System and method of identifying sources associated with biological rhythm disorders

• US 10,398,326 B2
• Filed: 08/29/2014
• Issued: 09/03/2019
• Est. Priority Date: 03/15/2013
• Status: Active Grant

• Current 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)
• Original Assignee: 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 L
• Application Number:
  US14/473,990
• Publication Number:
  US 20140371609A1
• Time in Patent Office: 1,831 Days
• CPC Class Codes: A61B 18/12 by passing a current through the tissue to be heated, e.g. high-frequency current
• CPC Class Codes: A61B 2018/00577 Ablation
• CPC Class Codes: A61B 5/0006 ECG or EEG signals
• CPC Class Codes: A61B 5/02405 Determining heart rate variability
• CPC Class Codes: A61B 5/287 Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
• CPC Class Codes: A61N 1/327 for enhancing the absorption properties of tissue, e.g. by electroporation
• CPC Class Codes: A61N 1/368 comprising more than one electrode co-operating with different heart regions A61N1/3622, A61N1/3627 take precedence

Abstract

An example system and method associated with identifying and treating a source of a heart rhythm disorder are disclosed. In accordance with therewith, a spatial element associated with a region of the heart is selected. Progressive rotational activations or progressive focal activations are determined in relation to the selected spatial element. A plurality of indexes of progressive rotational activations or progressive focal activations over time is formed. One or more indexes are selected from the plurality of indexes that indicate consistency of the successive rotational activations or the progressive focal activations in relation to a portion of the region of the heart.

Claims

1. A method associated with identifying one or more sources of a heart rhythm disorder, the method comprising a computing device:

selecting a spatial element associated with a region of a heart;

determining progressive rotational activations or progressive focal activations in relation to the selected spatial element;

forming a plurality of indexes of successive rotational activations or successive focal activations over time;

selecting from the plurality of indexes one or more indexes that indicate consistency of the successive rotational activations or successive focal activations;

generating a representation associated with the successive rotational activations or successive focal activations in relation to a portion of the region of the heart; and

identifying, using the generated representation, one or more sources associated with the heart rhythm disorder.

2. The method of claim 1, wherein an index of a successive rotational activation is a progressive angular displacement in relation to the selected spatial element.

3. The method of claim 1, wherein an index of a successive focal activation is a progressive angular displacement in relation to the selected spatial element.

4. The method of claim 1, wherein an index of a successive rotational activation is a polar analysis of rotation in relation to the selected spatial element.

5. The method of claim 1, wherein an index of a successive focal activation is a polar analysis of rotation in relation to the selected spatial element.

6. The method of claim 1, wherein the selecting, determining, forming, and selecting are performed for a plurality of regions of the heart.

7. The method of claim 1, wherein a successive rotational activation is measured by progressively increasing or decreasing angular deviation.

8. The method of claim 1, wherein a successive rotational activation is measured in a polar coordinate system.

9. The method of claim 1, wherein a successive rotational activation is measured by progressively increasing or decreasing activation time.

10. The method of claim 1, wherein a successive rotational activation is measured by progressive change in phase.

11. The method of claim 1, wherein a successive rotational activation is measured as periodic activity with one or more superimposed non-periodic components.

12. The method of claim 1, wherein a successive rotational activation is determined using a measure of regularity or a measure of irregularity.

13. The method of claim 1, wherein a successive rotational activation is determined using Shannon entropy, Kolmogorov disorder, or other indexes of disorganization.

14. The method of claim 1, wherein deviations from the successive rotational activations or the successive focal activations represent disorganized breakdown from the one or more sources associated with the heart rhythm disorder.

15. The method of claim 1, wherein activations that are not part of the successive rotational activations are determined by disruption of successive activation times, disruption of polar analysis of rotation, disruption of periodic activations, or disruption of phase of rotations.

16. The method of claim 1, wherein deviations from the successive rotational activations or the successive focal activations associated with the one or more sources of the heart rhythm disorder represent interruptions, the interruptions being associated with a different source from the one or more sources associated with the heart rhythm disorder.

17. The method of claim 16, wherein the interruptions have a repeatable frequency.

18. The method of claim 16, wherein the interruptions have a repeatable spatial.

19. The method of claim 16, wherein a location of the different source of the heart rhythm disorder is indicated by spatial direction from which the interruptions disrupt the successive rotational activations or the successive focal activations.

20. The method of claim 1, wherein selecting from the plurality of indexes is based on a ratio of centrifugal to non-centrifugal activations that exceeds a threshold.

21. The method of claim 1, wherein selecting from the plurality of indexes is based on a ratio of rotating to non-rotating activations that exceeds a threshold.

22. The method of claim 21, wherein the threshold varies with a type of the heart rhythm disorder, being higher for a single source and lower for multiple sources associated with the heart rhythm disorder.

23. The method of claim 21, wherein the threshold varies with a type of the heart rhythm disorder, being higher for simple heart rhythm disorders and lower for complex heart rhythm disorders.

24. The method of claim 1, further comprising refining the determining based upon spatial migration of the one or more sources of the heart rhythm disorder.

25. The method of claim 1, further comprising determining a dominant source from the one or more sources when successive rotational activations or successive focal activations are detected at electrodes with a greater distance from the spatial element relative to neighboring electrodes.

26. The method of claim 1, further comprising delivering treatment to the one or more sources to treat the heart rhythm disorder.

27. The method of claim 26, further comprising delivering treatment to a source from the one or more sources that is dominant in order to treat the heart rhythm disorder.

28. The method of claim 26, further comprising delivering treatment to a source from the one or more sources that is not dominant in order to treat the heart rhythm disorder.

29. The method of claim 1, further comprising delivering treatment to modulate a source from the one or more sources of the heart rhythm disorder.

30. The method of claim 29, wherein the treatment comprises delivering one or more of destructive energy (ablation), therapy based on electroporation, non-destructive energy (pacing), gene therapy, and stem cell therapy.

31. The method of claim 29, wherein modulation is measurable in one of time, space, and combination of time and space.

32. The method of claim 1, wherein the heart rhythm disorder comprises one or more of atrial fibrillation, ventricular fibrillation, atrial tachycardia, atrial flutter, polymorphic or monomorphic ventricular tachycardia, ventricular flutter, and other rhythm disorder within the heart.

33. The method of claim 1, wherein the region of the heart lies in one or more of the heart, nerves that supply regions of the heart, blood vessels that supply regions of the heart, and tissues adjacent to the heart.

34. The method of claim 1, further comprising delivering treatment by modifying the portion of the region.

35. The method of claim 34, wherein modifying comprises destroying the portion.

36. The method of claim 34, wherein modifying the portion comprises delivery to the portion of one or more of ablation, electrical therapy, mechanical therapy, drug therapy, gene therapy, therapy based on electroporation, and stem cell therapy.

37. The method of claim 1, further comprising delivering treatment by selectively modifying one or more parts of the portion.

38. The method of claim 37, wherein modifying comprises destroying the one or more parts.

39. The method of claim 1, wherein the progressive rotational activations or progressive focal activations are angular deviations of activation in relation to the selected spatial element.

40. The method of claim 1, wherein selecting one or more indexes that indicate consistency of the successive rotational activations or the successive focal activations is based on one or more criteria selected from the group consisting of periodicity, slope, linearity, non-linearity, root mean square error (RMSE), cycle length, best-fit analysis, time interval, and combinations thereof.

41. The method of claim 1, further comprising performing selecting, determining, forming, and selecting in connection with additional selected spatial elements to identify consistency of activation in relation to additional portions of the region of the heart.

42. The method of claim 41, further comprising delivering treatment to the one or more of the additional portions of the region of the heart.

43. The method of claim 1, wherein activations that are not part of the successive rotational activations are determined by disruption of progressive angular deviations.

44. A system associated with identifying one or more sources of a heart rhythm disorder, the system comprising:

a processor; and

a memory storing instructions that, when executed by the processor, cause the processor to perform operations comprising;

selecting a spatial element associated with a region of a heart;

determining progressive rotational activations or progressive focal activations in relation to the selected spatial element;

forming a plurality of indexes of successive rotational activations or successive focal activations over time;

selecting from the plurality of indexes one or more indexes that indicate consistency of the successive rotational activations or successive focal activations;

generating a representation associated with the successive rotational activations or successive focal activations in relation to a portion of the region of the heart; and

identifying, using the generated representation, one or more sources associated with the heart rhythm disorder.

45. A non-transitory storage medium storing instructions that, when executed by the processor, cause the processor to perform operations associated with identifying one or more sources of a heart rhythm disorder, the operations comprising:

selecting a spatial element associated with a region of a heart;

determining progressive rotational activations or progressive focal activations in relation to the selected spatial element;

forming a plurality of indexes of successive rotational activations or successive focal activations over time;

selecting from the plurality of indexes one or more indexes that indicate consistency of the successive rotational activations or successive focal activations;

generating a representation associated with the successive rotational activations or successive focal activations in relation to a portion of the region of the heart; and

identifying, using the generated representation, one or more sources associated with the heart rhythm disorder.