apparatus according to claim 106, wherein the ablation sensor comprises the ablation electrode, and wherein the ablation electrode is adapted to sense the parameter indicative of the level of ablation.
110. Apparatus according to claim 103, wherein the ablation sensor comprises an energy sensor, adapted to sense a measure of the energy applied by the ablation device.
111. Apparatus according to claim 110, wherein the computer is adapted to receive, from the ablation sensor, respective sensed measures of enemy applied at each of the sites, and to calculate for each site a measure of a total amount of energy applied.
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