System and method to define drivers of sources associated with biological rhythm disorders

• US 10,085,655 B2
• Filed: 03/14/2014
• Issued: 10/02/2018
• Est. Priority Date: 03/15/2013
• Status: Active Grant

• Current Assignee: Topera, Inc (Abbott Laboratories), United States Department of Veterans Affairs Office of General Counsel, Regents of the University of California (University of California)
• Original Assignee: Topera, Inc (Abbott Laboratories), US Department of Veterans Affairs (Government of the United States of America), Regents of the University of California (University of California)
• Inventors: Narayan, Sanjiv, Briggs, Carey Robert, Sehra, Ruchir
• Primary Examiner(s): Layno, Carl H
• Assistant Examiner(s): GHAND, JENNIFER LEIGH-STEWAR
• Application Number:
  US14/774,120
• Publication Number:
  US 20160022163A1
• Time in Patent Office: 1,663 Days
• CPC Class Codes: A61B 2560/0475 Special features of memory means, e.g. removable memory cards
• CPC Class Codes: A61B 2562/04 Arrangements of multiple sensors of the same type
• CPC Class Codes: A61B 5/0002 Remote monitoring of patients using telemetry, e.g. transmission of vital signals via a communication network A61B5/07 takes precedence; transmission systems for measured values G08C; transmission H04B; transmission of digital information H04L; wireless communication networks H04W
• CPC Class Codes: A61B 5/0006 ECG or EEG signals
• CPC Class Codes: A61B 5/02405 Determining heart rate variability
• CPC Class Codes: A61B 5/02444 Details of sensor A61B5/02427 takes precedence
• CPC Class Codes: A61B 5/287 Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
• CPC Class Codes: A61B 5/316 Modalities, i.e. specific diagnostic methods
• CPC Class Codes: A61B 5/339 Displays specially adapted therefor
• CPC Class Codes: A61B 5/349 Detecting specific parameters of the electrocardiograph cycle
• CPC Class Codes: A61B 5/361 Detecting fibrillation
• CPC Class Codes: A61B 5/6852 Catheters

Abstract

A system and method are provided for identifying a driver of a source associated with a heart rhythm disorder. Data are accessed from a plurality of sensors representing biological activity in the heart. A local first region of the heart that has repeating activation and determine whether the first region controls a second distant region of the heart for at least a predetermined number of beats is identified. The first local region is assigned as a driver of a source of the heart rhythm disorder, the source including the first local region and the second distant region.

Claims

1. A method to define a driver of a source associated with a cardiac rhythm disorder of a human heart, the method comprising:

processing a plurality of cardiac signals associated with sensors arranged spatially in relation to an area of the heart to determine a sequence of arcs of rotation in relation to the sensors over a time interval;

determining rotational directions of the arcs of rotation in the sequence; and

identifying and displaying on a graphical display the area of the heart as associated with controlling the source when the rotational directions of the arcs of rotation in the sequence continue in a same rotational direction in excess of a threshold of a magnitude of rotation determined by a phase analysis.

2. The method of claim 1, wherein the sensors define vertices of the area of the heart.

3. The method of claim 2, wherein the area comprises a plurality of areas of the heart defined by the vertices, the plurality of areas associated with controlling the source of the cardiac rhythm disorder.

4. The method of claim 3, wherein one or more of the areas of the heart form a rotor.

5. The method of claim 1, wherein the rotational direction is one of clockwise and counterclockwise.

6. The method of claim 1, wherein the method further comprises generating an indicator associated with the area of the heart as associated with controlling the source.

7. The method of claim 6, wherein the method further comprises corresponding the indicator to the sensors arranged spatially in relation to the area of the heart.

8. The method of claim 7, wherein corresponding the indicator to the sensors arranged spatially in relation to the area of the heart comprises overlaying the indicator over a representation of the plurality of cardiac signals.

9. The method of claim 8, wherein the method further comprises displaying the indicator as overlaid over the representation of the plurality of cardiac signals.

10. The method of claim 8, wherein the representation of the plurality of cardiac signals is a monophasic action potential representation.

11. The method of claim 1, wherein determining a rotational direction of an arc of rotation comprises:

selecting a first cardiac signal and a second cardiac signal from the plurality of cardiac signals;

determining indices of rotational activity among the first cardiac signal and the second cardiac signal at a plurality of time points during the time interval; and

combining the indices of rotational activity to define the rotational direction of the arc of rotation.

12. The method of claim 11, wherein determining an index of rotational activity comprises:

calculating a phase difference among the first cardiac signal and the second cardiac signal at a time point of the time interval; and

determining whether the phase difference is less than or equal to a first phase threshold, or whether the phase difference is greater than a second phase threshold;

incrementing the phase difference by a phase value when the phase difference is less than or equal to the first phase threshold; and

decrementing the phase difference by the phase value when the phase difference is greater than the second phase threshold.

13. The method of claim 12, wherein combining the indices of rotational activity comprises summing calculated phase differences, as incremented or decremented, at the plurality of time points of the time interval.

14. The method of claim 1, wherein the method further comprises:

performing processing, determining and identifying over a plurality of time intervals; and

determining persistence of the identified area associated with controlling the source as the rotational directions of the arcs continue in the same rotational direction over the plurality of time intervals.

15. The method of claim 14, wherein the method further comprises generating an indicator associated with the persistence of the identified area as controlling the source.

16. The method of claim 15, wherein the method further comprises corresponding the indicator to the sensors arranged spatially in relation to the area of the heart.

17. The method of claim 16, wherein corresponding the indicator to the sensors arranged spatially in relation to the area of the heart comprises overlaying the indicator over representations of the plurality of cardiac signals associated with the plurality of time intervals.

18. The method of claim 17, wherein the method further comprises displaying the indicator as overlaid over the representations of the plurality of cardiac signals.

19. The method of claim 17, wherein the representations of the plurality of cardiac signals are monophasic action potential representations.

20. A system to define a driver of a source associated with a cardiac rhythm disorder of a human heart, the system comprising:

a processing device; and

a memory device to store a plurality of instructions that, when executed by the processing device, cause the processing device to perform operations comprising;

processing a plurality of cardiac signals associated with sensors arranged spatially in relation to an area of the heart to determine a sequence of arcs of rotation in relation to the sensors over a time interval;

determining rotational directions of the arcs of rotation in the sequence; and

identifying and displaying on a graphical display the area of the heart as associated with controlling of the source when the rotational directions of the arcs of rotation in the sequence continue in a same rotational direction in excess of a threshold of a magnitude of rotation determined by a phase analysis.

21. The system of claim 20, wherein the sensors define vertices of the area of the heart.

22. The system of claim 21, wherein the area comprises a plurality of areas of the heart defined by the vertices, the plurality of areas associated with controlling the source of the cardiac rhythm disorder.

23. The system of claim 22, wherein one or more of the areas of the heart form a rotor.

24. The system of claim 20, wherein the rotational direction is one of clockwise and counterclockwise.

25. The system of claim 20, wherein the operations further comprise generating an indicator associated with the area of the heart as associated with controlling the source.

26. The system of claim 25, wherein the operations further comprise corresponding the indicator to the sensors arranged spatially in relation to the area of the heart.

27. The system of claim 26, wherein the operations further comprise overlaying the indicator over a representation of the plurality of cardiac signals.

28. The system of claim 27, wherein the operations further comprise displaying the indicator as overlaid over the representation of the plurality of cardiac signals.

29. The system of claim 28, wherein the representation of the plurality of cardiac signals is a monophasic action potential representation.

30. The system of claim 20, wherein the operations to determine a rotational direction of an arc of rotation comprise:

selecting a first cardiac signal and a second cardiac signal from the plurality of cardiac signals;

determining indices of rotational activity among the first cardiac signal and the second cardiac signal at a plurality of time points during the time interval; and

combining the indices of rotational activity to define the rotational direction of the arc of rotation.

31. The system of claim 30, wherein the operations to determine an index of rotational activity comprise:

calculating a phase difference among the first cardiac signal and the second cardiac signal at a time point of the time interval; and

determining whether the phase difference is less than or equal to a first phase threshold, or whether the phase difference is greater than a second phase threshold;

incrementing the phase difference by a phase value when the phase difference is less than or equal to the first phase threshold; and

decrementing the phase difference by the phase value when the phase difference is greater than the second phase threshold.

32. The system of claim 31, wherein the operation to combine the indices of rotational activity comprise summing calculated phase differences, as incremented or decremented, at the plurality of time points of the time interval.

33. The system of claim 20, wherein the operations further comprise:

performing processing, determining and identifying over a plurality of time intervals; and

determining persistence of the identified area associated with controlling the source as the rotational directions of the arcs continue in the same rotational direction over the plurality of time intervals.

34. The system of claim 33, wherein the operations further comprise generating an indicator associated with the persistence of the identified area as controlling the source.

35. The system of claim 34, wherein the operations further comprise corresponding the indicator to the sensors arranged spatially in relation to the area of the heart.

36. The system of claim 35, wherein the operations to correspond the indicator to the sensors arranged spatially in relation to the area of the heart comprise overlaying the indicator over representations of the plurality of cardiac signals associated with the plurality of time intervals.

37. The system of claim 36, wherein the operations further comprise displaying the indicator as overlaid over the representations of the plurality of cardiac signals.

38. The system of claim 36, wherein the representations of the plurality of cardiac signals are monophasic action potential representations.