System for analysis of complex rhythm disorders

• US 9,955,879 B2
• Filed: 06/08/2016
• Issued: 05/01/2018
• Est. Priority Date: 10/09/2008
• Status: Active Grant

• Current Assignee: 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, Rappel, Wouter-Jan
• Primary Examiner(s): Bertram, Eric D.
• Application Number:
  US15/177,317
• Publication Number:
  US 20160278657A1
• Time in Patent Office: 692 Days
• CPC Class Codes: A61B 18/1206 Generators therefor
• 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 2018/00214 Expandable means emitting energy, e.g. by elements carried thereon
• CPC Class Codes: A61B 2018/00351 Heart
• CPC Class Codes: A61B 2018/00357 Endocardium
• CPC Class Codes: A61B 2018/00375 Ostium, e.g. ostium of pulmonary vein or artery
• CPC Class Codes: A61B 2018/00839 Bioelectrical parameters, e.g. ECG, EEG
• CPC Class Codes: A61B 2018/1435 Spiral
• CPC Class Codes: A61B 5/02 Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
• CPC Class Codes: A61B 5/02405 Determining heart rate variability
• CPC Class Codes: A61B 5/02416 using photoplethysmograph signals, e.g. generated by infrared radiation A61B5/14552 takes precedence
• CPC Class Codes: A61B 5/0245 by using sensing means generating electric signals, i.e. ECG signals
• CPC Class Codes: A61B 5/243 specially adapted for magnetocardiographic [MCG] signals
• CPC Class Codes: A61B 5/283 Invasive
• CPC Class Codes: A61B 5/287 Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
• 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 5/35 by template matching
• CPC Class Codes: A61B 5/361 Detecting fibrillation
• CPC Class Codes: A61B 5/363 : Detecting tachycardia or bradycardia
• CPC Class Codes: A61B 5/4836 : Diagnosis combined with treatment in closed-loop systems or methods A61B5/0036 takes precedence
• CPC Class Codes: A61B 5/6857 : with a distal pigtail shape
• CPC Class Codes: A61B 5/6858 : with a distal basket, e.g. expandable basket
• CPC Class Codes: A61B 5/6859 : with multiple distal splines
• CPC Class Codes: A61B 5/7203 : for noise prevention, reduction or removal
• CPC Class Codes: A61B 5/726 : using Wavelet transforms
• CPC Class Codes: A61B 5/7405 : using sound
• CPC Class Codes: A61B 7/04 : Electric stethoscopes microphones, acoustic transducers therefor H04R
• CPC Class Codes: A61B 8/0883 : for diagnosis of the heart

Abstract

A system to generate a representation of a rhythm disorder includes a plurality of sensors disposed at multiple locations spatially in relation to the heart, wherein cardiac information signals are sensed. A processor receives and analyzes the activation onsets of the cardiac information signals to determine an arrangement of activation onsets. A representation that indicates the clinical source of the rhythm disorder is generated based on the arrangement of the activation onsets.

Claims

1. A system for generating a representation of a clinical source of a complex heart rhythm disorder comprising:

a plurality of sensors disposed at multiple locations in relation to the heart to sense cardiac information signals; and

a processor interfacing with the plurality of sensors, wherein the processor is configured to;

receive data associated with the cardiac information signals, the data comprising an activation onset of each cardiac information signal at each location such that a plurality of activation onsets at a plurality of locations is collected;

determine a sequential arrangement of activation onsets derived from the data associated with the cardiac information signals; and

generate a sensory representation based on the sequential arrangement of activation onsets, wherein the sensory representation indicates a region of the heart associated with the clinical source of the complex heart rhythm disorder.

2. The system of claim 1, wherein the sequential arrangement is based on an ordering of the activation onsets.

3. The system of claim 2, wherein the sensory representation comprises an activation trail based on the sequential arrangement of activation onsets as ordered.

4. The system of claim 3, wherein the activation trail comprises activations that revolve around or radially emanate from a core region, the core region indicative of the complex heart rhythm disorder.

5. The system of claim 3, wherein the sensory representation comprises an activation trail that is repeating.

6. The system of claim 3, wherein the activation trail comprises a rotational pattern or an outwardly emanating pattern.

7. The system of claim 6, wherein the rotational pattern or the outwardly emanating pattern is repeating.

8. The system of claim 3, wherein the processor is further configured to visually depict on a display device the sensory representation comprising the activation trail.

9. The system of claim 8, wherein the display device is arranged for visually depicting the activation onsets in relation to a location of each sensor to display the activation trail.

10. The system of claim 3, wherein the processor is further configured to perform:

analyzing the cardiac information signals at one or more of the multiple locations; and

approximating the activation trail based on the analyzing.

11. The system of claim 10, wherein analyzing comprises analyzing one or more of rate, regularity, amplitude, duration, and location.

12. The system of claim 3, wherein the processor is further configured to determine an approximate core region in relationship to the activation trail.

13. The system of claim 12, wherein the activation trail revolves about the approximate core region or the activation trail emanates outwardly from the approximate core region.

14. The system of claim 12, wherein the approximate core region is a rotor or a focal activation.

15. The system of claim 1, wherein the sensory representation indicates the clinical source of the complex heart rhythm disorder by providing a visualization of at least one of existence, type, and location of the complex heart rhythm disorder.

16. The system of claim 1, wherein the sensory representation indicates the clinical source of the complex heart rhythm disorder by providing at least one of an image, textual, tactile, graphic and auditory visualization of a rotor or other cause of the complex heart rhythm disorder.

17. The system of claim 1, wherein the sensory representation is one or more of a visual display and auditory signal.

18. The system of claim 17, wherein the visual display includes one or more of a real-time presentation, textual data, and graphical data.

19. The system of claim 17, wherein the auditory signal comprises an auditory identification of the clinical source of the complex heart rhythm disorder.

20. The system of claim 1, wherein the sensory representation comprises an activation trail based on a sequential ordering of the activation onsets.

21. The system of claim 1, wherein the processor is further configured to generate the sensory representation based on an activation trail, the activation trail based on at least one of a direct phase, Hilbert transform, wavelet transform, phase-delay, and time-domain analysis associated with the cardiac information signals.

22. The system of claim 1, wherein the sensory representation is at least one of a set of data, an image, a graphic, and a textual description.

23. The system of claim 1, wherein the sensory representation comprises a rotational pattern or an outwardly emanating pattern.

24. The system of claim 23, wherein the rotational pattern or the outwardly emanating pattern is repeating.

25. The system of claim 1, wherein one or more of the multiple locations are within the heart or proximal to the heart.

26. The system of claim 1, further comprising a sensor device to sense the cardiac information signals at the multiple locations using the plurality of sensors.

27. The system of claim 26, wherein the sensor device performs sensing of the cardiac information signals at the multiple locations concurrently.

28. The system of claim 26, wherein the sensor device performs sensing of the cardiac information signals at the multiple locations stepwise.

29. The system of claim 1, further comprising an ablation component for modifying or destroying regions of the heart responsible for a cause of the complex heart rhythm disorder.

30. The system of claim 1, further comprising a plurality of sensors including an ablation component for modifying or destroying regions of the heart responsible for a cause of the complex heart rhythm disorder.

31. The system of claim 1, further comprising software for processing said data.

32. The system of claim 1, further comprising determining whether a cause of the complex heart rhythm disorder is a primary cause of the complex heart rhythm disorder.

33. The system of claim 32, wherein criteria used for determining whether the cause of the complex heart rhythm disorder is a primary cause are selected from the group consisting of the number of activation trail repetitions, the rate of activation trail repetitions, the number of localized causes, the volume of tissue contained within the activation trail, whether the cause is localized or dispersed, the location of the cause within the heart, and combinations thereof.

34. The system of claim 32, wherein the complex heart rhythm disorders are selected from a group consisting of supraventricular tachycardia, supraventricular bradycardia, ventricular bradycardia, atrial fibrillation, atrial flutter, atrial tachycardia, ventricular tachycardia, ventricular fibrillation or a combination thereof.

35. The system of claim 1, further comprising an electronic control system for connecting to one or more of a plurality of sensors.

36. The system of claim 35, further comprising an electronic connection switching component for independently switching connections between said plurality of sensors and said electronic control system.

37. The system of claim 1, wherein the activation onsets are arranged based on their relative activation onset time.

38. The system of claim 1, wherein the processor is further configured to determine at least one approximate core region that is a rotor.

39. The system of claim 38, wherein said at least one approximate core region is a focal activation.

40. The system of claim 1, wherein the processor is further configured to filter signal noise.

41. The system of claim 1, wherein an activation time associated with an activation onset of a cardiac information signal at a location includes the activation onset time and its corresponding offset time.

42. The system of claim 41, wherein the activation onset time includes a diastolic interval.

43. The system of claim 1, wherein the system comprises a storage device for storing data associated with said activation trail in a database.

44. The system of claim 1, wherein the processor is further configured to augment or modify the activation trail based upon comparisons with similar activation trail patterns associated with data stored in a database.

45. The system of claim 1, wherein the processor is further configured to:

construct an electrograph having a voltage-time tracing of heart function at each of the multiple locations; and

insert a physiological pattern in the electrograph at the activation onset of each cardiac information signal at each location.

46. The system of claim 45, wherein the physiological pattern comprises a pattern selected from the group consisting of a prior recording from a same patient, a prior recording from a different patient, and a simulated pattern.

47. The system of claim 45, wherein the physiological pattern is a pattern selected from a group consisting of a unipolar electrogram, a bipolar electrogram, an action potential representation, and a combination thereof.

48. The system of claim 45, wherein the physiological pattern is adjusted for rate.

49. The system of claim 45, wherein the physiological pattern is a model of cellular ion function or a model of a pharmacological ligand.