EP2967399A2 - Système et procédé de reconstruction d'informations d'activation cardiaque - Google Patents

Système et procédé de reconstruction d'informations d'activation cardiaque

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Publication number
EP2967399A2
EP2967399A2 EP14763969.4A EP14763969A EP2967399A2 EP 2967399 A2 EP2967399 A2 EP 2967399A2 EP 14763969 A EP14763969 A EP 14763969A EP 2967399 A2 EP2967399 A2 EP 2967399A2
Authority
EP
European Patent Office
Prior art keywords
point
change
cardiac signal
analysis
signal
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP14763969.4A
Other languages
German (de)
English (en)
Other versions
EP2967399A4 (fr
Inventor
Sanjiv Narayan
Carey Robert Briggs
Ruchir Sehra
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
University of California
Topera Inc
Original Assignee
University of California
Topera Inc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from US13/840,334 external-priority patent/US9050006B2/en
Application filed by University of California, Topera Inc filed Critical University of California
Publication of EP2967399A2 publication Critical patent/EP2967399A2/fr
Publication of EP2967399A4 publication Critical patent/EP2967399A4/fr
Withdrawn legal-status Critical Current

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
    • A61B5/024—Detecting, measuring or recording pulse rate or heart rate
    • A61B5/02405—Determining heart rate variability
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/72—Signal processing specially adapted for physiological signals or for diagnostic purposes
    • A61B5/7235—Details of waveform analysis
    • A61B5/7239—Details of waveform analysis using differentiation including higher order derivatives
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/316—Modalities, i.e. specific diagnostic methods
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
    • A61B5/0205—Simultaneously evaluating both cardiovascular conditions and different types of body conditions, e.g. heart and respiratory condition
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
    • A61B5/024—Detecting, measuring or recording pulse rate or heart rate
    • A61B5/0255—Recording instruments specially adapted therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/25—Bioelectric electrodes therefor
    • A61B5/279—Bioelectric electrodes therefor specially adapted for particular uses
    • A61B5/28—Bioelectric electrodes therefor specially adapted for particular uses for electrocardiography [ECG]
    • A61B5/283—Invasive
    • A61B5/287—Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/316—Modalities, i.e. specific diagnostic methods
    • A61B5/318—Heart-related electrical modalities, e.g. electrocardiography [ECG]
    • A61B5/339—Displays specially adapted therefor
    • A61B5/341—Vectorcardiography [VCG]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/316—Modalities, i.e. specific diagnostic methods
    • A61B5/318—Heart-related electrical modalities, e.g. electrocardiography [ECG]
    • A61B5/346—Analysis of electrocardiograms
    • A61B5/349—Detecting specific parameters of the electrocardiograph cycle
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/316—Modalities, i.e. specific diagnostic methods
    • A61B5/318—Heart-related electrical modalities, e.g. electrocardiography [ECG]
    • A61B5/346—Analysis of electrocardiograms
    • A61B5/349—Detecting specific parameters of the electrocardiograph cycle
    • A61B5/361—Detecting fibrillation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/316—Modalities, i.e. specific diagnostic methods
    • A61B5/318—Heart-related electrical modalities, e.g. electrocardiography [ECG]
    • A61B5/346—Analysis of electrocardiograms
    • A61B5/349—Detecting specific parameters of the electrocardiograph cycle
    • A61B5/363—Detecting tachycardia or bradycardia
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/72—Signal processing specially adapted for physiological signals or for diagnostic purposes
    • A61B5/7203—Signal processing specially adapted for physiological signals or for diagnostic purposes for noise prevention, reduction or removal
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/72—Signal processing specially adapted for physiological signals or for diagnostic purposes
    • A61B5/7203—Signal processing specially adapted for physiological signals or for diagnostic purposes for noise prevention, reduction or removal
    • A61B5/7217—Signal processing specially adapted for physiological signals or for diagnostic purposes for noise prevention, reduction or removal of noise originating from a therapeutic or surgical apparatus, e.g. from a pacemaker
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/72—Signal processing specially adapted for physiological signals or for diagnostic purposes
    • A61B5/7235—Details of waveform analysis
    • A61B5/7246—Details of waveform analysis using correlation, e.g. template matching or determination of similarity
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/72—Signal processing specially adapted for physiological signals or for diagnostic purposes
    • A61B5/7271—Specific aspects of physiological measurement analysis
    • A61B5/7278—Artificial waveform generation or derivation, e.g. synthesising signals from measured signals
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/74—Details of notification to user or communication with user or patient ; user input means
    • A61B5/742—Details of notification to user or communication with user or patient ; user input means using visual displays
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B2562/00—Details of sensors; Constructional details of sensor housings or probes; Accessories for sensors
    • A61B2562/04—Arrangements of multiple sensors of the same type
    • A61B2562/046—Arrangements of multiple sensors of the same type in a matrix array

Definitions

  • the present application relates generally to heart rhythm disorders. More specifically, the present application is directed to a system and method for reconstructing cardiac activation information (activation onset) associated with heart rhythm disorders.
  • Heart (cardiac) rhythm disorders are common and represent significant causes of morbidity and death throughout the world. Malfunction of the electrical system in the heart represents a proximate cause of heart rhythm disorders.
  • Heart rhythm disorders exist in many forms, of which the most complex and difficult to treat are atrial fibrillation (AF), ventricular tachycardia (VT) and ventricular fibrillation (VF).
  • Other rhythm disorders are more simple to treat, but may also be clinically significant including atrial tachycardia (AT), supraventricular tachycardia (SVT), atrial flutter (AFL), supraventricular ectopic complexes/beats (SVE) and premature ventricular complexes/beats (PVC).
  • AT atrial tachycardia
  • SVT supraventricular tachycardia
  • AFL atrial flutter
  • SVE supraventricular ectopic complexes/beats
  • PVC premature ventricular complexes/beats
  • While under normal conditions the sinus node keeps the heart in sinus rhythm, under
  • AF, VF and polymorphic VT— can be very difficult.
  • Pharmacologic therapy for complex rhythm disorder is not optimal, with poor efficacy and significant side effects.
  • Ablation has been used increasingly in connection with heart rhythm disorders by maneuvering a sensor/probe to the heart through the blood vessels, or directly at surgery, and delivering energy to a location of the heart that harbors a cause of the heart rhythm disorder to mitigate and in some cases to eliminate the heart rhythm disorder.
  • ablation is often difficult and ineffectual because tools that identify and locate a cause of the heart rhythm disorder are poor and hinder attempts to deliver energy to the correct region of the heart to eliminate the disorder.
  • Certain systems and methods are known for treating simple heart rhythm disorders.
  • a simple heart rhythm disorder e.g., atrial tachycardia
  • consistent activation onset patterns from beat to beat can generally be traced back to an earliest location, which can be ablated to mitigate and in some cases to eliminate the disorder.
  • ablation of the cause of a heart rhythm disorder is challenging and experienced practitioners often require hours to ablate simple rhythm disorders with consistent beat-to-beat activation patterns, such as atrial tachycardia.
  • Diagnosing and treating heart rhythm disorders often involves the introduction of a catheter having a plurality of sensors/probes into the heart through the blood vessels of a patient.
  • the sensors detect electric activity of the heart at sensor locations in the heart.
  • the electric activity is generally processed into electrogram signals that represent the activation of the heart at the sensor locations.
  • the signal at each sensor location is generally consistent from beat to beat in timing and often in shape and number of its deflections, enabling identification of activation onsets at each sensor location.
  • the signal at each sensor location from beat to beat may transition between one, several, and multiple deflections of various shapes.
  • a signal for a sensor location in AF includes 5, 7, 11 or more deflections
  • the present invention is applicable to reconstructing activation information of various rhythm disorders, including heart rhythm disorders, as well as other biological rhythm disorders, such as neurological seizures, esophageal spasms, bladder instability, irritable bowel syndrome, and other biological disorders for which biological activation information can be reconstructed to permit determination, diagnosis, and/or treatment of the cause or source of the disorders. It is particularly useful, however, in complex rhythm disorders which result in complex activation patterns, and especially useful in complex rhythm disorders of the heart, in order to find the cause(s) or source(s) of the disorders such that they can be treated with expediency.
  • the present invention provides a relatively few number of steps to reconstruct the activation information in order to determine the activation onset times at various sensor locations for a heart beat amidst the virtually
  • reconstruction is a process of identifying activation onset time in a cardiac or biological signal at a sensor location distinct from nearby or adjacent sensor locations for one or more beats of a biological or cardiac rhythm disorder.
  • activation onset time is a time point at which activation commences in a cell or tissue, as opposed to other time points during activation.
  • activation is a process whereby a cell commences its operation from a quiescent (diastolic) state to an active (electrical) state.
  • a system to reconstruct biological activation information includes at least one computing device.
  • the computing device is configured to process an analysis cardiac signal and a reference cardiac signal to determine whether there is a first point of change in a first selected-order derivative of the analysis cardiac signal with respect to a first selected-order derivative of the reference cardiac signal above a first threshold.
  • the computing device is also configured to process the analysis the analysis cardiac signal and the reference cardiac signal to determine whether there is a second point of change in a second selected-order derivative of the analysis cardiac signal with respect to a second selected- order derivative of the reference cardiac signal above a second threshold.
  • the computing device is further configured assign an activation onset time in the analysis cardiac signal at a point based on a mathematical association of the first point of change and the second point of change to define cardiac activation indicating a beat in the analysis cardiac signal if it is determined that at least one of the first point of change is above the first threshold and the second point of change is above the second threshold.
  • a method of reconstructing biological activation information includes processing an analysis cardiac signal and a reference cardiac signal to determine whether there is a first point of change in a first selected-order derivative of the analysis cardiac signal with respect to a first selected- order derivative of the reference cardiac signal above a first threshold.
  • The also includes processing the analysis cardiac signal and the reference cardiac signal to determine whether there is a second point of change in a second selected-order derivative of the analysis cardiac signal with respect to a second selected- order derivative of the reference cardiac signal above a second threshold.
  • the method further includes assigning an activation onset time in the analysis cardiac signal at a point based on a mathematical association of the first point of change and the second point of change to define cardiac activation indicating a beat in the analysis cardiac signal if it is determined that at least one of the first point of change is above the first threshold and the second point of change is above the second threshold.
  • a method of treating a cardiac rhythm disorder includes iteratively accessing an analysis cardiac signal and a reference cardiac signal from a plurality of cardiac signals.
  • the analysis cardiac signal and the reference cardiac signal are processed to determine whether there is a first point of change in a first selected- order derivative of the analysis cardiac signal with respect to a first selected-order derivative of the reference cardiac signal above a first threshold.
  • the analysis cardiac signal and the reference cardiac signal are processed to determine whether there is a second point of change in a second selected-order derivative of the analysis cardiac signal with respect to a second selected- order derivative of the reference cardiac signal above a second threshold.
  • Activation onset times are assigned in the analysis cardiac signal at points based on a mathematical association of first points of change and second points of change to define cardiac activations indicating a beats in the analysis cardiac signal if it is determined that at least one of the first points of change is above the first threshold and the second points of change is above the second threshold.
  • the method further includes reconstructing a cardiac activation pattern based on the assigned activation onset times to indicate a source of the cardiac rhythm disorder. Still further, the method includes treating cardiac tissue at the source to suppress or eliminate the cardiac rhythm disorder.
  • FIG. 1 illustrates an example cardiac activation reconstruction system
  • FIG. 2 illustrates an example simple electrogram signal of a heart rhythm disorder from a sensor positioned at a sensor location in a heart illustrated in FIG. 1;
  • FIG. 3 illustrates an example complex electrogram signal of a heart rhythm disorder from a sensor positioned at a sensor location in a heart illustrated in FIG. 1;
  • FIG. 4 illustrates an example array of sensors of a catheter illustrated in FIG. 1 and an example selection of signals from the sensors to reconstruct cardiac activation information
  • FIG. 5 illustrates example comparison pairs of signals from the sensors array illustrated in FIG. 4;
  • FIG. 6 is an illustration of an example signal pair comparison of analysis signal
  • FIG. 7 is an illustration of another example signal pair comparison of analysis signal (SIGl) and reference signal (SIG2);
  • FIG. 8 is an illustration of a further example signal pair comparison of analysis signal (SIGl) and reference signal (SIG2) utilizing a composite signal;
  • FIG. 9 is a flowchart that illustrates an example method of reconstructing cardiac activation information associated with heart rhythm disorders
  • FIG. 10 is an illustration of an example signal pair comparison of analysis signal
  • SIGl and reference signal (SIG2) that can be processed in accordance with the method of FIG. 9 to reconstruct cardiac activation information
  • FIG. 11 is an illustration of an example mapping of processed signals in accordance with FIGS. 1-10.
  • FIG. 12 is a block diagram of an illustrative embodiment of a general computer system.
  • FIG. 1 illustrates an example cardiac activation reconstruction system 100.
  • the example system 100 is configured to detect and reconstruct cardiac activation information collected/detected from a patient's heart in connection with a heart rhythm disorder.
  • the heart includes a right atrium 122, left atrium 124, right ventricle 126 and left ventricle 128.
  • the example system 100 includes a catheter 102, signal processing device 1 14, computing device 116 and analysis database 118.
  • the catheter 102 is configured to detect cardiac activation information in the heart and to transmit the detected cardiac activation information to the signal processing device 114, either via a wireless or wired connection.
  • the catheter includes a plurality of probes/sensors 104-112, which can be inserted into the heart through the patient's blood vessels.
  • one or more of the sensors 104-112 are not inserted into the patient' s heart.
  • some sensors may detect cardiac activation via the patient's surface (e.g., electrocardiogram) or remotely without contact with the patient (e.g., magnetocardiogram).
  • some sensors may also derive cardiac activation information from cardiac motion of a non-electrical sensing device (e.g., echocardiogram). In various embodiments or aspects, these sensors can be used separately or in different
  • the sensors 104- 112 which are positioned at sensor locations in the heart under consideration, can detect cardiac activation information at the sensor locations and can further deliver energy to ablate the heart at the sensor locations. It is noted that the sensors 104- 112 can also detect cardiac activation information from overlapping regions of the heart (e.g., right atrium 122 and left atrium 124).
  • the signal processing device 114 is configured to process (e.g., clarify and amplify) the cardiac activation information detected by the sensors 104-112 at the sensor locations into electrogram signals and to provide the processed cardiac signals to the computing device 116 for analysis or processing in accordance with methods disclosed herein. In processing the cardiac activation information from the sensors 104- 112, the signal processing device 114 can subtract cardiac activation information from overlapping regions of the heart 120 to provide processed cardiac signals to the computing device 116 for analysis. While in some embodiments or aspects, the signal processing device 114 is configured to provide unipolar signals, in other embodiments or aspects, the signal processing device 114 can provide bipolar signals.
  • the computing device 116 is configured to receive (or access) cardiac signals from the signal processing device 114 and further configured to analyze or process the cardiac signals in accordance with methods, functions or logic disclosed herein to reconstruct cardiac activation information in the cardiac signals such that it is possible to locate a cause of the heart rhythm disorder and to eliminate the cause.
  • the computing device 116 can process a first cardiac signal and a second cardiac signal from the received cardiac signals to determine whether there is a point of change in a derivative of the first cardiac signal with respect to a derivative of the second cardiac signal above a threshold. The computing device 116 can then assign an activation onset time in the first signal at the point of change to define cardiac activation indicating a beat in the first signal if it is determined that the point of change is above the threshold.
  • the computing device 116 can iteratively select pairs of cardiac signals from the received cardiac signals, each pair having a first cardiac signal and second cardiac signal.
  • the computing device 116 can process and assign for each of the pairs in order to define multiple cardiac activations indicating beats for the first cardiac signal in each of the pairs.
  • the computing device 116 is configured to perform processing and assigning to define multiple cardiac activations indicating beats in the first cardiac signal.
  • the computing device 116 can then reconstruct a cardiac activation pattern based on assigned activation onset times of cardiac activations from the received cardiac signals to indicate a source of a rhythm disorder.
  • the computing device 116 can also display the reconstructed cardiac activation pattern to facilitate treatment of cardiac tissue at the source to suppress, lessen or eliminate the cardiac rhythm disorder.
  • the analysis database 118 is configured to support or aid in the analysis of the signals by the computing device 116.
  • the analysis database 118 can store a catalog of reference signals and associated activations to enable the computing device 116 to determine an activation onset associated with a signal being considered (e.g., when point of change is below threshold during a time window), as will be described in greater detail herein.
  • FIG. 2 illustrates an example simple electrogram signal 200 of a heart rhythm disorder from a sensor positioned at a sensor location in the heart 120.
  • sensor 104 of catheter 102 can be positioned at a sensor location in the right atrium 122, as shown in FIG. 1.
  • the heart rhythm disorder can be a complex rhythm disorder AF, VF and polymorphic VT, or another heart rhythm disorder.
  • the example signal 200 is for a time period between about 300 ms and about 900 ms.
  • the signal 200 is expected to have four (4) local activation onsets 202-208, e.g., those activation onsets that originate at or near (locally to) the sensor location in the heart 120 of sensor 104.
  • cycle length between activation onsets of about 100 ms to about 300 ms can be expected for AF
  • cycle length between activation onsets of about 180 ms to about 240 ms can be expected for complex ventricular arrhythmias.
  • cycle length 210 of about 100 ms to about 300 is expected between activation onset 202 and activation onset 204.
  • the activation onsets 202-208 are generally identifiable as having a small degree of baseline wander superposed in the local signal with few far-field artifacts that could be mistaken as local activity.
  • Local activity in this example can be characterized by an activation onset with a sharp inflection point and high slope, followed by a period of gentle, low-deviation slope representing repolarization, typically lasting between about 100 ms and 250 ms.
  • an example far-field deflection 212 is illustrated between location activation onset 206 and local activation onset 208, e.g., an activation onset that originates at a location in the heart 120 that is different than the sensor location associated with the sensor 104.
  • the heart 120 at the sensor location associated with sensor 104 cannot physiologically activate again after activation onset 206 in a shorter cycle than about 100 ms to about 300 ms because local tissue must undergo repolarization.
  • the deflection 212 cannot be local to the sensor location associated with the sensor 104 when the deflection 212 is also significantly present in signals collected by neighbor sensors in multiple directions to sensor 104.
  • FIG. 3 illustrates an example complex electrogram signal 300 of a heart rhythm disorder from a sensor positioned at a sensor location in the heart 120.
  • sensor 106 of catheter 102 can be positioned at a sensor location in the right atrium 122, as shown in FIG. 1.
  • the heart rhythm disorder can be a complex rhythm disorder AF, VF and polymorphic VT, or another heart rhythm disorder.
  • example signal 300 is for a time period between about 300 ms and about 900 ms. During this time period, the signal 300 is expected to have four (4) local activation onsets, e.g., activation onsets that originate locally to the sensor location in the heart 120 of sensor 106. However, in the example signal 300 there are eleven (11) possible activation onsets 302-322. Multiple deflections of short duration (shorter than shortest cycle length of about 100 ms) caused by the heart rhythm disorder makes the discernment of local activation onsets at the sensor location of sensor 104 as opposed to far-field activations or simply noise prohibitively difficult.
  • FIG. 4 illustrates an example array of sensors 400 of catheter 102 and an example selection of signals from the sensors to reconstruct cardiac activation information (e.g., activation onsets).
  • the array 400 includes fifteen (15) example sensors for simplicity and clarity of the description. It is to be understood that the array 400 can include fewer or more sensors to as may be determined to cover different portions of the heart 120. In some embodiments or aspects, the array 400 can include 160 or more sensors.
  • the sensors of the array 400 are shown in example spatial arrangement with respect to the right atrium 122 of the heart 120.
  • the array 400 can be spatially arranged in other chambers of the heart, e.g., left atrium, right ventricle, left ventricle, or for combinations of chambers including the endocardial or epicardial surfaces.
  • the spatial arrangement of electrodes in the array 400 is shown to be uniform and planar for simplicity and clarity of the description.
  • the heart 120 is not a uniform or planar structure.
  • the spatial arrangement of electrodes in the array 400 can be varied with respect to the shape of the heart 120 to improve detection of electric activity in the heart 120.
  • catheter 102 of FIG. 1 can be a basket catheter with the example sensors of the array 400 disposed in spatial arrangements along splines 406-408 of the basket catheter 102.
  • Different catheters with various spatial arrangements of the sensors in the sensor array 400 can be used, such as spiral, radial spokes or other spatial arrangements.
  • Pairs of sensors (signals of sensors) in the array 400 are iteratively selected for processing as will be described in greater detail herein in order to reconstruct cardiac activation information (activation onsets) of the heart 120 in the right atrium 122, or another chamber in which the array 400 may be disposed.
  • an analysis signal (1) is selected for processing.
  • a reference signal (2)— a neighbor to the analysis signal (1)— is then selected to form a first pair that is processed to determine activation onsets in the analysis signal (1).
  • an analysis signal (1) is selected for processing.
  • a reference signal (2)— another neighbor to the analysis signal (1)— is then selected to form a second pair that is processed to determine activation onsets in the analysis signal (1).
  • the activation onsets from the first pair and the second pair of signals can be stored in memory of computing device 116 or database 118 of FIG. 1.
  • the neighboring sensors (signals) can but do not have to be adjacent, as will be described in greater detail below.
  • the activation onsets in the analysis signal (1) for all pairs of signals can also be stored in memory of computing device 116 or database 118.
  • each of the plurality of analysis signals in array 400 is processed against its neighboring signals.
  • the number of neighboring signals for a given analysis signal can be fewer or greater depending on the spatial arrangement of the sensors in the array 400, the chamber of the heart analyzed and the heart rhythm disorder treated.
  • FIG. 5 illustrates example comparison pairs of signals from the sensors of the array 400 illustrated in FIG. 4.
  • Neighbor signals can include not only those signals that are immediately adjacent to the analysis signal but also those signals not adjacent to the analysis signal. Spatially separating the paired sensors can have the effect of spatially extending the area over which deflections are considered to be local activity. Local activity is therefore approximately defined by the separation of the paired sensors.
  • selected analysis signal (1) is processed against adjacent signals (2)-(5) and also against a non-adjacent signal (6).
  • selected analysis signal (1) is processed against adjacent signals (2)-(5) and also against a non-adjacent signals (6) and (7). While closest neighbor signals are preferred, neighbor signals in various spatial orientations with respect to the analysis signal can be used.
  • each analysis signal there could be a plurality of reference signals (e.g., four
  • a final activation onset in the analysis signal is determined with reference to or based on the combination of the reference signals' possible activation onsets. Specifically, the activation onsets determined from each pair can be referenced against each other to check for correspondence or association of activations in the analysis signal. An activation onset for the analysis signal is finalized based on the possible activation onsets of the referenced pairs of signals.
  • the final activation onset for the analysis signal can be determined in various ways. In one embodiment or aspect, the final activation onset for the analysis signal can be determined based on an average of the possible activation onsets from the various pairs of referenced signals. In another embodiment or aspect, the final activation onset for the analysis signal can be determined based on an average of the possible activation onsets from those pairs of signals in which a majority of the possible activation onsets are within a predetermined time interval of each other (e.g., ⁇ 5 ms).
  • the final activation onset for the analysis signal can be determined based on an average of the possible activation onsets from those pairs of signals in which a plurality of the possible activation onsets are within a predetermined time interval of each other (e.g., ⁇ 5 ms). The time interval used can be chosen to be lower or higher.
  • the final activation can also be determined by performing a "center-of-mass" calculation weighted by the significance value of each of the possible activation onsets in the majority, or by analysis of a predominant direction of activation onsets relative to sensor locations.
  • the activation onsets of 190 ms and 193 ms that are outside the time interval can be discounted from the determination of the final activation onset for the analysis signal.
  • the final activation onset determined for each signal can be saved in the database 118 of FIG. 1.
  • the activation onset of 176 ms is outside the time interval (e.g., ⁇ 5 ms) and is discounted from the
  • Activation onsets 165 ms and 170 ms do not form a plurality of possible activation onsets within the predetermined time interval (e.g., ⁇ 5 ms).
  • the final activation onset determined for each signal can be saved in the database 118 of FIG. 1.
  • each signal from a sensor of array 400 can represent multiple successive analysis intervals (e.g., activation cycles) as illustrated in FIG. 2, each of which can have an activation onset as determined based on the same time interval of multiple reference signals (neighboring sensors of array 400).
  • FIG. 6 is an illustration of an example signal pair comparison 600 of example analysis signal (SIG1) and example reference signal (SIG2).
  • the signals can be from comparison pair 402 (or comparison pair 404) illustrated in FIG. 4, or from any comparison pair illustrated in FIG. 5. It is noted that the signals are illustrative and occur during the same analysis interval. As noted herein, the signals can have multiple successive analysis intervals (e.g., activation cycles), as illustrated in FIG. 2.
  • the signals are processed at one or more successive time points (e.g., every millisecond, two milliseconds, or other time points) to determine whether there is a point of change in a derivative of the analysis signal with respect to a derivative of the reference signal above a threshold.
  • the point of change can be determined from one or more of slope, amplitude, timing and shape for the first cardiac signal and the second cardiac signal. It is noted that in some embodiments or aspects, processing of some time points can be omitted (e.g., every other time point or two of three time points). While the slope can be determined by a first-order derivative and/or a second-order derivative for each of the time points in the signals, this example shows calculations using the first-order derivative.
  • a root mean squared is determined for each of the signals. For example, RMS 1 and RMS2 are determined by taking a root mean squared of the derivatives (first-order and/or second-order) for the entire signal of each of the signals (e.g., all activation cycles). RMS can be used to normalize the amplitude of the signals with respect to one another, such that amplitudes (e.g., voltage) of the deflections in the signals do not affect the processing of the signals as described below.
  • a time point (same time point or about the same time point) is successively selected from each of the signals (SIG1, SIG2) for consideration and processing.
  • a time increment 602, 604 in each signal starting at that time point can be considered.
  • a time increment of 10 ms can be used.
  • Different time increments can be selected.
  • a line which is pinned to the point under consideration in each signal and which provides the best fit to the time points in the time increment of each signal is determined. The determined lines represent the slopes (e.g., volts/per second) of the signals for the selected time point.
  • the slopes of the lines can be determined by first-order and/or second order derivatives More specifically, the determined lines represent slopes of the signals at the selected time point for the same time increment (e.g., 10 ms). A significance value ( ⁇ ) is determined with respect to the slopes.
  • the significance threshold indicates that there is a potentially significant point of change (based on slopes) for the time point in the signals under consideration, e.g., that the derivatives diverge sufficiently from each other.
  • the low significance value indicates that the deflection in SIG1 is far-field and not sufficiently local to a sensor location from which the signal originated, e.g., a sensor shown in FIG. 4. Accordingly, there is no potentially significant point of change in the example signal pair comparison 600.
  • significance value ( ⁇ ) calculations are shown and described with reference to the slopes using first-order derivatives, it should be noted that second-order derivatives can be computed instead of, or in addition to, the first-order derivatives in a similar fashion.
  • a second significance value ( ⁇ ) calculated based on slopes using-second order derivatives can then be compared to a second significance threshold defined for the second-order derivative. Significance thresholds can be different for the first and second calculated significance values ( ⁇ ).
  • the signals can have multiple successive analysis intervals (e.g., activation cycles), as illustrated in FIG. 2.
  • each analysis interval it is possible to have zero, one or more potentially significant points of change as described above.
  • the time point under consideration and the potentially significant point(s) of change can be recorded, such as in database 118.
  • FIG. 7 is an illustration of an example signal pair comparison 700 of example analysis signal (SIG1) and example reference signal (SIG2).
  • the signals can be from comparison pair 402 (or comparison pair 404) illustrated in FIG. 4, or from any comparison pair illustrated in FIG. 5.
  • the signals are illustrative and occur during the same analysis interval.
  • the signals can have multiple successive analysis intervals (e.g., activation cycles), as illustrated in FIG. 2.
  • the signals are processed at one or more successive time points to determine whether there is a point of change in a derivative of the analysis signal with respect to a derivative of the reference signal above a threshold.
  • processing of some time points can be omitted (e.g., every other time point or two of three time points).
  • a first derivative (or second derivative) is determined for each of the time points in the signals.
  • a root mean squared is further determined for each of the signals.
  • a time point (same time point or about the same time point) is successively selected from each of the signals (SIG1, SIG2) for consideration and processing. For each time point under consideration, a time increment 702, 704 (e.g., 10 ms) in each signal starting at that time point can be considered.
  • a line which is pinned to the point under consideration in each signal and which provides the best fit to the time points in the time increment of each signal is determined.
  • the determined lines represent the slopes (e.g., volts/per second) of the signals for the selected time point. More specifically, the determined lines represent the slopes at the selected time point for the same time increment.
  • a significance value ( ⁇ ) is determined with respect to the slopes.
  • a significance threshold e.g. 0.25
  • a noise level can be defined as fraction of the significance threshold (first, second or third) or can be defined programmatically in various ways.
  • noise level can be one-tenth (0.025) of the significance threshold (0.25).
  • a different fraction level can be selected.
  • the noise level can be defined as a Gaussian standard deviation of a plurality of significance values.
  • the significance threshold e.g., 0.25
  • the noise level is higher than the noise level that can be associated with the analysis signal and reference signal in the example signal pair comparison 700. Accordingly, a point of change at or below noise level can be associated with one or more signals from other regions of a heart, respiratory system, gastrointestinal tract, neurological system as well as electronic interference.
  • significance value ( ⁇ ) calculations are shown and described with reference to the slopes using first-order derivatives, it should be noted that second-order derivatives can be computed instead of, or in addition to, the first-order derivatives in a similar fashion.
  • a second significance value ( ⁇ ) calculated based on slopes using-second order derivatives can then be compared to a second significance threshold defined for the second-order derivative. Significance thresholds can be different for the first and second calculated
  • the signals can have multiple successive analysis intervals (e.g., activation cycles) and in each analysis interval, it is possible to have zero, one or more potentially significant points of change as described above.
  • the time point under consideration and the potentially significant point(s) of change can be recorded, such as in database 118.
  • FIG. 8 is an illustration of an example signal pair comparison 800 of example analysis signal (SIG1) and example reference signal (SIG2) utilizing a composite signal.
  • the signals can be from comparison pair 402 (or comparison pair 404) illustrated in FIG. 4, or from any comparison pair illustrated in FIG. 5.
  • the signals are illustrative and occur during the same analysis interval.
  • the signals can have multiple successive analysis intervals (e.g., activation cycles), as illustrated in FIG. 2.
  • the signals are processed at one or more successive time points to determine whether there is a point of change in a derivative of the analysis signal with respect to a derivative of the reference signal above a threshold.
  • processing of some time points can be omitted (e.g., every other time point or two of three time points).
  • a first derivative zero order derivative or second derivative
  • a root mean squared is further determined for each of the signals.
  • a time point (same time point or about the same time point) is successively selected from each of the signals (SIG1, SIG2) for consideration and processing.
  • a time increment 802, 804 (e.g., 10 ms) in each signal starting at that time point can be used.
  • a line which is pinned to the point under consideration in each signal and which provides the best fit to the time points in the time increment of each signal is determined.
  • the determined lines represent the slopes (e.g., volts/per second) of the signals for the selected time point. More specifically, the determined lines represent the slopes of the signals at the selected time point for same time increment.
  • the signals can have multiple successive analysis intervals (e.g., activation cycles) and in each analysis interval, it is possible to have zero, one or more potentially significant points of change as described above.
  • the time point under consideration and the potentially significant point(s) of change can be recorded, such as in database 118.
  • significance value ( ⁇ ) calculations are shown and described with reference to the slopes using first-order derivatives, it should be noted that second-order derivatives can be computed instead of, or in addition to, the first-order derivatives in a similar fashion.
  • a second significance value ( ⁇ ) calculated based on slopes using-second order derivatives can then be compared to a second significance threshold defined for the second-order derivative. Significance thresholds can be different for the first and second calculated significance values ( ⁇ ).
  • the significance value ( ⁇ ) can be determined with respect to a composite signal.
  • the composite signal can represent a bipolar signal (COMP) of constituent unipolar signals (SIGl, SIG2).
  • the composite signal COMP can also be computed by adding signals SIGl and SIG2.
  • the signals in the signal pair comparison 800 are illustrative and occur during the same analysis interval. As noted herein, the signals can have multiple successive analysis intervals (e.g., activation cycles), as illustrated in FIG. 2.
  • the signals SIGl, SIG2 are processed at one or more successive time points with respect to the composite signal COMP to determine whether there is a point of change in a derivative of the analysis signal with respect to a derivative of the reference signal above a threshold.
  • a first derivative (or second derivative) is determined for each of the time points in the signals, SIG1, SIG2, COMP.
  • a time point (same time point or about the same time point) is successively selected from each of the signals (SIG1, SIG2, COMP) for consideration and processing.
  • a time increment 802, 804, 806 e.g., 10 ms in each signal starting at that time point can be considered.
  • a line which is pinned to the point under consideration in each signal and which provides the best fit to the time points in the time increment of each signal is determined.
  • the determined lines represent the slopes (e.g., volts/per second) of the signals for the selected time point. More specifically, the determined lines represent the slopes of the signals at the selected time point for the same time increment.
  • a significance value ( ⁇ ) is determined with respect to the slopes.
  • the significance value ( ⁇ ) can be determined by a ratio taking an absolute value of the second slope and subtracting an absolute value of the composite slope, and dividing by a logarithm of a result of an absolute value the first slope subtracting an absolute value of the composite slope.
  • Significance values can be computed for all points under consideration.
  • a significance threshold can be determined to be an average of the computed significance values ( ⁇ ) plus a standard deviation. Thereafter, only those significance values ( ⁇ ) that are above the significance threshold can be considered to be potentially significant points of change for the comparison pair 800.
  • the determined significance threshold can be 10. It is noted that the significance value(s) that is above the significance threshold generally extends substantially above the significance threshold. For example, a significance value ( ⁇ ) — having the largest ratio— can therefore be selected.
  • significance value ( ⁇ ) calculations using the composite signal are shown and described with reference to the slopes using first-order derivatives, it should be noted that second-order derivatives can be computed instead of, or in addition to, the first-order derivatives in a similar fashion.
  • a third significance value ( ⁇ ) calculated based on slopes using-second order derivatives can then be compared to a third significance threshold defined for the second-order derivative. Significance thresholds can be different for the first, second and third calculated significance values ( ⁇ ).
  • the signals can have multiple successive analysis intervals (e.g., activation cycles) and in each analysis interval, it is possible to have zero, one or more potentially significant points of change as described above.
  • the time point under consideration and the potentially significant point(s) of change can be recorded, such as in database 118.
  • FIG. 9 is a flowchart that illustrates an example method 900 of reconstructing cardiac activation information (activation onset) associated with heart rhythm disorders.
  • the example method 900 can be performed by the computing device 116 illustrated in FIG. 1. More specifically, the example method 900 starts at operation 902 at which signals are received by the computing device 116 via signal processing device 114 from sensors disposed in the heart 120. For example, signals can be received from sensors of the sensor array 400 disposed in the right atrium 122 of the heart 120, as shown in FIGS, 1 and 4. In some embodiments or aspects, at least a portion of the signals from the sensors can be recorded by signal processing device 114 and then provided to computing device 116.
  • a first signal is selected.
  • a second signal is selected. Selection of the analysis signal and the reference signal can be performed as described in greater detail with reference to FIGS. 4 and 5. In some embodiments or aspects, a root mean squared (RMS) can be determined for the first signal and for the second signal.
  • RMS root mean squared
  • a time interval over which the first signal and the second signal are to be compared is selected. The time interval can be selected to be an activation cycle (e.g., 100 ms to 300 ms) as described in FIG. 2. In some embodiments or aspects, the time interval can be determined by a dominant frequency analysis or other analysis of the average cycle length of the first (analysis) signal.
  • a default time interval of 200 ms can be used if the time interval cannot be determined computationally.
  • the time interval can be selected manually, computationally by a different analysis method, from a database that catalogs such time intervals for patients of a certain age, gender and type of heart rhythm disorder, or defaulted to a value between about 100 ms and about 300 ms.
  • a composite signal can be determined based on the selected first signal and the second signal, such as by subtracting or adding the signals as described with reference to FIG. 8.
  • a time point is selected for consideration in the selected time interval.
  • the same or about the same time point is selected for consideration in each signal (e.g., first signal and second signal).
  • derivatives are calculated for a time increment (e.g., 10 ms) extending from the point of consideration in each signal. It is noted that first-order derivatives and/or second-order derivatives are calculated in each signal. In those embodiments or aspects that use a composite signal, a derivative is also calculated for a time increment (e.g., 10 ms) extending from a time point of consideration in the composite signal. Similarly, in those embodiments or aspects using the composite signal, first-order derivatives and/or second-order derivatives are calculated in each signal.
  • the time point of consideration in the composite signal is the same or about the same as in the other signals (e.g., first signal and second signal).
  • points of change between the first-order derivatives of the first signal with respect to the first-order derivatives of the second signal are determined in the time interval under consideration.
  • points of change between the second-order derivatives of the first signal with respect to the second-order derivatives of the second signal are determined in the time interval under consideration.
  • a first significance value ( ⁇ ) can be determined at each point of change using the first-order derivatives
  • a second significance value ( ⁇ ) can be determined at each point of change using the second-order derivatives, as described with reference to FIGS. 6-8.
  • the point of change for the first-order derivatives can be determined with reference to a first threshold, while the point of change for second-order derivatives can be determined with reference to a second threshold, and the point of change for composite signals can be determined with reference to a third threshold.
  • the first threshold can be 0.25 (or another value) as described with reference to FIGS. 6-8 and the second threshold can be the same or a different value, while in those embodiments or aspects that use a composite signal, a third threshold can be computed as an average value plus a standard deviation of all points of change as described with reference to FIG. 8.
  • the method 900 continues at operation 920 where the significant point(s) of change is recorded (selected) as a possible activation onset(s) for the time interval under consideration in the first (analysis) signal. If however, it is determined that there is no point of change above the threshold (no significant point of change), the method 900 continues at operation 924 where the first signal is compared over the time interval to a catalog of reference signals. For example, the catalog of reference signals for heart rhythm disorders can be maintained in database 118. At operation 926, a determination is made as to whether there is a match to a reference signal in the database. The comparison can be based on at least one characteristic of the first signal to at least one characteristic of the reference signal, such as shape, slope, amplitude, frequency and/or timing. Other characteristics can be used together with or instead of the enumerated characteristics.
  • the threshold e.g., first threshold, second threshold, third threshold
  • the method 900 continues at operation 920 where the significant point(s) of change is recorded (selected) as a
  • the method 900 continues at operation 922.
  • the method 900 continues at operation 928 where the point(s) of change in the time interval under consideration is recorded (selected), which would correspond to activation onset(s) in the reference signal that was matched.
  • determination of the next time interval can be extended to consider significant points of change from all second (reference) signals for the same time interval under consideration. However, if it is determined that all time intervals have been processed at operation 922, the method 900 continues at operation 930.
  • an activation onset(s) is assigned in the first signal at the point(s) of change to define cardiac activation(s) indicating a beat(s) in the first signal if it is determined (at operation 918) that the point(s) of change is above the threshold (e.g., first threshold, second threshold, third threshold). Contention among points of change based on the different thresholds (first, second and third thresholds) can be resolved as set forth below in greater detail.
  • an activation onset(s) can be assigned in the first signal at the point(s) of change to define cardiac activation(s) indicating a beat(s) in the first signal based on a matched reference signal (at operation 928).
  • activation onsets are assigned to the time intervals of the first signal based on the recorded (or significant) point(s) of change of the first signal with reference to the second signal(s). That is, an activation onset is assigned to each time interval in the first (analysis) signal based possible activation onset(s) associated with the significant point(s) of change in the same time interval of the second (reference) signal(s).
  • the activation onset for the time interval of the first (analysis) signal can be determined based on an average of the activation onsets with reference to the second (reference) signals.
  • the activation onset for the time interval of the first signal can be determined based on an average of activation onsets with reference to those second signals in which a majority of activation onsets are within a predetermined time interval of each other (e.g., ⁇ 5 ms).
  • the activation onset for the time interval can be determined based on an average of activation onsets with reference to those second signals in which a plurality of activation onsets are within a predetermined time interval of each other (e.g., ⁇ 5 ms).
  • the assigned onset can be recorded for each interval in the first (analysis) signal such as in database 118.
  • signals collected from the heart 120 have been reconstructed with cardiac activation information (activation onsets) such that a cause of the heart rhythm disorder can be determined. More specifically, unipolar electrograms or monophasic action potentials (MAPs) can be mapped to the reconstructed activation onsets of the signals to show unipolar or MAP sequences or representations for the signals. An activation map or pattern can be constructed from these unipolar voltage or MAP voltage representations of the signals to locate the cause of the heart rhythm disorder. An example MAP representation and example activation map are illustrated in FIG. 11. [00101] FIG.
  • FIG. 10 is an illustration of an example signal pair comparison 1000 of analysis signal (SIG1) and reference signal (SIG2) that can be processed in accordance with method 900 of FIG. 9 to assign an activation onset 1004.
  • a time interval 1002 e.g., 100 ms - 300 ms
  • the signals in the time interval (SIG1, SIG2, COMP) are smoothed, such as via median filter.
  • Significance values ( ⁇ ) are determined for the points of changes in the signals' first or second derivative, as described herein with reference to FIGS. 1-9.
  • point of change 1012 in SIG1 that is above threshold 1010 is assigned as the activation onset 1004 for the time interval 1002 in SIG1 based on the first derivative.
  • point of change 1014 in SIG1 that is above threshold 1010 is assigned as the activation onset 1004 for the time interval 1002 in SIG1 based on the second derivative.
  • Subsequent time intervals are selected and activation onsets are assigned as described herein with reference to FIGS. 1-9 until the analysis signal (SIG1) is processed.
  • FIG. 11 is an illustration of an example mapping 1 100 of processed signals in accordance with FIGS. 1-10.
  • Raw signal 1100 represents a signal that is processed to assign activation onsets (vertical lines) as described herein.
  • a composite signal 1102 is shown, which results from the raw (analysis) signal 1100 and another (reference) signal (not shown).
  • a monophasic action potential (MAP) voltage representation is generated from for each processed signal 1100.
  • Multiple signals are processed as described herein and MAPs generated based on the processed signals.
  • the electrical activity of all MAPs is mapped in a sequence of example activation mappings 1106 to show activation onsets 1108, 1110, 1112 and 1114 at each time interval, respectively.
  • These mappings can be displayed by computing device 116. Although only four mapping are shown for illustrative purposes, there can be fewer or greater number of mappings 1106 based on the time intervals represented in the signals.
  • mappings 1106 e.g., activation onsets
  • the electrical activity indicates a rotational activation pattern of activation onsets (rotor) in the heart rhythm disorder.
  • a rotational activation pattern of activation onsets at least a portion of the area of the heart 120 indicated by the rotational activation pattern indicated by the arrows in FIG. 11 can be treated to eliminate the cause of the heart rhythm disorder, and therefore the heart rhythm disorder itself.
  • Such treatment may be delivered by ablation using various energy sources (including but not limited to radiofrequency, cryoenergy, microwave, and ultrasound), gene therapy, stem cell therapy, pacing stimulation, drug or other therapy.
  • the MAP representation and activation map are examples to illustrate a rotational activation pattern. Other activation patterns can result from different example signals collected by the sensors from the heart 120.
  • FIG. 12 is a block diagram of an illustrative embodiment of a general computer system 1200.
  • the computer system 1200 can be the signal processing device 114 and the computing device 116 of FIG. 1.
  • the computer system 1200 can include a set of instructions that can be executed to cause the computer system 1200 to perform any one or more of the methods or computer based functions disclosed herein.
  • the computer system 1200, or any portion thereof, may operate as a standalone device or may be connected, e.g., using a network or other connection, to other computer systems or peripheral devices.
  • the computer system 1200 may be operatively connected to signal processing device 114 and analysis database 118.
  • the computer system 1200 may also be implemented as or incorporated into various devices, such as a personal computer (PC), a tablet PC, a personal digital assistant (PDA), a mobile device, a palmtop computer, a laptop computer, a desktop computer, a communications device, a control system, a web appliance, or any other machine capable of executing a set of instructions (sequentially or otherwise) that specify actions to be taken by that machine.
  • PC personal computer
  • PDA personal digital assistant
  • mobile device a palmtop computer
  • laptop computer a laptop computer
  • desktop computer a communications device
  • control system a web appliance
  • the computer system 1200 may include a processor
  • CPU central processing unit
  • GPU graphics-processing unit
  • the computer system 1200 may include a main memory 1204 and a static memory 1206 that can communicate with each other via a bus 1226.
  • the computer system 1200 may further include a video display unit 1210, such as a liquid crystal display (LCD), an organic light emitting diode (OLED), a flat panel display, a solid state display, or a cathode ray tube (CRT).
  • the computer system 1200 may include an input device 1212, such as a keyboard, and a cursor control device 1214, such as a mouse.
  • the computer system 1200 can also include a disk drive unit 1216, a signal generation device 1222, such as a speaker or remote control, and a network interface device 1208.
  • the disk drive unit In a particular embodiment or aspect, as depicted in FIG. 12, the disk drive unit
  • the 1216 may include a computer-readable medium 1218 in which one or more sets of instructions 1220, e.g., software, can be embedded. Further, the instructions 1220 may embody one or more of the methods or logic as described herein. In a particular embodiment or aspect, the instructions 1220 may reside completely, or at least partially, within the main memory 1204, the static memory 1206, and/or within the processor 1202 during execution by the computer system 1200. The main memory 1204 and the processor 1202 also may include computer-readable media.
  • dedicated hardware implementations such as application specific integrated circuits, programmable logic arrays and other hardware devices, can be constructed to implement one or more of the methods described herein.
  • Apps that may include the apparatus and systems of various embodiments or aspects can broadly include a variety of electronic and computer systems.
  • One or more embodiments or aspects described herein may implement functions using two or more specific interconnected hardware modules or devices with related control and data signals that can be communicated between and through the modules, or as portions of an application-specific integrated circuit. Accordingly, the present system encompasses software, firmware, and hardware
  • the methods described herein may be implemented by software programs tangibly embodied in a processor-readable medium and may be executed by a processor. Further, in an exemplary, non-limited embodiment or aspect, implementations can include distributed processing, component/object distributed processing, and parallel processing. Alternatively, virtual computer system processing can be constructed to implement one or more of the methods or functionality as described herein.
  • a computer-readable medium includes instructions
  • the 1220 or receives and executes instructions 1220 responsive to a propagated signal, so that a device connected to a network 1224 can communicate voice, video or data over the network 1224. Further, the instructions 1220 may be transmitted or received over the network 1224 via the network interface device 1208.
  • “computer-readable medium” includes a single medium or multiple media, such as a centralized or distributed database, and/or associated caches and servers that store one or more sets of instructions.
  • the term “computer-readable medium” shall also include any medium that is capable of storing, encoding or carrying a set of instructions for execution by a processor or that cause a computer system to perform any one or more of the methods or operations disclosed herein.
  • the computer- readable medium can include a solid-state memory, such as a memory card or other package, which houses one or more non-volatile read-only memories. Further, the computer-readable medium can be a random access memory or other volatile re- writable memory. Additionally, the computer-readable medium can include a magneto-optical or optical medium, such as a disk or tapes or other storage device to capture carrier wave signals, such as a signal communicated over a transmission medium. A digital file attachment to an e-mail or other self-contained
  • the methods described herein may be implemented as one or more software programs running on a computer processor.
  • Dedicated hardware implementations including, but not limited to, application specific integrated circuits, programmable logic arrays, and other hardware devices can likewise be constructed to implement the methods described herein.
  • alternative software implementations including, but not limited to, distributed processing or component/object distributed processing, parallel processing, or virtual machine processing can also be constructed to implement the methods described herein.
  • software that implements the disclosed methods may optionally be stored on a tangible storage medium, such as: a magnetic medium, such as a disk or tape; a magneto-optical or optical medium, such as a disk; or a solid state medium, such as a memory card or other package that houses one or more read-only (non-volatile) memories, random access memories, or other re- writable (volatile) memories.
  • the software may also utilize a signal containing computer instructions.
  • a digital file attachment to e-mail or other self- contained information archive or set of archives is considered a distribution medium equivalent to a tangible storage medium. Accordingly, a tangible storage medium or distribution medium as listed herein, and other equivalents and successor media, in which the software implementations herein may be stored, are included herein.
  • inventive subject matter may be referred to herein, individually and/or collectively, by the term "invention" merely for convenience and without intending to voluntarily limit the scope of this application to any single invention or inventive concept if more than one is in fact disclosed.
  • inventive subject matter may be referred to herein, individually and/or collectively, by the term "invention" merely for convenience and without intending to voluntarily limit the scope of this application to any single invention or inventive concept if more than one is in fact disclosed.
  • inventive subject matter merely for convenience and without intending to voluntarily limit the scope of this application to any single invention or inventive concept if more than one is in fact disclosed.

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Abstract

La présente invention concerne un système et un procédé de reconstruction d'informations d'activation cardiaque donnés à titre d'exemple. Un signal d'analyse et un signal de référence sont traités pour déterminer s'il existe un premier point de changement dans une première dérivée d'ordre sélectionné du signal d'analyse par rapport à une première dérivée d'ordre sélectionné du signal de référence au-dessus d'un premier seuil. Le signal d'analyse et le signal de référence sont traités pour déterminer s'il y a un second point de changement dans une seconde dérivée d'ordre sélectionné du signal d'analyse cardiaque au-dessus d'un second seuil. Un temps de début d'activation est attribué dans le signal cardiaque d'analyse au niveau d'un point sur la base d'une association mathématique du premier point de changement et du second point de changement pour définir une activation cardiaque indiquant un battement dans le signal cardiaque d'analyse.
EP14763969.4A 2013-03-15 2014-03-14 Système et procédé de reconstruction d'informations d'activation cardiaque Withdrawn EP2967399A4 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US13/840,334 US9050006B2 (en) 2011-05-02 2013-03-15 System and method for reconstructing cardiac activation information
PCT/US2014/029616 WO2014144983A2 (fr) 2011-05-02 2014-03-14 Système et procédé de reconstruction d'informations d'activation cardiaque

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EP2967399A2 true EP2967399A2 (fr) 2016-01-20
EP2967399A4 EP2967399A4 (fr) 2016-11-23

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WO2017139340A1 (fr) * 2016-02-12 2017-08-17 Cardiac Pacemakers, Inc. Déclenchement de stockage d'apparition d'état physiologique
WO2017200773A1 (fr) * 2016-05-18 2017-11-23 Topera, Inc. Système et procédé d'identification de sources distantes associées à un trouble du rythme biologique
US10383534B2 (en) * 2016-08-11 2019-08-20 Biosense Webster (Israel) Ltd. Annotation of a wavefront
US11058342B2 (en) * 2016-08-11 2021-07-13 Biosense Webster (Israel) Ltd. Classifying ECG signals
GB2573109B (en) * 2018-04-23 2022-09-14 Barts Health Nhs Trust Methods and systems useful in mapping heart rhythm abnormalities
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US5433198A (en) * 1993-03-11 1995-07-18 Desai; Jawahar M. Apparatus and method for cardiac ablation
US7328063B2 (en) * 2004-11-30 2008-02-05 Cardiac Pacemakers, Inc. Method and apparatus for arrhythmia classification using atrial signal mapping
KR20130057998A (ko) * 2010-04-08 2013-06-03 더 리젠츠 오브 더 유니버시티 오브 캘리포니아 생물학적 리듬 장애의 검출, 진단 및 처치를 위한 방법, 시스템 및 장치
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BR112015022401A2 (pt) 2017-07-18
CN105142509A (zh) 2015-12-09
RU2015141382A (ru) 2017-04-21
JP2016518166A (ja) 2016-06-23
AU2014233461A1 (en) 2015-08-13
JP6386024B2 (ja) 2018-09-05
KR20150141965A (ko) 2015-12-21
CA2903109A1 (fr) 2014-09-18
CN105142509B (zh) 2018-05-11
EP2967399A4 (fr) 2016-11-23

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