DETERMINING ONSETS AND OFFSETS OF CARDIAC DEPOLARIZATION AND REPOLARIZATION WAVES

• US 20170143976A1
• Filed: 12/02/2016
• Published: 05/25/2017
• Est. Priority Date: 07/26/2013
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Ghosh, Subham
• Granted Patent: US 10,449,365 B2
• Time in Patent Office: Days
• CPC Class Codes: A61B 2562/043 in a linear array
• 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 5/1107 Measuring contraction of parts of the body, e.g. organ, muscle apparatus for measuring work or force in general G01L
• 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 5/318 Heart-related electrical modalities, e.g. electrocardiography [ECG]
• CPC Class Codes: A61B 5/349 Detecting specific parameters of the electrocardiograph cycle
• 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 1/36507 controlled by gradient or slope of the heart potential
• CPC Class Codes: A61N 1/3684 for stimulating the heart at multiple sites of the ventricle or the atrium
• CPC Class Codes: A61N 1/36842 Multi-site stimulation in the same chamber

Abstract

An exemplary computer-implemented method is disclosed for detection of onset of depolarization on far-field electrograms (EGMs) or electrocardiogram (ECG)-or ECG-like signals. The method includes determining a baseline rhythm using a plurality of body-surface electrodes. The baseline rhythm includes an atrial marker and a ventricular marker. A pre-specified window is defined as being between the atrial marker and the ventricular marker. A low pass filter is applied to a signal within the window. A rectified slope of the signal within the window is determined. A determination is made as to whether a time point (t1) is present such that the rectified slope exceeds 10% of a maximum value of the rectified slope. A point of onset of a depolarization complex in the signal is determined. The point of onset occurs at a largest curvature in the signal within the window.

Claims

1. A method of comprising:

a) determining a baseline rhythm using a plurality of body-surface electrodes, the baseline rhythm includes an atrial marker and a ventricular marker (Vs);

b) defining a window between the atrial marker and the ventricular marker;

c) applying a low pass filter to a signal within the defined window;

d) determining a rectified slope of the signal;

e) determining a time point (t1) in which the rectified slope exceeds 10% of a maximum value of the rectified slope;

f) determining a point of onset of a depolarization complex in the signal, wherein the point of onset occurs at a largest curvature in the signal within the defined window prior to t1;

(g) determining an electromechanical delay for each of a plurality of candidate cardiac pacing sites using the determined point of onset of the depolarization complex; and

h) selecting an implant site for an implantable pacing electrode for delivering cardiac pacing based upon the determined electromechanical delays.

2. The method of claim 1 wherein the point of onset of the depolarization complex is determined without detection of a threshold.

3. The method of claim 1 wherein the largest curvature in the signal is determined from a curvature of the signal defined as

r=|y″

|/(1+|y′

|²)^(3/2) in which y″ and

y′

are the double and single derivatives of y=f(t), respectively.

4. The method of claim 1 wherein a simplified version of a curvature equation, r≈

|y″

|/(1+|y′

|2), may be used to compute an index that tracks the curvature of the signal, eliminating computation of square roots.

5. The method of claim 2 wherein determining the point of onset of the depolarization complex comprises searching for the largest curvature of the signal or an index tracking a curvature of the signal at a sharp deflection in the curvature of the signal, the sharp deflection being indicative of the onset of the depolarization complex.

6. The method of claim 1 further comprising:

searching for the largest curvature within the pre-specified window and ending on a maximum peak or a minimum valley.

7. The method of claim 1 further comprising:

removing high-frequency artifacts in the signal through the low pass filter.

8. The method of claim 1 further comprising:

receiving a signal by a cardiac resynchronization therapy (CRT) device,

wherein determining the point of onset of the depolarization complex comprises determining a point of onset of a QRS complex in the signal received by the CRT device.

9. The method of claim 8 wherein receiving the signal by the CRT device includes receiving one of a leadless signal and a far-field signal.

10. The method of claim 8 further comprising:

automating measurements of cardiac electrical activation times with respect to the determined point of onset of the QRS complex.

11. The method of claim 1 wherein the point of onset of the depolarization complex in the signal is determined without using a threshold-based detection algorithm.

12. A system comprising:

a) processing means for determining intrinsic rhythm using a plurality of body-surface electrodes, the intrinsic rhythm includes an atrial marker and a ventricular marker (Vs);

b) processing means for defining a pre-specified window between the atrial marker and the ventricular marker;

c) processing means for applying a low pass filter to a signal within the window;

d) processing means for determining a rectified slope of the signal;

e) processing means for determining a time point (t1) in which the rectified slope exceeds 10% of a maximum value of the rectified slope;

f) processing means for determining a point of onset of a depolarization complex in the signal, wherein the point of onset occurs at a largest curvature in the signal within the pre-specified window prior to t1; and

g) using the determined point of onset of depolarization to select a pacing site to be paced by an implantable electrode.

13. The system of claim 12 wherein automated determination of the point of onset of the depolarization is performed without detection of a threshold.

14. The system of claim 12 wherein the largest curvature in the signal is determined from a curvature in the signal defined as

r=|y″

|/(1+|y′

|²)^(3/2) in which y″ and

y′

are the double and single derivatives of y=f(t), respectively.

15. The system of claim 12 wherein a simplified version of a curvature equation r≈

|y″

|/(1+|y′

|2), may be used to compute an index that tracks the curvature of the signal thereby eliminating computation of square roots.

16. The system of claim 13 wherein determining the point of onset of the depolarization complex comprises searching for the largest curvature in the signal or an index tracking a curvature of the signal at a sharp deflection in the curvature of the signal, the sharp deflection being indicative of the onset of the depolarization complex.

17. The system of claim 12 further comprising:

processing means for searching for the largest curvature within the pre-specified window and ending on a maximum peak or a minimum valley.

18. The system of claim 12 further comprising:

removing high-frequency artifacts in the signal through the low pass filter.

19. The system of claim 12 further comprising:

receiving means for receiving an ECG signal by a cardiac resynchronization therapy (CRT) device

wherein determining the point of onset of the depolarization complex comprises determining a point of onset of a QRS complex in the ECG signal received by the CRT device.

20. The system of claim 18 wherein the receiving means for receiving the ECG signal by the CRT device includes means for receiving one of a leadless ECG signal and a far-field ECG signal.

21. The system of claim 18 further comprising:

processing means for automating measurements of cardiac electrical activation times with respect to the determined point of onset of the QRS complex.

22. A non-transitory, computer-readable storage medium comprising instructions that, when executed, cause a processor to perform a method comprising:

a) determining a baseline rhythm using a plurality of body-surface electrodes, the baseline rhythm includes an atrial marker and a ventricular marker (Vs);

b) defining a pre-specified window between the atrial marker and the ventricular marker;

c) applying a low pass filter to a signal within the window;

d) determining a rectified slope of the signal;

e) determining a time point (t1) in which the rectified slope exceeds 10% of a maximum value of the rectified slope; and

f) determining a point of onset of a depolarization complex in the signal, wherein the point of onset occurs at a largest curvature in the signal within the pre-specified window prior to t1.

23. The medium of claim 22 wherein automated determination of the point of onset of the depolarization is performed without detection of a threshold.

24. The medium of claim 22 wherein the largest curvature in the signal is determined from a curvature in the signal i-s defined as r=|y″

|/(1+|y′

|²)^(3/2) in which y″ and

y′

are the double and single derivatives of y=f(t), respectively.

25. The medium of claim 23 wherein a curvature of the signal has the largest value at a sharp deflection in the curve of the signal, the sharp deflection being indicative of the onset of the depolarization complex on an ECG-like signal.

26. The medium of claim 22 wherein the method further comprising:

searching for the largest curvature within the defined window and ending on a maximum peak or a minimum valley.

27. A method of comprising:

a) determining intrinsic rhythm using a plurality of body-surface electrodes, the intrinsic rhythm includes an atrial marker and a ventricular marker;

b) defining a window between the atrial marker and the ventricular marker;

c) applying a low pass filter to a signal within the defined window;

d) determining a rectified slope of the signal;

e) determining a time point (t1) in which the rectified slope exceeds a prespecified percentage of a maximum value of the rectified slope; and

f) determining a point of onset of a depolarization complex in the signal, wherein the point of onset occurs at a largest curvature in the signal within the defined window prior to t1.