Systems and methods for anterior and posterior electrode signal analysis

• US 10,433,746 B2
• Filed: 12/21/2018
• Issued: 10/08/2019
• Est. Priority Date: 12/22/2017
• Status: Active Grant

• Current Assignee: Bank Alan Dr, Medtronic Incorporated (Medtronic Plc), Regents of The University of Minnesota (University of Minnesota)
• Original Assignee: Regents of The University of Minnesota (University of Minnesota)
• Inventors: Ghosh, Subham, Curtin, Antonia E., Bank, Alan J., Gage, Ryan M., Burns, Kevin V., Gillberg, Jeffrey M., Du, Juan
• Primary Examiner(s): Stice, Paula J
• Application Number:
  US16/229,224
• Publication Number:
  US 20190192034A1
• Time in Patent Office: 291 Days
• CPC Class Codes: A61B 5/259 using conductive adhesive means, e.g. gels
• CPC Class Codes: A61B 5/282 Holders for multiple electrodes for introduction into the body A61B5/287
• CPC Class Codes: A61B 5/316 Modalities, i.e. specific diagnostic methods
• CPC Class Codes: A61B 5/341 Vectorcardiography [VCG]
• 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 5/363 Detecting tachycardia or bradycardia
• CPC Class Codes: A61B 5/366 Detecting abnormal QRS complex, e.g. widening
• CPC Class Codes: A61B 5/6805 Vests
• CPC Class Codes: A61B 5/6823 Trunk, e.g., chest, back, abdomen, hip
• CPC Class Codes: A61B 5/7203 for noise prevention, reduction or removal
• CPC Class Codes: A61N 1/362 Heart stimulators heart defibrillators A61N1/39
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
• CPC Class Codes: A61N 1/368 comprising more than one electrode co-operating with different heart regions A61N1/3622, A61N1/3627 take precedence
• CPC Class Codes: A61N 1/3904 External heart defibrillators [EHD]
• CPC Class Codes: A61N 1/3956 Implantable devices for applying electric shocks to the heart, e.g. for cardioversion

Abstract

The exemplary systems, methods, and interfaces may obtain and analyze electrode signals from a plurality of external electrodes. The electrode signals may include at least an anterior set of electrode signals and a posterior set of electrode signals. The anterior and posterior sets of electrode signals may be used to generate, or provide, various metrics of cardiac electrical heterogeneity and various graphical depictions that may be useful in assessing a patient'"'"'s cardiac functionality.

Claims

1. A system for use in cardiac evaluation comprising:

electrode apparatus comprising a plurality of external electrodes to be located proximate a patient'"'"'s skin, wherein the plurality of external electrodes comprises;

a posterior set of electrodes located proximate the patient'"'"'s posterior, and

an anterior set of electrodes located proximate the patient'"'"'s anterior;

a display comprising a graphical user interface to present cardiac signal information; and

computing apparatus comprising processing circuitry, the computing apparatus operably coupled to the electrode apparatus and the display, the computing apparatus configured to;

monitor electrical activity from the patient'"'"'s skin using the plurality of external electrodes over a cardiac cycle resulting in a posterior set of electrode signals monitored from one or more of the posterior set of electrodes and an anterior set of electrode signals monitored from one or more of the anterior set of electrodes, wherein the posterior set of electrode signals and anterior set of electrode signals are representative of cardiac activity,

process the posterior set of electrode signals and the anterior set of electrode signals for at least one cardiac cycle, and

display on the graphical user interface the posterior set of electrode signals and the anterior set of electrode signals on a single-cycle graph, wherein the anterior set of electrode signals are graphically distinguishable from the posterior set of electrode signals.

2. The system of claim 1, wherein the posterior set of electrode signals displayed on the single-cycle graph are a different color than the anterior set of electrode signals displayed on the single-cycle graph.

3. The system of claim 1, wherein the each of the plurality of electrode signals displayed on the single-cycle graph are graphically distinguishable from each other based on location of the electrode from which the electrode signal is monitored.

4. The system of claim 1, wherein the computing apparatus is further configured to:

determine an electrical activation time for each of the plurality of electrode signals; and

display a map of electrical activation based on the electrical activation times for the plurality of electrode signals.

5. The system of claim 4, wherein the computing apparatus is further configured to:

allow selection of an area within the map of electrical activation; and

indicate the electrode signal of the plurality of electrode signals on the single-cycle graph corresponding to the selected area within the map of electrical activation.

6. The system of claim 4, wherein the computing apparatus is further configured to:

allow selection of a signal of the posterior set of electrode signals and the anterior set of electrode signals on the single-cycle graph; and

indicate an area within the map of electrical activation corresponding to the selected signal.

7. The system of claim 1, wherein the computing apparatus is further configured to:

determine an activation time of a QRS complex of the cardiac cycle for each of the plurality of electrode signals; and

display an activation time indicator based on the determined activation time on each of the plurality of electrode signals on the single-cycle graph.

8. The system of claim 1, wherein the computing apparatus is further configured to:

determine a composite onset time of a QRS complex of the cardiac cycle based on all of the plurality of electrode signals; and

display a composite onset time indicator based on the determined composite onset time on the single-cycle graph.

9. The system of claim 8, wherein the composite onset time is the earliest onset time of the QRS complex of the cardiac cycle of the plurality of electrode signals.

10. The system of claim 1, wherein the computing apparatus is further configured to:

determine a composite offset time of a QRS complex of the cardiac cycle based on all of the plurality of electrode signals; and

display a composite offset time indicator based on the determined composite offset time on the single-cycle graph.

11. The system of claim 10, wherein the composite offset time is the latest offset time of the QRS complex of the cardiac cycle of the plurality of electrode signals.

12. The system of claim 1, wherein the computing apparatus is further configured to:

determine a metric of electrical heterogeneity based on the monitored electrical signals for the cardiac cycle; and

display the metric of electrical heterogeneity proximate the single-cycle graph.

13. The system of claim 1, wherein the computing apparatus is further configured to:

initiate cardiac therapy to the patient applying a plurality of different cardiac therapy settings over a plurality of cardiac cycles; and

display on the graphical user interface a plurality of single-cycle graphs, each single-cycle graph corresponding to a different cardiac cycle where different cardiac therapy settings are applied, each single-cycle graph including all of the plurality of electrode signals.

14. The system of claim 13, wherein the plurality of different cardiac therapy settings comprises one or more of selection between intrinsic rhythm, left ventricular-only pacing and biventricular pacing, V-V pacing delay, and A-V pacing delay.

15. A method for use in cardiac evaluation comprising:

monitoring electrical activity from a patient'"'"'s skin using a plurality of external electrodes over a cardiac cycle resulting in a posterior set of electrode signals monitored from one or more of a posterior set of electrodes located proximate the patient'"'"'s posterior and an anterior set of electrode signals monitored from one or more of an anterior set of electrodes located proximate the patient'"'"'s anterior, wherein the posterior set of electrode signals and anterior set of electrode signals are representative of cardiac activity;

processing the posterior set of electrode signals and the anterior set of electrode signals for at least one cardiac cycle; and

displaying on a graphical user interface the posterior set of electrode signals and the anterior set of electrode signals on a single-cycle graph, wherein the anterior set of electrode signals are graphically distinguishable from the posterior set of electrode signals.

16. The method of claim 15, wherein the posterior set of electrode signals displayed on the single-cycle graph are a different color than the anterior set of electrode signals displayed on the single-cycle graph.

17. The method of claim 15, wherein the each of the plurality of electrode signals displayed on the single-cycle graph are graphically distinguishable from each other based on location of the electrode from which the electrode signal is monitored.

18. The method of claim 15, the method further comprising:

determining an electrical activation time for each of the plurality of electrode signals; and

displaying a map of electrical activation based on the electrical activation times for the plurality of electrode signals.

19. The method of claim 18, the method further comprising:

allowing selection of an area within the map of electrical activation; and

indicating the electrode signal of the plurality of electrode signals on the single-cycle graph corresponding to the selected area within the map of electrical activation.

20. The method of claim 18, the method further comprising:

allowing selection of a signal of the posterior set of electrode signals and the anterior set of electrode signals on the single-cycle graph; and

indicating an area within the map of electrical activation corresponding to the selected signal.

21. The method of claim 15, the method further comprising:

determining an activation time of a QRS complex of the cardiac cycle for each of the plurality of electrode signals; and

displaying an activation time indicator based on the determined activation time on each of the plurality of electrode signals on the single-cycle graph.

22. The method of claim 15, the method further comprising:

determining a composite onset time of a QRS complex of the cardiac cycle based on all of the plurality of electrode signals; and

displaying a composite onset time indicator based on the determined composite onset time on the single-cycle graph.

23. The method of claim 22, wherein the composite onset time is the earliest onset time of the QRS complex of the cardiac cycle of the plurality of electrode signals.

24. The method of claim 15, the method further comprising:

determining a composite offset time of a QRS complex of the cardiac cycle based on all of the plurality of electrode signals; and

displaying a composite offset time indicator based on the determined composite offset time on the single-cycle graph.

25. The method of claim 24, wherein the composite offset time is the latest offset time of the QRS complex of the cardiac cycle of the plurality of electrode signals.

26. The method of claim 15, the method further comprising:

determining a metric of electrical heterogeneity based on the monitored electrical signals for the cardiac cycle; and

displaying the metric of electrical heterogeneity proximate the single-cycle graph.

27. The method of claim 15, the method further comprising:

initiating cardiac therapy to the patient applying a plurality of different cardiac therapy settings over a plurality of cardiac cycles; and

displaying on the graphical user interface a plurality of single-cycle graphs, each single-cycle graph corresponding to a different cardiac cycle where different cardiac therapy settings are applied, each single-cycle graph including all of the plurality of electrode signals.

28. The method of claim 27, wherein the plurality of different cardiac settings comprises one or more of selection between intrinsic rhythm, left ventricular-only pacing and biventricular pacing, V-V pacing delay, and A-V pacing delay.