Therapy optimization via multi-dimensional mapping

• US 8,326,419 B2
• Filed: 04/06/2010
• Issued: 12/04/2012
• Est. Priority Date: 04/07/2009
• Status: Active Grant

• Current Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Original Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Inventors: Rosenberg, Stuart, Ryu, Kyungmoo, Hou, Wenbo, Nguyen, Thao Thu, Koh, Steve, Noren, Kjell, Yang, Michael, Keel, Allen
• Primary Examiner(s): Holmes, Rex R
• Application Number:
  US12/755,366
• Publication Number:
  US 20100268059A1
• Time in Patent Office: 973 Days
• Field of Search: 607/17, 607/25, 607/27, 607/119, 607/122, 607/123, 600/374, 600/424, 600485-486, 600/508, 600/527
• US Class Current: 607/9
• CPC Class Codes: A61B 5/283 Invasive
• CPC Class Codes: A61B 5/7203 for noise prevention, reduction or removal
• 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 1/36521 the parameter being derived from measurement of an electrical impedance
• CPC Class Codes: A61N 1/36535 controlled by body position or posture
• CPC Class Codes: A61N 1/36542 controlled by body motion, e.g. acceleration
• CPC Class Codes: A61N 1/36578 controlled by mechanical motion of the heart wall, e.g. measured by an accelerometer or microphone
• 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
• CPC Class Codes: A61N 1/36843 Bi-ventricular stimulation
• CPC Class Codes: A61N 1/37258 Alerting the patient
• CPC Class Codes: A61N 1/37264 Changing the program; Upgrading firmware

Abstract

An exemplary method includes accessing cardiac information acquired via a catheter located at various positions in a venous network of a heart of a patient where the cardiac information comprises position information, electrical information and mechanical information; mapping local electrical activation times to anatomic positions to generate an electrical activation time map; mapping local mechanical activation times to anatomic positions to generate a mechanical activation time map; generating an electromechanical delay map by subtracting local electrical activation times from corresponding local mechanical activation times; and rendering at least the electromechanical delay map to a display. Various other methods, devices, systems, etc., are also disclosed.

Claims

1. A method comprising:

accessing cardiac information acquired via a catheter located at various positions in a venous network of a heart of a patient wherein the cardiac information comprises position information, electrical information and mechanical information;

for the various positions, mapping local electrical activation times to anatomic positions to generate an electrical activation time map, the electrical activation times based on the electrical information and the anatomic positions based on the position information;

for the various positions, mapping local mechanical activation times to anatomic positions to generate a mechanical activation time map, the mechanical activation times based on the mechanical information and the anatomic positions based on the position information;

transforming coordinates for the various positions to a non-cartesian coordinate system;

generating an electromechanical delay map by subtracting local electrical activation times from corresponding local mechanical activation times; and

rendering at least the electromechanical (EM) delay map to a display relative to the non-cartesian coordinate system.

2. The method of claim 1 further comprising selecting a location for placement of an electrode in the venous network based on the electromechanical delay map.

3. The method of claim 1 further comprising locating one or more electrodes in the venous network based on the electromechanical delay map.

4. The method of claim 3 wherein locating comprises locating at least one electrode in a region of the EM delay map that comprises a highest electromechanical delay.

5. The method of claim 1 wherein the transforming further comprises transforming coordinates for the various positions to a cardiac coordinate system.

6. The method of claim 5 wherein the cardiac coordinate system comprises a cylindrical coordinate system.

7. The method of claim 1 wherein the transforming comprises determining at least a principle component via a principle component analysis.

8. The method of claim 7 wherein the principle component corresponds to a long axis of the left ventricle and wherein another component corresponds to a radial axis of the left ventricle.

9. The method of claim 1 further comprising determining the local mechanical activation times based on motion along a radial direction of the cylindrical coordinate system configured to represent longitudinal, radial and circumferential coordinates of the left ventricle of the heart.

10. The method of claim 1 further comprising determining each of the local mechanical activation times based on a slope of electrode position with respect to time.

11. The method of claim 1 further comprising determining each of the local electrical activation times based on a slope of potential with respect to time.

12. The method of claim 1 further comprising identifying a region of greatest electrical activation latency and rendering the region to a display of an anatomic map of the venous network, the anatomic map based on the position information.

13. The method of claim 1 further comprising identifying a region of greatest mechanical activation latency and rendering the region to a display of an anatomic map of the venous network, the anatomic map based on the position information.

14. The method of claim 1 further comprising identifying a region of greatest electromechanical delay and rendering the region to a display of an anatomic map of the venous network, the anatomic map based on the position information.

15. The method of claim 1 further comprising analyzing the position information, the electrical information and the mechanical information to identify a region of discrepancy between electrical activation latency and mechanical activation latency.

16. The method of claim 15 wherein a region of discrepancy between electrical activation latency and mechanical activation latency corresponds to a region of functional abnormality.

17. The method of claim 15 wherein a region of discrepancy between electrical activation latency and mechanical activation latency corresponds to a region of structural abnormality.

18. The method of claim 15 wherein a region of discrepancy between electrical activation latency and mechanical activation latency corresponds to an ischemic region of the heart.

19. The method of claim 15 further comprising selecting a location for placement of an electrode in the venous network based on a region of discrepancy between electrical activation latency and mechanical activation latency.

20. The method of claim 1 wherein rendering comprises rendering the electromechanical delay map in color wherein a color scale quantitatively identifies electromechanical delay values.

21. The method of claim 1 further comprising generating an anatomic map based on the position information wherein the anatomic map comprises surfaces representative of at least a portion of the venous network.

22. The method of claim 21 wherein mapping local electrical activation times comprises mapping each of the times to a surface position of the anatomic map.

23. The method of claim 21 wherein mapping local mechanical activation times comprises mapping each of the times to a surface position of the anatomic map.

25. The method of claim 1, wherein the non-cartesian coordinate system is one of a cylindrical, spherical, oblate spherical, and prolate spherical coordinate systems.

24. One or more non-transitory computer-readable media comprising processor executable instructions to instruct a computing device to:

access cardiac information acquired via a catheter located at various positions in a venous network of a heart of a patient wherein the cardiac information comprises position information, electrical information and mechanical information;

for the various positions, map local electrical activation times to anatomic positions to generate an electrical activation time map, the electrical activation times based at least in part on the electrical information and the anatomic positions based at least in part on the position information;

for the various positions, map local mechanical activation times to anatomic positions to generate a mechanical activation time map, the mechanical activation times based at least in part on the mechanical information and the anatomic positions based at least in part on the position information;

transforming coordinates for the various positions to a non-cartesian coordinate system;

generate an electromechanical delay map by subtracting local electrical activation times from corresponding local mechanical activation times; and

render at least the electromechanical delay map to a display relative to the non-cartesian coordinate system.