WO2018073722A1 - Procédé mis en œuvre par ordinateur pour identifier le substrat arythmogène ventriculaire dans une cicatrice myocardique ou un tissu fibreux et programmes informatiques associés - Google Patents

Procédé mis en œuvre par ordinateur pour identifier le substrat arythmogène ventriculaire dans une cicatrice myocardique ou un tissu fibreux et programmes informatiques associés Download PDF

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WO2018073722A1
WO2018073722A1 PCT/IB2017/056404 IB2017056404W WO2018073722A1 WO 2018073722 A1 WO2018073722 A1 WO 2018073722A1 IB 2017056404 W IB2017056404 W IB 2017056404W WO 2018073722 A1 WO2018073722 A1 WO 2018073722A1
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egm
signal
mapping point
rmp
component
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PCT/IB2017/056404
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English (en)
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Antonio Berruezo Sánchez
Alejandro ALCAINE OTIN
Juan Pablo MARTÍNEZ CORTÉS
Pablo LAGUNA LASAOSA
Oscar CÁMARA REY
David SOTO IGLESIAS
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Hospital Clinic De Barcelona
Universidad De Zaragoza
Universitat Pompeu Fabra
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Publication of WO2018073722A1 publication Critical patent/WO2018073722A1/fr

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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
    • A61B5/72—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
    • A61B5/24—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
    • A61B5/24—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
    • A61B5/25—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]
    • A61B5/282—Holders for multiple electrodes
    • 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
    • A61B5/72—Signal processing specially adapted for physiological signals or for diagnostic purposes
    • A61B5/7235—Details of waveform analysis
    • A61B5/7264—Classification of physiological signals or data, e.g. using neural networks, statistical classifiers, expert systems or fuzzy systems
    • 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
    • A61B5/7275—Determining trends in physiological measurement data; Predicting development of a medical condition based on physiological measurements, e.g. determining a risk factor

Definitions

  • the present invention relates in general to the field of medical signal processing techniques.
  • the invention relates to a computer implemented method, and computer programs, to identify the ventricular arrhythmogenic substrate in myocardial scar or fibrotic tissue.
  • a qualitative analysis of the intracardiac electrogram (EGM) signal during normal sinus rhythm or during arrhythmia rhythm of a patient is performed to be later used as guidance for catheter ablation interventions of scar-related ventricular tachycardias (VTs).
  • EGM intracardiac electrogram
  • the analysis of substrate voltage maps using an electroanatomical mapping (EAM) system is one of the most used techniques for mapping the arrhythmogenic substrate in scar-related VTs in order to identify the isthmuses of the VT and thus perform the ablation.
  • the peak-to-peak voltage amplitude of the recorded EGMs can help to locate the small bundles of viable tissue within the scar (known as slow conducting channels (or CCs)) which form the substrate for reentry and promotion of VTs; therefore, those slow conducting channels become the area of interest of the ablation treatment.
  • Current substrate mapping inaccurately identifies those areas of interest, forcing clinicians and companion technicians to manually perform this task, thus being affected by many variables dependent on the substrate itself, catheter used, operator expertise, etc., which increases its imprecision.
  • EGM signals from slow conducting channels in the scar are characterized by the presence of very low amplitude and high-frequency delayed potentials reflecting the delayed conduction of the viable tissue within the myocardial scar. These delayed potentials are often preceded by a broader and lower frequency activation or "far-field" caused by the healthy tissue surrounding the scar area.
  • the identification of the presence of delayed potentials is done manually by an operator of the electroanatomical mapping system assisted by the electrophysiologist in charge of handling the catheters and intervention.
  • This identification is very subjective and dependent on the operator training and experience.
  • this manual identification is more expensive when multipole mapping catheters are used due to the amount of signals acquired during a single cardiac cycle.
  • US-A1 -2016128785 discloses a system and a method for identifying the arrhythmogenic circuit of a patient or subject.
  • the method comprises obtaining data for electrograms recorded at various locations of the heart while programmed ventricular pacing with extra stimuli was performed, obtaining decrement values for at least two different locations of the heart using the recorded electrograms, generating at least a portion of a decrement map using the decrement values, and identifying the arrhythmogenic circuit based on electrograms having significant decremental properties.
  • the system, and corresponding method, of this patent application is not based on an electroanatomical mapping system but on a multipoint mapping system.
  • US-A1 -2014235996 discloses a method for mapping of myocardial electric activity includes measuring electrocardiogram data or magnetocardiogram data and mapping the degree of electric activity of a myocardial surface using the electrocardiogram data or the magnetocardiogram data.
  • a signal source of the electrocardiogram data or the magnetocardiogram data is a myocardial surface potential that is scalar quantity.
  • the mapping uses a lead-field vector which represents the sensitivity between the myocardial surface potential and the electrocardiogram or magnetocardiogram data, and a modified lead-field vector which combines a constraint matrix with a constraint condition where no potential sources exist in a specific region.
  • the slow conductive channels are not identified nor is a qualitative analysis associated with the existence or not or a delayed potential and its relation with a previous potential is performed. More adequate automatic processing methods are therefore needed to assist the catheter ablation treatment in patients with scar-related VTs due to slow conducting channels.
  • the proposed invention aims to solve the above-mentioned problems, by identifying the presence or absence of delayed potentials in the bipolar electrogram signal.
  • a tool is provided automating and speeding up decision making during surgery, thus supporting the characterization of the slow conduction channels and identifying entries of such channels as targets for ablation. Furthermore, this identification can eliminate redundancies in the acquisition of similar and very close signals and can associate a correct measurement of the bipolar voltage (amplitude) to more accurately characterize the scar.
  • the new bipolar voltage maps are compared with contrast nuclear-magnetic resonances (delayed gadolinium) checking a better correlation of these voltage maps than that of the ones originally obtained.
  • Embodiments of the present invention provide according to a first aspect a computer implemented method to identify the ventricular arrhythmogenic substrate in myocardial scar or fibrotic tissue, wherein a plurality of mapping points acquired from a patient are stored in a signal acquisition unit, said plurality of mapping points including a plurality of electrocardiogram (ECG) signals, a plurality of corresponding intracardiac electrogram (EGM) signals, and a 3D location of each of said plurality of EGM signals, the method comprising, as commonly in the field, performing by a computer including one or more processors the following steps for at least one acquired mapping point, termed reference mapping point:
  • the proposed method further comprises:
  • d1 discriminating the primary delineated EGM signal based on a decision policy that takes into account EGM signal features thereof; d2) based on said discriminating, tagging the reference mapping point with a first tag indicative that the primary delineated EGM signal becomes a double component EGM signal or with a second tag indicative that the primary delineated EGM signal becomes a single component EGM signal; and
  • the plurality of mapping points have been acquired during a normal sinus rhythm of the patient and later stored in the signal acquisition unit.
  • the plurality of mapping points can be acquired during arrhythmia rhythm of the patient.
  • the EGM signal features in step d1 ) are the width and amplitude of the signal.
  • other EGM signal features such as the frequency, power, root mean square (RMS) value, among other signal features, could be similarly used by the proposed method to discriminate the primary delineated EGM signal.
  • RMS root mean square
  • step d1 comprises classifying the primary delineated EGM signal of said reference mapping point into two categories/classes, a first category indicating that the primary delineated EGM signal of said reference mapping point is a normal EGM signal and a second category indicating that the primary delineated EGM signal of the reference mapping point is an abnormal EGM signal.
  • the second category comprises a first sub- category/sub-class indicating that the primary delineated EGM signal of the reference mapping point is a short duration abnormal amplitude EGM signal candidate of having a second component EGM signal and a second sub-category indicating that the primary delineated EGM signal of the reference mapping point is a wide duration EGM signal candidate of having a second component EGM signal.
  • the reference mapping point is classified onto the first category, then, the reference mapping point is tagged with the second tag.
  • the method performs, before said step d2), and based on said discriminating step of step d1 ), a searching procedure over the primary delineated EGM signal determining existence or not of a second EGM component thereof.
  • the searching procedure comprises, if the primary delineated EGM signal of said reference mapping point being classified in said second category, looking for the existence of a second EGM component within a first defined searching region representing a time window corresponding to the occurrence of a QRS complex of the beat of interest in the recorded ECG signal of said reference mapping point; and/or a second defined searching region representing a time window corresponding to the rest of the cardiac cycle until the next QRS complex in the recorded ECG signal of said reference mapping point.
  • the method further comprises identifying a principal wave of the second EGM component found, identifying an onset and an end time landmarks of said principal wave of the second EGM component found and measuring the voltage thereof, and tagging the reference mapping point with the first tag.
  • the searching procedure does not find a second EGM component in the primary delineated EGM signal of said reference mapping point, the reference mapping point is tagged with the second tag.
  • step d2) the reference mapping point has been tagged with the first tag
  • the method further comprises measuring a time distance between the two EGM components of the delineated EGM signal, and based on said measured time distance, tagging the reference mapping point with a first sub-tag of the first tag indicative of a slow conducting channel entrance signal or with a second sub-tag of the first tag indicative of a slow conducting channel signal, based on a time threshold decision.
  • the conducting channel map and the propagation map are created by, defining a mapping window and checking that the location of the second EGM component falls within the defined mapping window, wherein if the second EGM component falls within the defined mapping window, the voltage of the second EGM component is associated to the corresponding reference mapping point anatomical location on a conducting channel map and a time of activation of the second EGM component is associated to the corresponding reference mapping point anatomical location on a propagation map, or wherein if the second EGM component doesn't fall within the defined mapping window, voltage and time properties of the reference mapping point are being evaluated as said reference mapping point tagged with the second tag, re-tagging the reference mapping point with the second tag.
  • the conducting channel map and the propagation map are created by checking the voltage of the first EGM component based on a voltage threshold value, wherein if the voltage is above said voltage threshold value, the voltage is associated to the corresponding reference mapping point anatomical location on a conducting channel map and a time of activation of the first EGM component is associated to the propagation map, or wherein if the voltage is below said voltage threshold value, a zero voltage value is associated to the corresponding reference mapping point anatomical location on a conducting channel map and the reference mapping point is removed from being mapped into the propagation map.
  • the conducting channel map and the propagation map may be created by: for the case of the reference mapping point being tagged with the first tag, the bipolar voltage of the second EGM component is associated to the corresponding reference mapping point anatomical location on a conducting channel map and a time of activation of the second EGM component is associated to the corresponding reference mapping point anatomical location on a propagation map; and for the case of the reference mapping point being tagged or re-tagged with the second tag, the bipolar voltage is associated to the corresponding reference mapping point anatomical location on a conducting channel map and a time of activation of the first EGM component is associated to the propagation map.
  • a conditioning step/strategy of the EGM signal associated to the recorded ECG signal is performed by:
  • the method further comprises searching for a plurality of other acquired mapping points tagged with the first tag and located in a neighbourhood of said reference mapping point, and for each neighbour mapping point:
  • step i performing a first checking of whether the identified beat of interest of the stored ECG signal of one neighbour mapping point is similar and synchronized with the identified beat of interest of the stored ECG signal of the reference mapping point using a shape and synchronization comparison measurement criterion; ii. based on the result of said first checking, if the similarity and synchronization has been proven, aligning the beat of interest of the stored ECG signal of said one neighbour mapping point with the identified beat of interest of the stored ECG signal of the reference mapping point and continue to step iii; or if the similarity and synchronization has not been proven, going back to step i, performing the first checking for another neighbour mapping point;
  • step iv. based on the result of said second checking, if the similarity and synchronization between the second EGM components has been proven, evaluating the voltage of both second EGM components using a voltage threshold value and re-tagging the mapping points depending on the result of said evaluation, and going back to step i, performing the first checking for another neighbour mapping point; or if the similarity and synchronization between the second EGM components has not been proven, going back to step i, performing the first checking for another neighbour mapping point.
  • step d) can be executed on an area of interest of the patient, said area of interest being predefined by using a radiographic imaging technique.
  • a computer program product is one embodiment that has a computer-readable medium including computer program instructions encoded thereon that when executed on at least one processor in a computer system causes the processor to perform the operations indicated herein as embodiments of the invention.
  • Present invention could be included in current electroanatomical mapping systems such as CARTO ® , NavXTM or RythmiaTM as an update package.
  • Fig. 1 is a block diagram of the processing chain that can be executed by the proposed method to identify the ventricular arrhythmogenic substrate in myocardial scar or fibrotic tissue according to an embodiment of the present invention.
  • Fig. 2 is a block diagram of the whole processing chain that can be executed by the proposed method to identify the ventricular arrhythmogenic substrate in myocardial scar or fibrotic tissue according to an embodiment of the present invention.
  • Fig. 3 is a block diagram of the processing chain of the EGM signal conditioning strategy proposed in an embodiment of the present invention.
  • Fig. 4 is a general block diagram of the processing chain of the qualitative EGM signal analysis block.
  • Fig. 5 is an example of the proposed decision tree for EGM signal classification.
  • Fig. 6 is a block diagram of the processing chain of the block diagram for the searching process of the second EGM component signal.
  • Fig. 7 is a block diagram of the processing chain of the tagging process of the EGM signal.
  • Fig. 8 is a block diagram of the processing chain of the spatiotemporal filtering strategy proposed in an embodiment of the present invention.
  • Fig. 9 is a block diagram of the processing chain of the maps creation block.
  • Fig. 1 represents a general schematic, according to a first embodiment, of different processing blocks of the invention to execute the proposed computer implemented method.
  • the invention is annexed to a signal acquisition unit (101 ) performed by any electroanatomical mapping system software which provides general information about the mapping points.
  • the mapping points may be acquired from a patient either during a normal sinus rhythm or during arrhythmia rhythm and are further stored in the signal acquisition unit.
  • the acquired mapping points include a plurality of ECG signals, a plurality of corresponding EGM signals, and the 3D location of each of said plurality of EGM signals.
  • the proposed method for one or more acquired mapping points, detects each beat present in at least one recorded ECG signal (the surface ECG within the recording excerpt) either during the normal sinus rhythm or during the arrhythmia rhythm of the patient and identifies the beat of interest from the detected beats.
  • ECG signal the surface ECG within the recording excerpt
  • the method executes an electrogram detection and delineation strategy (102) that provides detection and delineation of the bipolar EGM signal associated to the beat of interest. That is, a principal EGM wave related to the identified beat of interest is identified, and then, an onset and an end time landmarks of said principal EGM wave are also identified providing a primary delineated EGM signal. Finally, the voltage amplitude of the primary delineated EGM signal is measured.
  • the primary delineated EGM signal is discriminated based on a decision policy that takes into account EGM signal features thereof, preferably the width and voltage amplitude of the signal, however other signal features could be also used without departing from the scope of protection of present invention.
  • the reference mapping point RMP is tagged with a first tag indicative that the primary delineated EGM signal becomes a double component EGM signal or alternatively with a second tag indicative that the primary delineated EGM signal becomes a single component EGM signal.
  • the method then creates (104) a conducting channel map and a propagation map of the heart of the patient.
  • the qualitative analysis of the primary delineated EGM signal also comprises performing, before the execution of said tagging, and based on the result of the discriminating step, a searching procedure over the primary delineated EGM signal to determine existence or not of a second EGM component (potential) thereof.
  • Fig. 2 therein it is illustrated a third embodiment of the processing blocks that can be executed by the proposed method to identify the ventricular arrhythmogenic substrate in myocardial scar or fibrotic tissue.
  • the method besides the previous described processing steps also comprises the execution of an EGM signal conditioning strategy (202) and the execution of a spatiotemporal filtering strategy of EGM signals and tags (205).
  • the EGM signal conditioning strategy (202) is executed to include the information of the EGM signals from multiple beats in order to enhance the repetitive information included among beats of the same recording (if present).
  • the spatiotemporal filtering strategy (205) uses information enclosed in the neighbouring mapping points of the reference mapping point RMP in order to use and remove redundant and non- useful information. It should be noted that even though in the embodiment of Fig.
  • the method further includes the execution of two additional strategies, a conditioning strategy and a spatial-temporal filtering strategy, in alternative embodiments of the invention, in this case not illustrated either, a single strategy of those two strategies can be executed, that is, only the conditioning strategy or the spatiotemporal filtering strategy is implemented.
  • this searching procedure is optional, so in the other embodiments where the conditioning strategy and/or the spatiotemporal filtering strategy are/is applied the searching procedure is not mandatory.
  • the standard basic functions required to be performed by the signal acquisition unit are, as said before: I) detect each beat present in at least one recorded ECG signal (this detection provides the time landmark of the onset and end of each QRS complex and the time landmark of the R wave) and II) identify the beat of interest from the detected beats. Moreover, the signal acquisition unit also provides III) 3D location coordinates of each acquired mapping point and IV) generates a 3D mesh representing the mapping cardiac chamber where the mapping catheter moves and senses electrical activity. EGM Signal conditioning (202)
  • Fig. 3 illustrates an embodiment of the decision flow of the signal conditioning processing steps:
  • x ; [n] represent the fi beat signal contained in the recording excerpt with length L and x R [n] represent the beat of interest.
  • EGM signal s ; [n] from those similar beats x 7 [n] was considered similar to the reference beat x R [n] associated EGM signal s R [n] and also highly synchronized (small T ; EGM )
  • a combination signal 3 ⁇ 4 [n] is obtained and substitutes the associated EGM signal s R [n] of the reference ECG beat x R [n] for further processing.
  • This combination can be made using, but not limited to, the median value of all synchronized EGM signals including the EGM signal of the beat of interest.
  • each s ; [n] is synchronized using rf GM and the combination EGM signal 3 ⁇ 4 [n] associated to the ECG beat of interest is obtained as:
  • sfiW median ⁇ s ⁇ n— r GM , ... , Sj[n— T G ], s fi [n]J j.
  • Electrogram detection and delineation (102, 203) This block represents any signal processing strategy that provides detection and delineation of the bipolar EGM signal associated to the beat of interest.
  • the standard basic functions required to be performed by this detection and delineation strategy preferably are:
  • V Provide identification of the principal EGM wave related to the beat of interest.
  • This block describes the process to qualitatively analyze the EGM signal in order to decide whether to perform a searching process that looks for the existence of a second EGM component; and based on this decision and detection, performs tagging/identification of the reference mapping point RMP.
  • FIG. 4 An embodiment of this process is illustrated in Fig. 4 where it is divided in tree main sub-blocks that operate in cascade and are described in next subsections.
  • the mapping point RMP is classified into one category of two categories/classes: a first category (or normal category, i.e. short duration but bipolar voltage ⁇ threshold value), and a second category (or abnormal category, i.e. if the mapping point RMP doesn't fall within the first category and thus meaning that the mapping point is a double EGM signal candidate).
  • a first category or normal category, i.e. short duration but bipolar voltage ⁇ threshold value
  • second category or abnormal category, i.e. if the mapping point RMP doesn't fall within the first category and thus meaning that the mapping point is a double EGM signal candidate.
  • the second category may be divided into two different sub-categories/sub-classes, a first sub-category indicating that the mapping point RMP is of short duration and abnormal amplitude (i.e. bipolar voltage ⁇ threshold value), and a second sub-category indicating that the mapping point RMP is of wide duration.
  • a first sub-category indicating that the mapping point RMP is of short duration and abnormal amplitude (i.e. bipolar voltage ⁇ threshold value)
  • a second sub-category indicating that the mapping point RMP is of wide duration.
  • an EGM is considered short (e.g. width ⁇ 60-70 ms) and has normal amplitude (e.g. bipolar voltage ⁇ 1 .5-3.5 mV), then the EGM is identified as normal/single EGM signal.
  • a short EGM e.g. width ⁇ 60-70 ms
  • abnormal amplitude e.g. bipolar voltage ⁇ 1 .5-3.5 mV
  • these predefined thresholds are merely used as possible examples, being other similar values also usable in the qualitative EGM signal discrimination sub- process.
  • This searching process preferably applies over those EGM signals which are defined as abnormal EGM signals candidates of having a second EGM component.
  • the searching process defines two searching regions: Inside/first region and outside/second region:
  • - Outside region Represents a time window corresponding to the rest of the cardiac cycle until the next QRS complex in the recorded ECG signal. It can be defined as a time window spanning from the end of the QRS complex of the beat of interest to the onset of the QRS complex of the next beat (identified by general function I).
  • the searching process preferably looks for a sequentially or recursively strategy, within any combination of the searching regions for signal characteristics of the EGM signal, not limited to a particular processing or transformation of the signal, that reveals the existence of a second EGM component. The identification of these signal characteristics may imply the usage of thresholds over the EGM signal of the mapping point RMP that spans within the analysis windows.
  • This searching process may provide:
  • tags are associated to the mapping point RMP based on the outcomes of the previous described sub-processes.
  • the tags are associated depending on the qualities of each EGM signal, being those preferably the following:
  • This tag (or second tag) is associated to the EGM signals identified as normal/single EGM (i.e. single component EGM).
  • This sub-tag of the first tag (or second sub-tag) is associated to the identified double component EGM signals in which a distance metric between the first and second EGM components is above a predefined time threshold.
  • This distance metric can be defined as, but not limited to, the time distance between the principal waves of the first EGM component and the second EGM component.
  • This sub-tag of the first tag (or first sub-tag) is associated to the identified double component EGM signals in which a distance metric between the first and second EGM components is below a predefined time threshold.
  • This distance metric can be defined as, but not limited to, the time distance between the principal waves of the first EGM component and the second EGM component.
  • This block uses spatial information of the acquired mapping points in order to remove redundant mapping points.
  • the function of this block only applies over the mapping points tagged as slow conducting channel (either entrance or signal), that is, tagged with the first tag.
  • Fig. 8 illustrates an embodiment of the processing steps executed in this block:
  • step 8.6 Evaluation of similar and synchronized second EGM components can be done by evaluating its bipolar voltage based on a voltage threshold value; hence, the mapping point with higher bipolar voltage retains its tag whereas the other mapping point is re-tagged to Normal/single EGM mapping point (i.e. with the second tag) depending on the result of said evaluation. Then the process goes back to step 8.2. Creation of conducting channel and propagation maps (104, 206)
  • This block selects the values of each EGM signal to be represented within the anatomical reconstruction of the heart.
  • Two types of electroanatomical maps are preferably generated: the conducting channel map and the propagation map. Voltage and timing values of the EGM signal are associated to the anatomical 3D representation in conjunction with the tags.
  • Fig. 9 illustrates an embodiment in which mapping rules are defined for each tag:
  • This process preferably defines a mapping window comprised between the 5th percentile of the second EGM component onset landmarks and the 95 th percentile of the second EGM component offset landmarks. This mapping window is used to decide whether to map the EGM qualities following, for example, the following rules:
  • the bipolar voltage of the second EGM component is associated to the conducting channel map and the mapped propagation time, is, for example, the time difference between the onset landmark to the electrical reference landmark, o If the second EGM component is located outside the mapping window, then it is re-tagged to Normal/single EGM (second tag) and treated as Normal/single EGM.
  • the creation of conducting channel map and propagation map can be done following the rules:
  • the bipolar voltage of the first EGM component is associated to the conducting channel map, and the mapped propagation time on the propagation map, is, for example, the difference between the onset landmark to the electrical reference landmark.
  • the bipolar voltage of the second EGM component is associated to the conducting channel map, and the mapped propagation time on the propagation map, is, for example, the difference between the onset landmark of the second EGM component to the electrical reference landmark.
  • the proposed invention may be implemented in hardware, software, firmware, or any combination thereof. If implemented in software, the functions may be stored on or encoded as one or more instructions or code on a computer-readable medium.
  • Computer-readable media includes computer storage media.
  • Storage media may be any available media that can be accessed by a computer.
  • such computer-readable media can comprise RAM, ROM, EEPROM, CD-ROM or other optical disk storage, magnetic disk storage or other magnetic storage devices, or any other medium that can be used to carry or store desired program code in the form of instructions or data structures and that can be accessed by a computer.
  • Disk and disc includes compact disc (CD), laser disc, optical disc, digital versatile disc (DVD), floppy disk and Blu-ray disc where disks usually reproduce data magnetically, while discs reproduce data optically with lasers. Combinations of the above should also be included within the scope of computer-readable media. Any processor and the storage medium may reside in an ASIC.
  • the ASIC may reside in a user terminal.
  • the processor and the storage medium may reside as discrete components in a user terminal.
  • computer program products comprising computer-readable media including all forms of computer-readable medium except, to the extent that such media is deemed to be nonstatutory, transitory propagating signals.

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  • Measurement And Recording Of Electrical Phenomena And Electrical Characteristics Of The Living Body (AREA)

Abstract

La présente invention concerne un procédé mis en œuvre sur ordinateur pour identifier le substrat arythmogène ventriculaire dans une cicatrice myocardique ou un tissu fibreux et des produits de programme informatique. Une pluralité de points de cartographie acquis à partir d'un patient sont stockés dans une unité d'acquisition de signal, lesdits points de cartographie comprenant des signaux ECG, des signaux EGM et un emplacement 3D des signaux EGM, le procédé comprenant pour un point de cartographie de référence : a) la détection de chaque battement présent dans un signal ECG enregistré et l'identification d'un battement d'intérêt parmi les battements détectés ; b) l'identification d'une onde EGM principale liée au battement d'intérêt identifié ; c) l'identification de repères de temps de début et de fin de ladite onde EGM principale de façon à produire un signal EGM délimité primaire et la mesure d'une amplitude de tension du signal EGM délimité primaire ; d) la conduite d'une analyse supplémentaire de l'EGM délimité primaire ; et e) la création d'une carte de canal conducteur et d'une carte de propagation du cœur sur la base du résultat d'un balisage effectué au cours de ladite analyse.
PCT/IB2017/056404 2016-10-17 2017-10-16 Procédé mis en œuvre par ordinateur pour identifier le substrat arythmogène ventriculaire dans une cicatrice myocardique ou un tissu fibreux et programmes informatiques associés WO2018073722A1 (fr)

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EP4079216A1 (fr) 2021-04-19 2022-10-26 Biosense Webster (Israel) Ltd Annotation de parcours électrophysiologiques (ep) cardiaques lents en relation avec la tachycardie ventriculaire (vt)

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* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN113034578A (zh) * 2021-02-25 2021-06-25 上海联影智能医疗科技有限公司 感兴趣区域的信息处理方法及系统、电子设备及存储介质
EP4079216A1 (fr) 2021-04-19 2022-10-26 Biosense Webster (Israel) Ltd Annotation de parcours électrophysiologiques (ep) cardiaques lents en relation avec la tachycardie ventriculaire (vt)
US11998343B2 (en) 2021-04-19 2024-06-04 Biosense Webster (Israel) Ltd. Annotation of slow electrophysiological (EP) cardiac paths related to ventricular tachycardia (VT)

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