System and related methods for identifying a fibrillation driver

• US 8,010,186 B1
• Filed: 07/19/2006
• Issued: 08/30/2011
• Est. Priority Date: 07/19/2006
• Status: Active Grant

• Current Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Original Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Inventors: Ryu, Kyungmoo
• Primary Examiner(s): Layno; Carl H
• Assistant Examiner(s): PORTER, JR, GARY A
• Application Number:
  US11/458,655
• Time in Patent Office: 1,868 Days
• Field of Search: 600/515, 600/518, 607/122, 606/34, 606/41
• US Class Current: 600/509
• CPC Class Codes: A61B 2562/043 in a linear array
• CPC Class Codes: A61B 5/287 Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
• CPC Class Codes: A61B 5/6852 Catheters
• CPC Class Codes: A61B 5/6853 with a balloon
• CPC Class Codes: A61B 5/6858 with a distal basket, e.g. expandable basket
• CPC Class Codes: A61B 5/7257 using Fourier transforms

Abstract

A system and related methods for assisting a user approximate the location of a fibrillation driver within a heart. The system includes an electrode and a computer, which is coupled to the electrode. The electrode is configured to sense a signal emitted from a location in the heart. The computer is configured to calculate a standard deviation of cycle length value for the signal. The user can approximate the location of the fibrillation driver based on a comparison of the standard deviation of cycle length value to other standard deviation of cycle length values that previously have been calculated by the computer for signals emitted from other locations in the heart.

Claims

1. A system that is configured to approximate a location of a fibrillation driver within a heart, the system comprising:

a. a plurality of electrodes configured to sense, at each of a respective location in the heart, a signal comprising a plurality of cardiac cycles each having a corresponding cardiac cycle length; and

b. a computer that is coupled to the electrodes and configured to;

calculate, for each of a plurality of the locations, a plurality of cardiac cycle length values for the signal sensed at the location and a standard deviation of the plurality of calculated cardiac cycle length values for the signal sensed at the location using only the plurality of calculated cardiac cycle length values calculated for that location,

directly compare each of the respective calculated standard deviations to each of the other respective calculated standard deviations to determine the smallest standard deviation, and

identify the location with the smallest standard deviation of cardiac cycle length values as the location closest to the fibrillation driver.

2. The system according to claim 1, wherein the computer is configured to notify the user of the location in the heart that emitted the signal having the smallest standard deviation of cardiac cycle length values.

3. The system according to claim 1, wherein the computer includes a user output device that is configured to display data for the signal having the smallest standard deviation of cardiac cycle length values, the data selected from the group consisting of the standard deviation of cycle length value, a mean cycle length value for the signal, the signal in the form of an electrogram, and a Fast Fourier Transformation of the signal.

4. The system according to claim 3, wherein the user output device is further configured to display the data in color.

5. The system according to claim 1, wherein:

a. the computer includes a computer-readable medium; and

b. the computer is configured to store the signals sensed by the electrodes in the computer-readable medium.

6. The system according to claim 1, wherein:

the computer is configured to calculate a Fast Fourier Transformation (FFT) of each of the signals;

compare the plurality of FFTs;

select the one of the plurality of FFTs that has one or more of the following characteristics;

single frequency peak and the highest value of peak frequency; and

determine a location in the heart corresponding to the selected FFT.

7. The system according to claim 1, wherein:

a. the signals are selected from the group consisting of atrial signals and ventricular signals;

b. the fibrillation driver is selected from the group consisting of an atrial fibrillation driver and a ventricular fibrillation driver; and

c. the fibrillation driver is located within a portion of the heart selected from the group consisting of a right atrium, a left atrium, a right ventricle, and a left ventricle.

8. The system according to claim 1, wherein:

a. the plurality of electrodes is included as part of a device selected from the group consisting of a mapping catheter, an ablation catheter, and an implantable medical device lead;

b. the device has a distal end;

c. the plurality of electrodes is located at the distal end;

d. the heart is located within a patient'"'"'s body; and

e. the distal end is configured to be inserted into the patient'"'"'s body.

9. A method for determining an approximate location of a fibrillation driver within a heart using a plurality of electrodes that are coupled to a computer, the method comprising:

a. using the electrodes to sense, at each of a respective location in the heart, a signal comprising a plurality of cardiac cycles each having a corresponding cardiac cycle length;

b. communicating the signals from the electrodes to the computer;

c. using the computer to calculate, for each of a plurality of the locations, a plurality of cardiac cycle length values for the signal sensed at the location and a standard deviation of the plurality of calculated cardiac cycle length values for the signal sensed at the location using only the plurality of calculated cardiac cycle length values calculated for that location;

d. directly comparing each of the respective calculated standard deviations to each of the other respective calculated standard deviations to determine the smallest standard deviation; and

e. identifying the location with the smallest standard deviation of cardiac cycle length values as the approximate location of the fibrillation driver within the heart.

10. The method according to claim 9, further comprising:

using the computer to calculate a Fast Fourier Transformation (FFT) of each of the signals;

compare the plurality of FFTs;

select the one of the plurality of FFTs that has one or more of the following characteristics;

single frequency peak and the highest value of peak frequency; and

determine a location in the heart corresponding to the selected FFT.

11. The method according to claim 9, wherein the electrode is included as part of a mapping catheter and the approximate location of the fibrillation device is determined as part of an effort to ablate the fibrillation driver using an ablation catheter having a distal end that is configured to emit ablation energy into the heart, the method further comprising:

a. co-locating the distal end of the ablation catheter with the approximate location of the fibrillation driver;

b. emitting ablation energy from the distal end of the ablation catheter in an effort to destroy the fibrillation driver; and

c. determining if the fibrillation driver was destroyed;

d. wherein if the fibrillation driver was not destroyed after the emission of the ablation energy, repeating the steps of claim 9 and steps a-c of this claim.

12. The method according to claim 9, wherein the electrode is a mapping electrode that is included as part of a mapping catheter and the approximate location of the fibrillation driver is determined as part of an effort to install an implantable medical device lead having a lead electrode in the heart, the method further comprising:

a. positioning the implantable medical device lead so the lead electrode is co-located with the approximate location of the fibrillation driver; and

b. determining if the lead electrode is co-located with the fibrillation driver by applying stimulation energy to the heart via the lead electrode and observing a response of the heart.

13. The method according to claim 12, further comprising coupling the implantable medical device lead to a lining of the heart selected from the group consisting of an endocardial lining and an epicardial lining after it determining that the lead electrode is co-located with the fibrillation driver.

14. A system for determining an approximate location of a fibrillation driver within a heart, the system comprising:

a. means for sensing, at each of a respective location in the heart, a signal comprising a plurality of cardiac cycles each having a corresponding cardiac cycle length;

b. means for calculating, for each of a plurality of the locations, a plurality of cardiac cycle length values for the signal sensed at the location and a standard deviation of the plurality of calculated cardiac cycle length values for the signal sensed at the location using only the plurality of calculated cardiac cycle length values calculated for that location;

c. means for directly comparing each of the respective calculated standard deviations to each of the other respective calculated standard deviations to determine the smallest standard deviation; and

d. means identifying the location with the smallest standard deviation of cardiac cycle length values as the approximate location of the fibrillation driver within the heart.