System and method for reconstructing cardiac activation information

• US 9,398,883 B2
• Filed: 07/13/2015
• Issued: 07/26/2016
• Est. Priority Date: 05/02/2011
• Status: Active Grant

• Current Assignee: Topera, Inc (Abbott Laboratories)
• Original Assignee: Topera, Inc (Abbott Laboratories), US Department of Veterans Affairs (Government of the United States of America), Regents of the University of California (University of California)
• Inventors: Narayan, Sanjiv, Briggs, Carey Robert
• Primary Examiner(s): Koharski, Christopher D
• Assistant Examiner(s): Dinga, Roland
• Application Number:
  US14/798,363
• Publication Number:
  US 20150313548A1
• Time in Patent Office: 379 Days
• Field of Search: 600/547, 600/554, 600/424, 607/2, 607 27- 28, 607/62, 607/116, 128/898, 128/899
• US Class Current: 1/1
• 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 5/02405 Determining heart rate variability
• CPC Class Codes: A61B 5/287 Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
• CPC Class Codes: A61B 5/349 Detecting specific parameters of the electrocardiograph cycle
• CPC Class Codes: A61B 5/367 Electrophysiological study [EPS], e.g. electrical activation mapping or electro-anatomical mapping
• CPC Class Codes: A61B 5/7203 for noise prevention, reduction or removal
• CPC Class Codes: A61B 5/7239 using differentiation including higher order derivatives
• CPC Class Codes: A61B 5/7278 Artificial waveform generation or derivation, e.g. synthesising signals from measured signals A61B5/327 takes precedence
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 40/67 for remote operation
• CPC Class Codes: G16H 50/30 for calculating health indices; for individual health risk assessment

Abstract

An example method of representing cardiac information associated with a heart rhythm disorder includes accessing a plurality of neighboring cardiac signals obtained from a patient. The method also includes eliminating far-field activations from the plurality of neighboring cardiac signals using one or more divergence criteria that define local activations in the plurality of neighboring cardiac signals, the divergence criteria being associated with divergence among the plurality of neighboring cardiac signals. The method further includes constructing a clinical representation of local activations in the plurality of neighboring cardiac signals.

Claims

1. A method of processing cardiac information associated with a heart rhythm disorder, the method comprising:

accessing, using a computing device, a plurality of neighboring cardiac signals obtained from a patient;

eliminating, using the computing device, far-field activations from the plurality of neighboring cardiac signals using divergence criteria so that local activations are identified in the plurality of neighboring cardiac signals, the divergence criteria being associated at least with divergence among the plurality of neighboring cardiac signals; and

constructing, using the computing device, a clinical representation of the local activations in the plurality of neighboring cardiac signals.

2. The method of claim 1, wherein eliminating far-field activation from the plurality of neighboring signals comprises:

accessing a first cardiac signal and a second cardiac signal of the plurality of neighboring cardiac signals;

processing the first cardiac signal and the second cardiac signal to determine a point of change in the first cardiac signal at which a derivative of the first cardiac signal diverges with respect to a derivative of the second cardiac signal; and

assigning an activation onset time in the first cardiac signal at the point of change to define a local activation.

3. The method of claim 2, wherein the derivative of the first cardiac signal and the derivative of the second cardiac signal are selected from the group consisting of a zero order derivative, a first order derivative, a second order derivative, a higher order derivative, and combinations thereof.

4. The method of claim 2, wherein the derivative of the first cardiac signal and the derivative of the second cardiac signal are zero order derivatives.

5. The method of claim 2, wherein the derivative of the first cardiac signal and the derivative of the second cardiac signal are first order derivatives.

6. The method of claim 2, wherein the derivative of the first cardiac signal and the derivative of the second cardiac signal are second order derivatives.

7. The method of claim 2, wherein the method further comprises obtaining the first cardiac signal and the second cardiac signal from the patient using a first sensor and a second sensor, respectively.

8. The method of claim 7, wherein the first cardiac signal and the second cardiac signal are obtained contemporaneously from the patient.

9. The method of claim 2, wherein the point of change is determined at about the same time point for the first cardiac signal and the second cardiac signal.

10. The method of claim 2, wherein the point of change is determined from one or more of slope, amplitude, timing and shape for the first cardiac signal and the second cardiac signal.

11. The method of claim 2, wherein determination of the point of change comprises:

forming a composite cardiac signal from the first cardiac signal and the second cardiac signal;

determining ratio values at a plurality of points in the first cardiac signal, each ratio value representing a difference between the derivative of the second cardiac signal and a derivative of the composite cardiac signal to a difference between derivative of the first cardiac signal and the derivative of the composite cardiac signal; and

selecting as the point of change in the first cardiac signal a point having a largest ratio value from the determined ratio values.

12. The method of claim 2, wherein the point of change is higher than a noise level associated with the first cardiac signal and the second cardiac signal.

13. The method of claim 2, further comprising performing accessing, processing and assigning so that multiple local activations are identified in the first cardiac signal.

14. The method of claim 2, further comprising iteratively accessing the first cardiac signal and the second cardiac signal from the plurality of neighboring cardiac signals.

15. The method of claim 2, wherein the method further comprises:

accessing pairs of cardiac signals from the plurality of neighboring cardiac signals, each pair having a first cardiac signal and a different second cardiac signal;

performing processing and assigning for each of the pairs so that multiple local activations are identified in the first cardiac signal in each of the pairs; and

constructing the clinical representation based on the multiple local activations of the plurality of neighboring cardiac signals to indicate a source of a cardiac rhythm disorder.

16. The method of claim 15, further comprising presenting the clinical representation as constructed to facilitate treatment of cardiac tissue at the source to treat the cardiac rhythm disorder.

17. The method of claim 1, wherein the divergence criteria comprise signal divergence among neighboring cardiac signals, signal amplitude or voltage, signal rate or cycle length, signal upstroke velocity (dV/dt), signal frequency components, and signal repeatability.

18. The method of claim 1, wherein the clinical representation of the local activations includes a rotor.

19. The method of claim 1, wherein the clinical representation of the local activations includes a focal source.

20. A method of treating a heart rhythm disorder, the method comprising:

accessing a plurality of neighboring cardiac signals obtained from a patient;

eliminating far-field activations from the plurality of neighboring cardiac signals using divergence criteria so that local activations are identified in the plurality of neighboring cardiac signals, the divergence criteria being associated at least with divergence among the plurality of neighboring cardiac signals;

constructing a clinical representation of the local activations in the plurality of neighboring cardiac signals; and

treating the heart rhythm disorder using the clinical representation.