Detection and display of irregular periodic wave forms

• US 9,848,833 B2
• Filed: 04/18/2017
• Issued: 12/26/2017
• Est. Priority Date: 12/16/2014
• Status: Active Grant

• Current Assignee: Biosense Webster Incorporated (Johnson & Johnson)
• Original Assignee: Biosense Webster Incorporated (Johnson & Johnson)
• Inventors: Govari, Assaf, Ephrath, Yaron
• Primary Examiner(s): Ghulamali, Qutbuddin
• Application Number:
  US15/490,522
• Publication Number:
  US 20170215817A1
• Time in Patent Office: 252 Days
• Field of Search: 34087007
• CPC Class Codes: A61B 18/1492 having a flexible, catheter-like structure, e.g. for heart ablation A61B18/1477 takes precedence
• CPC Class Codes: A61B 2018/00351 Heart
• CPC Class Codes: A61B 2018/00642 with feedback, i.e. closed loop control
• CPC Class Codes: A61B 2018/00839 Bioelectrical parameters, e.g. ECG, EEG
• 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 5/339 Displays specially adapted therefor
• CPC Class Codes: A61B 5/35 by template matching
• 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 5/366 Detecting abnormal QRS complex, e.g. widening
• CPC Class Codes: A61B 5/6852 Catheters
• CPC Class Codes: A61B 5/7475 User input or interface means, e.g. keyboard, pointing device, joystick
• CPC Class Codes: G06T 11/206 Drawing of charts or graphs
• CPC Class Codes: G06T 11/60 Editing figures and text; Combining figures or text
• CPC Class Codes: G06T 2210/41 Medical
• CPC Class Codes: G09G 2320/10 Special adaptations of display systems for operation with variable images
• CPC Class Codes: G09G 2340/12 Overlay of images, i.e. displayed pixel being the result of switching between the corresponding input pixels
• CPC Class Codes: G09G 2340/14 Solving problems related to the presentation of information to be displayed
• CPC Class Codes: G09G 2380/08 Biomedical applications
• CPC Class Codes: G09G 5/00 : Control arrangements or circuits for visual indicators common to cathode-ray tube indicators and other visual indicators image data processing or generation, in general G06T
• CPC Class Codes: G09G 5/10 : Intensity circuits
• CPC Class Codes: G09G 5/377 : for mixing or overlaying two or more graphic patterns G09G5/02, G09G5/397 take precedence
• CPC Class Codes: G16H 40/63 : for local operation

Abstract

A method for display, consisting of acquiring an electrical signal from a heart of a subject over multiple heart cycles. The electrical signal is partitioned into a succession of synchronized segments having respective start times at a selected annotation point in the heart cycles. The method includes overlaying respective graphical representations of the synchronized segments in the succession on a display screen, such that each segment is first presented on the display screen with an initial display intensity at a respective display time corresponding to a respective start time of the segment. The method further includes gradually decreasing a display intensity of each segment overlaid on the display screen as a decaying function of a time elapsed since the respective display time.

Claims

1. An apparatus, comprising:

a display screen;

a processor; and

a catheter comprising an electrocardiogram (ECG) electrode, the ECG electrode being adapted to detect an ECG signal from a heart of a subject during a cardiac procedure;

wherein the processor is configured to;

receive the ECG signal from the ECG electrode when the catheter is inserted into the heart over multiple heart cycles;

partition the ECG signal into a succession of synchronized segments each having respective start times at a selected annotation point in the respective heart cycles, wherein said synchronized segments each represent ECG signals from heart cycles occurring at different time points;

provide a display axis on the display screen, the display axis representing a time period corresponding to one synchronized segment;

using the display screen, simultaneously display graphical representations of a plurality of synchronized segments on the display axis, such that synchronized segments corresponding to ECG signals from a plurality of different heart cycles occurring at different time points are simultaneously overlaid on the display axis, and wherein said graphical representations of the plurality of synchronized segments at least partially overlap on the display screen;

continuously create additional synchronized segments as the ECG signal is received from the heart of the subject, wherein graphical representations of newly created synchronized signals are continuously added to the display axis on the display screen, and wherein graphical representations of older synchronized signals are removed from the display axis after a period of time;

said processor being further configured to;

determine whether said plurality of graphical representations of the plurality of synchronized segments on the display axis comprise both (i) one or more synchronized segments which each include an irregular but periodic wave form, and also (ii) one or more synchronized segments which do not include said irregular but periodic wave form; and

to indicate atrial fibrillation in the subject when condition (i) and (ii) are both satisfied.

2. The apparatus of claim 1, the apparatus being further configured to:

first present each synchronized segment on the display screen with an initial display intensity at a respective display time corresponding to a respective start time of the synchronized segment; and

gradually decrease a display intensity of the graphical representation of each synchronized segment overlaid on the display screen as a decaying function of a time elapsed since the respective display time until each synchronized segment is, in respective turn, removed from the display axis; and

wherein graphical representations of synchronized segments having a plurality of different respective display intensities are simultaneously presented on the display axis.

3. The apparatus of claim 1:

said processor being configured so that where said graphical representations of said synchronized segments overlap on the display axis, the display intensity of overlapping points of the synchronized segments are summed and displayed on the display screen.

4. The apparatus of claim 1:

said processor being configured so that where said graphical representations of said synchronized segments overlap on the display axis, the display intensity of overlapping points of the synchronized segments are summed and displayed on the display screen, wherein summing the display intensity comprises summing the display intensity for a selected portion of the synchronized segments, and wherein the selected portion is smaller than the synchronized segments.

5. The apparatus of claim 1:

said processor being configured so that where said graphical representations of said synchronized segments overlap on the display axis, the display intensity of overlapping points of the synchronized segments are summed and displayed on the display screen;

said processor being further configured so that where portions of said graphical representations of said synchronized segments are within a selected number of pixels from each other on the display axis, the display intensity of said portions of the synchronized segments are summed and displayed on the display screen.

6. The apparatus of claim 1:

further configured wherein the selected annotation point is derived from a QRS complex of the heart signal.

7. The apparatus of claim 1:

further configured to overlay the respective graphical representations by at least one of (a) aligning respective baselines of the synchronized segments, and (b) aligning the selected annotation point of each of the synchronized segments with one another.

8. The apparatus of claim 1, further configured wherein each synchronized segment corresponds to one heart cycle.

9. The apparatus of claim 1, further configured:

to determine whether said plurality of graphical representations of the plurality of synchronized segments on the display axis comprises both (i) a plurality of synchronized segments which each include an irregular but periodic wave form, and also (ii) one or more synchronized segments which do not include said irregular but periodic wave form;

to diagnose atrial fibrillation in the subject when condition (i) and (ii) are both satisfied; and

using the display screen, to represent said (i) plurality of synchronized segments which each include said irregular but periodic wave form by a summed intensity of overlapping points corresponding to the irregular but periodic wave form in two or more different synchronized segments.

10. The apparatus of claim 1,

wherein the processor is mounted in a console, the console comprising operating controls, the operating controls being configured to allow an operator to interact with the processor;

wherein the catheter is linked to the console; and

wherein the catheter further comprises an ablation electrode.

11. An apparatus, comprising:

a display screen;

a processor; and

at least one body surface electrode, the body surface electrode being adapted to detect an ECG signal from a skin surface of a subject;

wherein the processor is configured to;

receive the ECG signal from the at least one body surface electrode when the at least one body surface electrode is positioned on the subject;

partition the ECG signal into a succession of synchronized segments each having respective start times at a selected annotation point in the respective heart cycles, wherein said synchronized segments each represent ECG signals from heart cycles occurring at different time points;

provide a display axis on the display screen, the display axis representing a time period corresponding to one synchronized segment;

using the display screen, simultaneously display graphical representations of a plurality of synchronized segments on the display axis, such that synchronized segments corresponding to ECG signals from a plurality of different heart cycles occurring at different time points are simultaneously overlaid on the display axis, and wherein said graphical representations of the plurality of synchronized segments at least partially overlap on the display screen;

continuously create additional synchronized segments as the ECG signal is received from the heart of the subject, wherein graphical representations of newly created synchronized signals are continuously added to the display axis on the display screen, and wherein graphical representations of older synchronized signals are removed from the display axis after a period of time;

said processor being further configured to;

determine whether said plurality of synchronized segments on the display axis comprise both (i) one or more synchronized segments which each include an irregular but periodic wave form, and also (ii) one or more synchronized segments which do not include said irregular but periodic wave form; and

to indicate atrial fibrillation in the subject when condition (i) and (ii) are both satisfied.

12. The apparatus of claim 11, the apparatus being further configured to:

first present each synchronized segment on the display screen with an initial display intensity at a respective display time corresponding to a respective start time of the synchronized segment; and

gradually decrease a display intensity of the graphical representation of each synchronized segment overlaid on the display screen as a decaying function of a time elapsed since the respective display time until each synchronized segment is, in respective turn, removed from the display axis; and

wherein graphical representations of synchronized segments having a plurality of different respective display intensities are simultaneously presented on the display axis.

13. The apparatus of claim 11:

said processor being configured so that where said graphical representations of said synchronized segments overlap on the display axis, the display intensity of overlapping points of the synchronized segments are summed and displayed on the display screen.

14. The apparatus of claim 11,

wherein the processor is mounted in a console, the console comprising operating controls, the operating controls being configured to allow an operator to interact with the processor;

wherein the catheter is linked to the console; and

wherein the catheter further comprises an ablation electrode.

15. An apparatus, comprising:

a display screen; and

a processor, which is configured to;

receive an electrocardiogram (ECG) signal from a heart of a subject over multiple heart cycles;

partition the ECG signal into a succession of synchronized segments each having respective start times at a selected annotation point in the respective heart cycles, wherein said synchronized segments each represent ECG signals from heart cycles occurring at different time points;

provide a display axis on the display screen, the display axis representing a time period corresponding to one synchronized segment;

using the display screen, simultaneously display graphical representations of a plurality of synchronized segments on the display axis, such that synchronized segments corresponding to ECG signals from a plurality of different heart cycles occurring at different time points are simultaneously overlaid on the display axis, and wherein said graphical representations of the plurality of synchronized segments at least partially overlap on the display screen;

continuously create additional synchronized segments as the ECG signal is received from the heart of the subject, wherein graphical representations of newly created synchronized signals are continuously added to the display axis on the display screen, and wherein graphical representations of older synchronized signals are removed from the display axis after a period of time;

said processor being further configured to;

determine whether said plurality of synchronized segments on the display axis comprise both (i) one or more synchronized segments which each include an irregular but periodic wave form, and also (ii) one or more synchronized segments which do not include said irregular but periodic wave form; and

to indicate atrial fibrillation in the subject when condition (i) and (ii) are both satisfied.

16. The apparatus of claim 15, the apparatus being further configured to:

first present each synchronized segment on the display screen with an initial display intensity at a respective display time corresponding to a respective start time of the synchronized segment; and

gradually decrease a display intensity of the graphical representation of each synchronized segment overlaid on the display screen as a decaying function of a time elapsed since the respective display time until each synchronized segment is, in respective turn, removed from the display axis; and

wherein graphical representations of synchronized segments having a plurality of different respective display intensities are simultaneously presented on the display axis.

17. The apparatus of claim 15:

said processor being configured so that where said graphical representations of said synchronized segments overlap on the display axis, the display intensity of overlapping points of the synchronized segments are summed and displayed on the display screen.

18. The apparatus of claim 15, further configured wherein each synchronized segment corresponds to one heart cycle.

19. The apparatus of claim 15, further configured:

to determine whether said plurality of graphical representations of the plurality of synchronized segments on the display axis comprises both (i) a plurality of synchronized segments which each include an irregular but periodic wave form, and also (ii) one or more synchronized segments which do not include said irregular but periodic wave form;

to diagnose atrial fibrillation in the subject when condition (i) and (ii) are both satisfied; and

using the display screen, to represent said (i) plurality of synchronized segments which each include said irregular but periodic wave form by a summed intensity of overlapping points corresponding to the irregular but periodic wave form in two or more different synchronized segments.

20. The apparatus of claim 15,

wherein the processor is mounted in a console, the console comprising operating controls, the operating controls being configured to allow an operator to interact with the processor.