System and method for reconstructing cardiac signals associated with a complex rhythm disorder

• US 9,549,684 B2
• Filed: 12/10/2015
• Issued: 01/24/2017
• Est. Priority Date: 04/08/2010
• Status: Active Grant

• Current Assignee: Topera, Inc (Abbott Laboratories Incorporated), US Department of Veterans Affairs (Government of the United States of America), Regents of the University of California (University of California)
• Original Assignee: US Department of Veterans Affairs (Government of the United States of America), Regents of the University of California (University of California)
• Inventors: Narayan, Sanjiv, Sehra, Ruchir
• Primary Examiner(s): Koharski, Christopher D
• Assistant Examiner(s): CAREY, MICHAEL JAMES
• Application Number:
  US14/965,388
• Publication Number:
  US 20160095531A1
• Time in Patent Office: 411 Days
• Field of Search: 600/513, 600/515, 600/523
• US Class Current: 1/1
• CPC Class Codes: A61B 5/0255 Recording instruments specially adapted therefor
• 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 5/333 Recording apparatus specially adapted therefor
• CPC Class Codes: A61B 5/339 Displays specially adapted therefor
• CPC Class Codes: A61B 5/341 Vectorcardiography [VCG]
• 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 5/363 Detecting tachycardia or bradycardia
• CPC Class Codes: A61B 5/366 Detecting abnormal QRS complex, e.g. widening
• CPC Class Codes: A61B 5/4857 Indicating the phase of biorhythm clocks or watches with indicators for biological cycles G04B19/264
• CPC Class Codes: A61B 5/6852 Catheters
• CPC Class Codes: A61B 5/7221 Determining signal validity, reliability or quality A61B5/7207 and A61B5/7217 take precedence
• CPC Class Codes: A61B 5/726 using Wavelet transforms
• 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: A61B 5/7278 Artificial waveform generation or derivation, e.g. synthesising signals from measured signals A61B5/327 takes precedence

Abstract

Reconstruction of cardiac information representing a complex rhythm disorder is facilitated by assigning activation onsets to non-discernible beats in low confidence signals based upon time associations relative to activation onsets in adjacent high confidence signals.

Claims

1. A system to reconstruct cardiac signals associated with a complex rhythm disorder received from a plurality of sensors associated spatially with a patient'"'"'s heart, the system comprising:

at least one computing device configured to;

identify a plurality of discernible beats on high-confidence signals of sensors that are spatially adjacent to a sensor associated with a low-confidence signal, the discernible beats on the high-confidence signals corresponding to a non-discernible beat on the low-confidence signal;

compute a time association between at least two activation onsets associated with the identified discernible beats on the high-confidence signals through the non-discernible beat on the low-confidence signal;

define a time interval associated with the non-discernible beat about a region of the low-confidence signal where the computed time association crosses the non-discernible beat, the time interval indicating how early the non-discernible beat can activate based on a previous beat on the low-confidence signal that has a selected or determined activation onset and how late the non-discernible beat can terminate based on at least one predetermined property; and

assign an activation onset to the non-discernible beat based on the time association and the time interval; and

a catheter comprising the plurality of sensors to receive the cardiac signals from the patient'"'"'s heart and operatively coupled to the at least one computing device to provide the cardiac signals to the at least one computing device.

2. The system according to claim 1, wherein the time association is a time vector between at least two activation onsets.

3. The system according to claim 2, wherein the time vector is between at least two discernible activation onsets.

4. The system according to claim 2, wherein the activation onset is assigned to the non-discernible beat during the defined time interval that is closest to the time vector.

5. The system according to claim 1, wherein the activation onset is assigned in association with a deflection or a quiescent period during the defined time interval.

6. The system according to claim 1, wherein the at least one computing device is further configured to:

determine a second time interval between discernible beats on the low-confidence signal occurring before the non-discernible beat, the second time interval extending from a first activation onset to a second activation onset of the respective discernible beats on the low-confidence signal;

advance the determined second time interval such that the first activation onset approximates the activation onset of a beat previous to the non-discernible beat;

reconcile the assigned activation onset with the second activation onset to a reconciled activation onset; and

update the assigned activation onset with the reconciled activation onset for the non-discernible beat.

7. The system according to claim 1, wherein the at least one computing device is further configured to classify high-confidence signals that include at least a predetermined percentage of discernible beats out of total beats, each discernible beat having an identifiable activation onset, and low-confidence signals that include a first number of discernible beats and a second number of non-discernible beats, each non-discernible beat having a plurality of deflections and quiescent periods associated with a possible activation onset, the first number of discernible beats being below the predetermined percentage.

8. The system according to claim 1, wherein the complex rhythm disorder comprises no discernible period during which the cardiac signals are quiescent.

9. The system according to claim 1, wherein the system further comprises at least one storage device configured to store the cardiac signals received from the patient'"'"'s heart, the at least one storage device operatively coupled to the at least one computing device to provide the cardiac signals to the at least one computing device.

10. The system according to claim 1, wherein the at least one computing device comprises a computer-readable medium storing instructions, which when executed by a processing device, cause the processing device to perform operations of the at least one computing device.

11. The system according to claim 1, wherein the at least one computing device is further configured to generate a clinical representation associated with the complex rhythm disorder using at least the activation onset assigned to the non-discernible beat.

12. An assembly to reconstruct cardiac signals associated with a complex rhythm disorder, the assembly comprising:

a catheter comprising a plurality of sensors spatially associated with a patient'"'"'s heart to receive the cardiac signals; and

a computer-readable medium operatively coupled to the sensors, the computer-readable medium comprising instructions, which when executed by a computing device, cause the computing device to;

identify a plurality of discernible beats on high-confidence signals of sensors that are spatially adjacent to a sensor associated with a low-confidence signal, the discernible beats on the high-confidence signals corresponding to a non-discernible beat on the low-confidence signal;

compute a time association between at least two activation onsets associated with the identified discernible beats on the high-confidence signals through the non-discernible beat on the low-confidence signal;

define a time interval associated with the non-discernible beat about a region of the low-confidence signal where the computed time association crosses the non-discernible beat, the defined time interval indicating how early the non-discernible beat can activate based on a previous beat on the low-confidence signal that has a selected or determined activation onset and how late the non-discernible beat can terminate based on at least one predetermined property; and

assign an activation onset to the non-discernible beat based on the time association and the time interval.

13. The assembly according to claim 12, wherein the time association is a time vector between at least two activation onsets.

14. The assembly according to claim 13, wherein the time vector is between at least two discernible activation onsets.

15. The assembly according to claim 13, wherein the activation onset is assigned to the non-discernible beat during the defined time interval that is closest to the time vector.

16. The assembly according to claim 12, wherein the activation onset is assigned in association with a deflection or a quiescent period during the defined time interval.

17. The assembly according to claim 12, wherein the computer-readable medium further comprises instructions, which when executed by the computing device, cause the computing device to:

determine a second time interval between discernible beats on the low-confidence signal occurring before the non-discernible beat, the second time interval extending from a first activation onset to a second activation onset of the respective discernible beats on the low-confidence signal;

advance the second time interval such that the first activation onset approximates the activation onset of a beat previous to the non-discernible beat;

reconcile the assigned activation onset with the second activation onset to a reconciled activation onset; and

update the assigned activation onset with the reconciled activation onset for the non-discernible beat.

18. The assembly according to claim 12, wherein the computer-readable medium further comprises instructions, which when executed by a computing device, cause the computing device to classify high-confidence signals that include at least a predetermined percentage of discernible beats out of total beats, each discernible beat having an identifiable activation onset, and low-confidence signals that include a first number of discernible beats and a second number of non-discernible beats, each non-discernible beat having a plurality of deflections and quiescent periods associated with a possible activation onset, the first number of discernible beats being below the predetermined percentage.

19. The assembly according to claim 12, wherein the complex rhythm disorder comprises no discernible period during which the cardiac signals are quiescent.

20. The assembly according to claim 12, wherein the assembly further comprises at least one storage device configured to store the cardiac signals received from the catheter, the at least one storage device accessible to the computer-readable medium to provide the cardiac signals to the computing device.

21. The assembly according to claim 12, wherein the computer-readable medium further comprises instructions, which when executed by a computing device, cause the computing device to generate a clinical representation associated with the complex rhythm disorder using at least the activation onset assigned to the non-discernible beat.

22. A method of reconstructing cardiac signals associated with a complex rhythm disorder using a computing device, the computing device configured to perform the steps of:

receiving cardiac information signals associated with a plurality of sensors spatially related with the patient'"'"'s heart;

identifying a plurality of discernible beats on high-confidence signals of sensors that are spatially adjacent to a sensor associated with a low-confidence signal, the discernible beats on the high-confidence signals corresponding to a non-discernible beat on the low-confidence signal;

computing a time association between at least two activation onsets associated with the identified discernible beats on the high-confidence signals through the non-discernible beat on the low-confidence signal;

defining a time interval associated with the non-discernible beat about a region of the low-confidence signal where the computed time association crosses the non-discernible beat, the time interval indicating how early the non-discernible beat can activate based on a previous beat on the low-confidence signal that has a selected or determined activation onset and how late the non-discernible beat can terminate based on at least one predetermined property; and

assigning an activation onset to the non-discernible beat based on the time association and the time interval.

23. The method according to claim 22, wherein the time association is a time vector between at least two activation onsets.

24. The method according to claim 23, wherein the time vector is between at least two discernible activation onsets.

25. The method according to claim 23, wherein the activation onset is assigned to the non-discernible beat during the defined time interval that is closest to the time vector.

26. The method according to claim 22, wherein the activation onset is assigned in association with a deflection or a quiescent period during the defined time interval.

27. The method according to claim 22, wherein the method further comprises the computing device configured to perform the steps of:

determining a second time interval between discernible beats on the low-confidence signal occurring before the non-discernible beat, the second time interval extending from a first activation onset to a second activation onset of the respective discernible beats on the low-confidence signal;

advancing the second time interval such that the first activation onset approximates the activation onset of a beat previous to the non-discernible beat;

reconciling the assigned activation onset with the second activation onset to a reconciled activation onset; and

updating the assigned activation onset with the reconciled activation onset for the non-discernible beat.

28. The method according to claim 22, wherein the method further comprises the computing device configured to perform the steps of:

classifying high-confidence signals that include at least a predetermined percentage of discernible beats out of total beats, each discernible beat having an identifiable activation onset; and

classifying low-confidence signals that include a first number of discernible beats and a second number of non-discernible beats, each non-discernible beat having a plurality of deflections and quiescent periods associated with a possible activation onset, the first number of discernible beats being below the predetermined percentage.

29. The method according to claim 22, wherein the method further comprises generating a clinical representation associated with the complex rhythm disorder using at least the activation onset assigned to the non-discernible beat.