System and method for reconstructing cardiac activation information

• US 10,271,786 B2
• Filed: 07/07/2016
• Issued: 04/30/2019
• Est. Priority Date: 05/02/2011
• Status: Active Grant

• Current Assignee: Topera, Inc (Abbott Laboratories Incorporated)
• Original Assignee: Topera, Inc (Abbott Laboratories Incorporated), 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
• Primary Examiner(s): Koharski, Christopher
• Assistant Examiner(s): Dinga, Roland
• Application Number:
  US15/204,455
• Publication Number:
  US 20170007176A1
• Time in Patent Office: 1,027 Days
• Field of Search: 600547, 600554, 600424, 607 2, 607 27- 28, 607 62, 607116, 128898, 128899
• CPC Class Codes: A61B 2562/046 in a matrix array
• CPC Class Codes: A61B 5/0036 including treatment, e.g., using an implantable medical device, ablating, ventilating
• CPC Class Codes: A61B 5/02405 Determining heart rate variability
• 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 5/349 Detecting specific parameters of the electrocardiograph cycle
• CPC Class Codes: A61B 5/7203 for noise prevention, reduction or removal
• CPC Class Codes: A61B 5/7239 using differentiation including higher order derivatives
• CPC Class Codes: A61B 5/7278 Artificial waveform generation or derivation, e.g. synthesising signals from measured signals A61B5/327 takes precedence
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 40/67 for remote operation
• CPC Class Codes: G16H 50/30 for calculating health indices; for individual health risk assessment

Abstract

Reconstruction of cardiac information associated with a heart rhythm disorder includes accessing a plurality of neighboring cardiac signals and eliminating far-field activations from the neighboring cardiac signals using one or more divergence criteria that define local activations, where the divergence criteria is associated with divergence among the plurality of neighboring cardiac signals. The local activations in the plurality of neighboring cardiac signals may be used to construct a clinical representation of the heart rhythm disorder.

Claims

1. A method of representing cardiac information associated with a heart rhythm disorder, the method comprising:

accessing, using a computing device, a plurality of neighboring cardiac signals obtained from a patient;

eliminating, using the computing device, far-field activations from the plurality of neighboring cardiac signals by;

processing a first cardiac signal and a second cardiac signal of the plurality of neighboring cardiac signals to determine whether there is a point of change in the first cardiac signal at which a derivative of the first cardiac signal diverges with respect to a derivative of the second cardiac signal above a threshold; and

assigning an activation onset time in the first cardiac signal at the point of change to define a local activation if the point of change is in the first cardiac signal; and

constructing, using the computing device, a clinical representation of local activations in the plurality of neighboring cardiac signals.

2. The method of claim 1, wherein the derivative of the first cardiac signal and the derivative of the second cardiac signal are selected from a group consisting of a zero-order derivative, a first-order derivative, a second-order derivative, a higher-order derivative, and combinations thereof.

3. The method of claim 1, wherein the derivative of the first cardiac signal and the derivative of the second cardiac signal are zero-order derivatives.

4. The method of claim 1, wherein the derivative of the first cardiac signal and the derivative of the second cardiac signal are first-order derivatives.

5. The method of claim 1, wherein the derivative of the first cardiac signal and the derivative of the second cardiac signal are second-order derivatives.

6. The method of claim 1, further comprising obtaining the first cardiac signal and the second cardiac signal from the patient using a first sensor and a second sensor, respectively.

7. The method of claim 1, wherein the first cardiac signal and the second cardiac signal are obtained contemporaneously from the patient.

8. The method of claim 1, wherein the point of change is determined at about the same time point for the first cardiac signal and the second cardiac signal.

9. The method of claim 1, wherein the point of change is determined from one or more of slope, amplitude, timing and shape of the first cardiac signal and the second cardiac signal.

10. The method of claim 1, wherein determination of the point of change comprises:

forming, by the computing device, a composite cardiac signal from the first cardiac signal and the second cardiac signal;

determining, by the computing device, ratio values at a plurality of points in the first cardiac signal, each ratio value representing a difference between the derivative of the second cardiac signal and a derivative of the composite cardiac signal in comparison to a difference between the derivative of the first cardiac signal and the derivative of the composite cardiac signal; and

selecting as the point of change in the first cardiac signal a point having a largest ratio value from the determined ratio values.

11. The method of claim 1, wherein the threshold is higher than a noise level associated with the first cardiac signal and the second cardiac signal.

12. The method of claim 11, wherein a point of change at or below the noise level is associated with one or more signals from a heart, respiratory system, gastrointestinal tract, neurological system and electronic interference.

13. The method of claim 1, further comprising the computing device:

matching at least one characteristic of the first cardiac signal to at least one characteristic of a reference cardiac signal in a catalog of cardiac signals if the point of change is not in the first cardiac signal; and

assigning an activation onset time in the first cardiac signal as an activation onset time of the reference cardiac signal to define a local activation in the first cardiac signal.

14. The method of claim 1, further comprising defining multiple local activations in the first cardiac signal.

15. The method of claim 1, further comprising the computing device iteratively accessing the first cardiac signal and the second cardiac signal from the plurality of neighboring cardiac signals.

16. The method of claim 1, further comprising the computing device:

accessing pairs of cardiac signals from the plurality of neighboring cardiac signals, each pair having a first cardiac signal and a different second cardiac signal;

performing the processing and the assigning for each of the pairs to define multiple local activations in the first cardiac signal in each of the pairs; and

constructing the clinical representation based on the multiple local activations of the plurality of neighboring cardiac signals to indicate a source of the heart rhythm disorder.

17. The method of claim 16 further comprising presenting the clinical representation as constructed to facilitate treatment of cardiac tissue at the source to treat the heart rhythm disorder.

18. The method of claim 1, wherein divergence at the point of change is based on one or more of signal divergence, signal amplitude or voltage, signal rate or cycle length, signal upstroke velocity (dV/dt), signal frequency components, and signal repeatability.

19. The method of claim 1, wherein the clinical representation of the local activations includes a rotor.

20. The method of claim 1, wherein the clinical representation of local activations includes a focal source.

21. A method of treating a heart rhythm disorder using the clinical representation of claim 4.

22. A system of representing cardiac information associated with a heart rhythm disorder, the system comprising a computing device configured to:

access a plurality of neighboring cardiac signals obtained from a patient;

eliminate far-field activations from the plurality of neighboring cardiac signals by processing a first cardiac signal and a second cardiac signal of the plurality of cardiac signals to determine whether there is a point of change in the first cardiac signal at which a derivative of the first cardiac signal diverges with respect to a derivative of the second cardiac signal above a threshold and assigning an activation onset time in the first cardiac signal at the point of change to define a local activation if the point of change is in the first cardiac signal; and

construct a clinical representation of local activations in the plurality of neighboring cardiac signals.

23. The system of claim 22, wherein the computing device is further configured to:

access a plurality of pairs of cardiac signals from the plurality of neighboring cardiac signals, each pair having a first cardiac signal and a different second cardiac signal;

repeat the processing and the assigning for each pair to define multiple local activations in the first cardiac signal in each of the plurality of pairs; and

construct the clinical representation based on the multiple local activations of the plurality of neighboring cardiac signals to indicate a source of the heart rhythm disorder.

24. The system of claim 22, wherein the computing device is further configured to determine the point of change by:

forming a composite cardiac signal from the first cardiac signal and the second cardiac signal;

determining ratio values at a plurality of points in the first cardiac signal, each ratio value representing a difference between the derivative of the second cardiac signal and a derivative of the composite cardiac signal in comparison to a difference between the derivative of the first cardiac signal and the derivative of the composite cardiac signal; and

selecting as the point of change in the first cardiac signal a point having a largest ratio value from the determined ratio values.

25. A method of representing cardiac information associated with a heart rhythm disorder, the method comprising:

accessing, using a computing device, a plurality of signal pairs of neighboring cardiac signals obtained from a patient, each signal pair having a first cardiac signal and a second cardiac signal;

processing, using the computing device, each signal pair to eliminate far-field activations by determining whether there is a point of change in the first cardiac signal at which a derivative of the first cardiac signal diverges with respect to a derivative of the second cardiac signal above a threshold;

assigning, using the computing device, an activation onset time in the first cardiac signal at the point of change to define a local activation if the point of change is in the first cardiac signal;

repeating the processing and the assigning for additional signal pairs, each additional signal pair having a different second cardiac signal, to define multiple local activations in the first cardiac signal in each of the additional signal pairs; and

constructing, using the computing device, a clinical representation based on the multiple local activations of the plurality of signal pairs to indicate a source of the heart rhythm disorder.