IDENTIFICATION AND VISUALIZATION OF CARDIAC ACTIVIATION SEQUENCE IN MULTI-CHANNEL RECORDINGS

• US 20190328260A1
• Filed: 07/12/2019
• Published: 10/31/2019
• Est. Priority Date: 06/10/2016
• Status: Active Grant

• Current Assignee: Biosense Webster Incorporated (Johnson & Johnson)
• Original Assignee: Biosense Webster Incorporated (Johnson & Johnson)
• Inventors: Zeidan, Ziyad, Hayam, Gal
• Granted Patent: US 11,278,228 B2
• Time in Patent Office: Days
• CPC Class Codes: A61B 5/061 Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body A61B1/00158 takes precedence
• CPC Class Codes: A61B 5/065 Determining position of the probe employing exclusively positioning means located on or in the probe, e.g. using position sensors arranged on the probe
• 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 5/352 Detecting R peaks, e.g. for synchronising diagnostic apparatus; Estimating R-R interval
• CPC Class Codes: A61B 5/361 Detecting fibrillation
• CPC Class Codes: A61B 5/6858 with a distal basket, e.g. expandable basket
• CPC Class Codes: A61B 5/7264 Classification of physiological signals or data, e.g. using neural networks, statistical classifiers, expert systems or fuzzy systems neural networks per se G06N3/00; expert systems per se G06N5/00
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems

Abstract

Intracardiac electrograms are recorded using a multi-electrode catheter and respective annotations established. Within a time window a pattern comprising a monotonically increasing local activation time sequence from a set of electrograms from neighboring electrodes is detected. The set is reordered and displayed for the operator.

Claims

1. A method comprising:

inserting a probe into a heart of a living subject, the probe having a plurality of electrodes;

recording respective intracardiac electrograms from the electrodes;

establishing annotations for each of the electrograms, including annotated activation times, the annotations being based on a change in voltage per unit time and defining a pattern comprising a velocity of electrical propagation in the heart;

within a time window detecting from the annotations a velocity pattern in the annotations of a set of the electrograms and the electrodes thereof;

sorting the electrograms by the annotated activation times;

sorting the electrograms by locations;

displaying the electrograms of the set, the electrograms being displayed in a graph of time-varying signal voltages; and

ablating a region of the heart based on the graph.

4. The method according to claim 1, wherein the velocity pattern includes a local activation time sequence pattern of a reentrant activation circuit.

5. The method according to claim 1, wherein the velocity pattern includes a local activation time sequence pattern with a micro reentry pattern.

6. The method according to claim 1, wherein the velocity pattern includes a local activation time sequence pattern with a focal source pattern.

7. The method according to claim 1, wherein the velocity pattern includes a local activation time sequence pattern with macro reentry pattern.

8. The method according to claim 1, further comprising the steps of:

in a new time window detecting a change in the pattern; and

responsively to the change, iterating the steps of sorting the set and displaying the electrograms.

9. The method according to claim 8, wherein the change comprises a change in a direction of electrical propagation.

10. The method according to claim 8, wherein the change comprises a change in a speed of electrical propagation.

18. The apparatus according to claim 1, wherein the processor is operative to:

in a new time window detect a change in the pattern; and

responsively to the change, iterate the steps of sorting the set and displaying the electrograms.

19. The apparatus according to claim 18, wherein the change comprises a change in a direction of electrical propagation.

20. The apparatus according to claim 18, wherein the change comprises a change in a speed of electrical propagation.

2. The method according to claim 2, wherein the electrograms are recorded concurrently.

3. The method according to claim 3, further comprising the step of sorting the set according to positions on the probe of the electrodes thereof.

11. An apparatus comprising:

a probe having a plurality of electrodes on a distal portion thereof;

electrical circuitry for recording respective time-varying electrograms from the electrodes when the probe is adapted to be at a location in a heart of a living subject;

a memory for storing the electrograms;

a display; and

a processor connected to the memory and operative to;

record respective intracardiac electrograms from the electrodes;

establish annotations for each of the electrograms, including annotated activation times, the annotations being based on a change in voltage per unit time and defining a pattern comprising a velocity of electrical propagation in the heart;

within a time window detect from the annotations a velocity pattern in the annotations of a set of the electrograms and the electrodes thereof;

sort the electrograms by the annotated activation times;

sort the electrograms by locations;

display the electrograms of the set, the electrograms being displayed in a graph of time-varying signal voltages; and

ablate a region of the heart based on the graph.

12. The apparatus according to claim 11, wherein the electrograms are recorded concurrently.

13. The apparatus according to claim 11, wherein the processor is operative to sort the set according to positions on the probe of the electrodes thereof.

14. The apparatus according to 11, wherein the velocity pattern includes a local activation time sequence pattern with a reentrant activation circuit.

15. The apparatus according to claim 11, wherein the velocity pattern includes a local activation time sequence pattern with a micro reentry pattern.

16. The apparatus according to claim 11, wherein the velocity pattern includes a local activation time sequence pattern with a focal source pattern.

17. The apparatus according to claim 11, wherein the velocity pattern includes a local activation time sequence pattern with macro reentry pattern.