Cardiac biopotential analysis system and method

• US 4,924,875 A
• Filed: 10/09/1987
• Issued: 05/15/1990
• Est. Priority Date: 10/09/1987
• Status: Expired due to Term

• Current Assignee: Imperial Bank (Imperial Bancorp)
• Original Assignee: Aspect Medical Systems, Inc. (Medtronic Plc)
• Inventors: Chamoun, Nassib G.
• Primary Examiner(s): Jaworski, Francis
• Assistant Examiner(s): MANUEL, GEORGE C
• Application Number:
  US07/107,419
• Time in Patent Office: 949 Days
• Field of Search: 128/696, 128/702, 128/703, 128/704, 128/705, 128/901
• US Class Current: 600/509
• CPC Class Codes: A61B 5/349 Detecting specific parameters of the electrocardiograph cycle
• CPC Class Codes: A61B 5/35 by template matching
• CPC Class Codes: A61B 5/7257 using Fourier transforms
• CPC Class Codes: Y10S 128/908 Patient protection from electric shock

Abstract

Disclosed is a cardiac biopotential analysis system and method for detecting, in a noninvasive manner, the degree of myocardial ischemia and the amount of cardiac electrophysiologic stability present in a subject. A suitable body surface electrode acquires the signal from a region of interest. The body surface electrocardiographic signals are then amplified, digitized and transmitted to a host computer where an arrhythmia free QRST complex template is chosen interactively. Using cross-correlation, 50 subsequent complexes that mask the template are extracted. A Fast Fourier Transform (FFT) is then performed on every beat. The FFT results of every QRST are used to produce a bispectral complex and real triple product arrays. Each point in these arrays is then averaged over the 50 previously acquired QRST complexes. The magnitude of each averaged point in the complex triple product arrays is then squared to produce a bispectral density array, which when divided by the complex real triple product array forms a bicoherence array. The bicoherence array provides a figure of merit for the detection and quantification of myocardial ischemia in the region probed by that lead. The array also provides a quantification of cardiac electrical properties.

Claims

1. A method of noninvasively detecting heart disorders that affect cardiac electrical activity, said method comprising the steps of:

acquiring electrocardiographic signals from a surface of the body of a subject being analyzed through a surface electrode;

determining a waveform template representing a normal QRST waveform in said subject;

selecting a number of complexes that match said waveform template and storing said number of complexes for processing;

computing bispectral parameters from said stored number of selected complexes;

utilizing said bispectral parameters to quantify the contribution to overall cardiac physiologic function provided by the region probed by said surface electrode.

2. The method of noninvasively detecting heart disorders of claim 1 wherein said step of acquiring electrocardiographic signals comprises the steps of

placing said surface electrode on a region of the body of said subject to be analyzed and detecting signals relating to cardiac activity in the region where said electrode is placed;

amplifying signals detected by said surface electrode;

digitized said amplified signals;

transmitting said digitized signals in a serial stream to a processing system.

3. The method of noninvasively detecting heart disorders of claim 1 wherein said determined waveform template is a sinus QRST complex template.

4. The method of noninvasively detecting heart disorders of claim 1 wherein the step of determining the waveform template comprises:

(a) viewing a number of QRST complexes;

(b) if a artifact-free sinus QRST complex is displayed, selecting the most artifact-free sinus QRST complex;

(c) if a an artifact-free sinus QRST complex is not displayed, display the next 100 complexes and repeat steps a through c until a suitable artifact-free sinus QRST complex is chosen.

5. The method of noninvasively detecting heart disorders of claim 1 wherein the step of selecting a number of complexes comprises:

comparing each complex from a lead to said determined waveform template;

selecting each complex matching said determined waveform template with a correlation coefficient greater than or equal to a preselected value.

6. The method of noninvasively detecting heart disorders of claim 5 wherein in said step of selecting said complexes comprises:

extracting a portion of each complex that corresponds to said waveform template;

subtracting the mean of all samples in the extracted portion from each sample;

dividing each sample by the standard deviation of the samples in that portion in order to normalize the energy present in said portion to 1;

cross-correlating the current normalized extracted portion and the template;

selecting a sample as one of the chosen complexes if the cross-correlation coefficient is not greater than or equal to a preselected value.

7. The method of noninvasively detected heart disorders of claim 1 wherein said bispectral parameter is bicoherence and said step of computing said bispectral parameters comprises the steps of:

performing a fast Fourier transform on each of said selected complexes;

deriving a bispectral complex triple product array and a bispectral real triple product array from the first Fourier transforms of said selected complexes;

averaging said points in said bispectral complex triple product array and in said bispectral real triple product array;

squaring the magnitude of each average in the complex triple product arrays to produce a bispectral density array;

dividing said bispectral density array by the real triple product array to obtain an array of bicoherences.

8. The method of noninvasively detecting heart disorders of claim 1 where said step of utilizing said bicoherence array to quantity the contribution to overall cardiac electrophysiological stability provided by the region probed surface electrode comprises the steps of:

subtracting bispectral parameters from control bispectral parameters and subtracting said bicoherence array from a control bicoherence, said control bispectral parameters being produced prior to the procedure intervention;

determining reduction in the bispectral parameter in frequency pairs in the bands between 0.05 to 100 Hz and 200 to 300 Hz;

determining heterogeneity in conduction and repolarization on the basis that the greater the reduction in said bispectral parameter in said frequency pairs, the greater the heterogeneity;

determining a likelihood of a subject suffering ventricular tachycardia or ventricular fibrillation based on the amount of heterogeneity.

9. The method of noninvasively detecting heart disorders of claim 1 where said step of utilizing said bispectral parameters to quantify the contribution to overall cardiac physiologic function provided by the region probed by said surface electrode comprises the steps of:

subtracting the bispectral parameters from control bispectral parameters, said control bispectral parameters being produced prior to the procedure intervention;

determining reduction in the bispectral parameter in frequency pairs in the bands between 0.05 to 200 Hz;

determining heterogeneity in conduction and repolarization on the basis that the greater the reduction in the bispectral parameters in said frequency pairs, the greater the heterogeneity;

determining a magnitude of induced ischemia on the basis of the greater the change in said bispectral parameter in the frequency pairs between 0 to 200 Hz the greater the magnitude of the induced ischemia.

10. The method of noninvasively detecting heart disorders of claim 1 wherein step of utilizing said bispectral parameters to quantify the contribution to overall cardiac physiologic function provided by the region probed by said surface electrode comprises the steps of:

subtracting the bispectral parameters from template bispectral parameters;

determining reduction in the bispectral parameters in the frequency pairs in the bands between 0.05 to 100 Hz and 200 to 300 Hz;

determining heterogeneity in conduction and repolarization based on the reduction in the bispectral parameters in the frequency pairs and the bands between 0.05 to 100 Hz and 200 to 300 Hz;

determining a likelihood of ventricular arrhythmias based on the heterogeneity the conduction and repolarization.

11. The method of noninvasively detecting heart disorders of claim 1 wherein said step of utilizing said bispectral parameters to quantify the contribution to overall cardiac physiologic function provided by the region probed by said surface electrode comprises the steps of:

subtracting the bispectral parameters from template bispectral parameters of a population of normal individuals;

determining heterogeneity in conduction and repolarization based on the reduction in the bispectral parameters in the frequency pairs in the bands between 0.05 to 200 Hz;

determining a magnitude of steady state ischemia based on the change in the bispectral parameters in the frequency pairs in the bands between 0 to 200 Hz.

12. The method of noninvasively detecting heart disorders of claim 1 wherein said step of utilizing said bispectral parameters to quantify the contribution to overall cardiac physiologic function provided by the region probed by said surface electrode comprises the steps of:

subtracting the bispectral parameters from template bispectral parameters of a population of normal individuals;

determining beat to beat consistency in cardiac electrical activation and repolarization patterns as detected in particular frequency bands in order to detect abnormalities of ventricular activation patterns and to detect intraventricular condition defects and accessory atrioventicular pathways.

13. The method of noninvasively detecting heart disorders of claim 1 wherein said step of utilizing said bispectral parameters to quantify the contribution to overall cardiac physiologic function provided by the region probed by said surface electrode comprises the steps of:

distinguishing between those individuals with a high likelihood of ventricular tachyarrhythmias and those with a low likelihood of ventricular tachyarrhythmias on the basis that the bispectral parameters will be lower in those individuals having a high propensity for the development of ventricular tachyarrhythmias than in those individuals having a lower propensity for the development of ventricular tachyarrhythmias.

14. The method of noninvasively detecting heart disorders of claim 1 wherein said step of utilizing said bispectral parameters to quantify the contribution to overall cardiac physiologic function provided by the region probed by said surface electrode comprises the steps of:

for individuals having high frequency potentials in the terminal 40 milliseconds of the selected complex, distinguishing between those individuals with a high likelihood of ventricular tachyarrhythmias and those with a low likelihood of ventricular tachyarrhythmias on the basis that bispectral density and bicoherence will be lower in those individuals having a high propensity for the development of ventricular tachyarrhythmias than in those individuals having a lower propensity for the development of ventricular tachyarrhythmias.

15. The method of noninvasively detecting heart disorders of claim 1 wherein said step of utilizing said bispectral parameters to quantify the contribution to overall cardiac physiologic function provided by the region probed by said surface electrode comprises the steps of:

correlating said bispectral density array with a control bispectral density array in order to produce a cross-correlation coefficient,

determining the reduction in the bispectral density cross-correlation coefficient in the frequency pairs in the bands between 0.05 to 200 Hz;

determining the magnitude of induced ischemia on the basis of the greater the reduction in the bispectral density cross-correlation coefficient in the frequency pairs between 0 to 200 Hz from a base cross-correlation coefficient, the greater the magnitude of the induced ischemia.

16. The method of noninvasively detecting heart disorders of claim 15 further comprising the step of:

after producing said cross-correlation coefficient, displaying the cross-correlation coefficient of the bispectral density array on a grid, said grid having an area representing a location probed by each electrode with each area containing a cross-correlation coefficient of the bispectral density array.

17. The method of noninvasively detecting heart disorders of claim 1 wherein said step of utilizing said bispectral parameters to quantify the contribution to overall cardiac physiologic function provided by the region probed by said surface electrode comprises the steps of:

correlating said bicoherence array with a control bicoherence array in order to produce a cross-correlation coefficient,

determining the reduction in the bicoherence cross-correlation coefficient in the frequency pairs in the bands between 0.05 to 200 Hz;

determining the magnitude of induced ischemia on the basis of the greater the reduction in the bicoherence cross-correlation coefficient in the frequency pairs between 0 to 200 Hz from a base cross-correlation coefficient, the greater the magnitude of the induced ischemia.

18. The method of noninvasively detecting heart disorders of claim 17 further comprising the step of:

after producing said cross-correlation coefficient, displaying the cross-correlation coefficient of the bicoherence array on a grid, said grid having an area representing a location probed by each electrode with each area containing a cross-correlation coefficient of the bicoherence array.

19. The method of noninvasively detecting heart disorders of claim 1 wherein said step of utilizing said bispectral parameters to quantify the contribution to overall cardiac physiologic function provided by the region probed by said surface electrode comprises the steps of:

correlating said bispectral density array with a control bispectral density array in order to produce a cross-correlation coefficient,

determining the reduction in the bispectral density cross-correlation coefficient in the frequency pairs in the bands between 0 to 100 Hz and 200 to 300 Hz;

determining the heterogeneity in conduction and repolarization on the basis that the greater the increase in the bispectral density cross-correlation coefficient in said frequency pairs, the greater the heterogeneity.

20. A system for noninvasively detecting heart disorders that affect cardiac electric activity, said system comprising

means for acquiring electrocardiographic signals from a surface of the body of a subject being analyzed

means for determining a waveform template representing a normal QRST waveform in said subject;

means for selecting a number of complexes that match said waveform template;

means for storing said number of complexes for processing;

means for computing bispectral parameters from said stored number of selected complexes.

21. The system for noninvasively detecting heart disorders of claim 20 further comprising a plurality of surface electrodes that are positionable on a surface of the body of a subject being analyzed.

22. The system for noninvasively detecting heart disorders of claim 20 wherein said means for acquiring electrocardiographic signals comprises a surface electrode that is positionable on the surface of the body of a subject being analyzed.

23. The system for noninvasively detecting heart disorders of claim 20 wherein said means for acquiring electrocardiographic signals comprises:

a plurality of surface electrodes mounted on the surface of the body of the subject being analyzed;

means of providing electrosurgery protection including a radio frequency filter for limiting radio frequency current to patient leads;

means for providing defibrillator protection for limiting the current to patient leads during a defibrillator discharge;

means for amplifying signals acquired by electrode leads;

means for multiplexing said amplified signals so as to provide one signal at a time, said one signal being fed to an analog to digital convertor;

means for providing said acquired digital signals in a serial fashion to said system for further processing.

24. The system for noninvasively detecting heart disorders of claim 20 wherein said means for computing bispectral parameters comprises a computer system including:

means for receiving data in a serial fashion from said means for acquiring electrocardiographic signals;

an array processor, connected to said means for storing, for performing simultaneous arithmetic calculations on an array of data;

a math coprocessor, connected to said means for storing, for calculating graphic modalities;

processor means for controlling input and output to peripheral devices connected to said means for computing.

25. A method of noninvasively detecting heart disorders that affect cardiac electrical activity, said method comprising the steps of:

acquiring electrocardiographic signals from a surface of the body of a subject being analyzed;

applying bispectral analysis to QRST complexes of said acquired electrocardiographic signal for a plurality of consecutive beats of the heart of the subject in order to quantity physiologic function that indicate heart disorders.