HIGH DENSITY ATRIAL FIBRILLATION CYCLE LENGTH (AFCL) DETECTION AND MAPPING SYSTEM

• US 20130303879A1
• Filed: 11/01/2012
• Published: 11/14/2013
• Est. Priority Date: 05/17/2004
• Status: Active Grant

• Current Assignee: Boston Scientific Scimed (Boston Scientific Corporation)
• Original Assignee: C.R. Bard, Inc. (Becton, Dickinson & Co)
• Inventors: MacAdam, David P., Mashimo, Minoru, Fanier, Sylvain
• Granted Patent: US 8,903,478 B2
• Time in Patent Office: Days
• US Class Current: 600/410
• CPC Class Codes: A61B 18/14 Probes or electrodes 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 2018/00351 Heart
• CPC Class Codes: A61B 2018/00577 Ablation
• 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 5/361 Detecting fibrillation
• CPC Class Codes: A61B 5/7257 using Fourier transforms

Abstract

Systems and methods to assist in locating the focus of an atrial fibrillation include the association of atrial fibrillation cycle length values and statistics relating thereto with temporal locations on an electrogram of a given electrode, and/or the coordination of electrode locations with respective the spectral analyses of electrogram signals and further parameters and statistics relating thereto. Ablation therapy can proceed under guidance of such information.

Claims

1. A method for annotating an electrocardiogram with an atrial fibrillation cycle length (AFCL) value that is displayable on a display of an electrophysiology system, comprising the steps of:

(a) providing an electrocardiogram signal within the electrophysiology system;

(b) accepting input to the electrophysiology system to define a time segment of interest within the electrocardiogram signal;

(c) locating successive activation signals within the time segment of interest on each electrocardiogram signal;

(d) determining one or more average AFCL values using the located successive activation signals; and

(e) associating on the display of the electrophysiology system at least one of the determined average AFCL values together with the electrocardiogram signal.

2. The method of claim 1, wherein the locating step comprises applying the electrocardiogram signal within the time segment of interest to an input of an FIR filter and outputting a stream of signals from the FIR filter which includes the located successive activation signals.

3. The method of claim 1, including the additional step of automatically marking the located successive activation signals on the display in association with the electrogram signal.

4. The method of claim 3, wherein the average AFCL values include at least a first set of values which correspond to the absolute value of the time interval between each successive activation signal that has been located.

5. The method of claim 4, wherein the first set of AFCL values is displayed on the display of the electrophysiology system proximate to the located successive activation signals.

6. The method of claim 1, wherein the determining step further includes the step of determining an AFCL statistic from the one or more average AFCL values and wherein the associating step associates one of the average AFCL values together with the electrocardiogram signal.

7. The method of claim 6, including the additional steps of depicting a rendering of a portion of at least one heart chamber;

and including the AFCL statistic in the rendering.

8. The method of claim 7, wherein the rendering is a model of the at least one heart chamber.

9. The method of claim 7, wherein the rendering is a captured image of the at least one heart chamber.

10. The method of claim 9, wherein the captured image is captured by a technique selected from the group consisting of:

fluoroscopy, magnetic resonance imaging, computer tomography, ultrasound imaging, and ultrasound echoing.

11. The method of claim 7, wherein the rendering is depicted in a window separate from the electro gram signal.

12. The method of claim 11, wherein the window is presented on a second display independent of the display of the electrophysiology system.

13. The method of claim 7, wherein the electrocardiogram signal is provided from a first electrode of a multi-electrode catheter and wherein there are plural electrocardiogram signals associated with respective plural additional electrodes on the multi-electrode catheter, each of said plural electrocardiogram signals having at least one AFCL statistic associated therewith over a time segment of interest that overlaps with the time segment of interest for the electrocardiogram signal from the first electrode.

14. The method of claim 13, wherein the step of including the AFCL statistic in the rendering comprises coordinating a position of one or more of the electrodes of the multi-electrode catheter with a respective AFCL statistic.

15. The method of claim 14, including the additional steps, after an ablation procedure has been initiated, of determining one or more additional AFCL values and statistics within the at least one heart chamber and depicting said additional AFCL statistics in a second rendering of the at least one heart chamber.

16. The method of claim 1, wherein the step of providing the electrocardiogram signal includes obtaining signals from an intracardiac lead and displaying the signals on the display.

52. The method of claim 1, wherein the time segment is defined based on an input provided by a user.

17. An electrophysiology system, comprising:

inputs configured to receive plural electrocardiogram signals from multiple intracardiac electrodes, each of the electrocardiogram signals corresponding to a respective location of one or more of the electrodes as disposed within a heart;

software operative to;

(a) apply a finite impulse response (FIR) filter to the plural electrocardiogram signals so as to output a location along a time-axis of two or more activation signals detected in the plural electrocardiogram signals and to determine one or more atrial fibrillation cycle length (AFCL) values, and (b) correlate each of the one or more AFCL values with a location of a corresponding one of the one or more electrodes; and

an output configured to display the plural electrocardiogram signals associated with each respective intracardiac electrode on a display, the output comprising;

a. a first window configured to display along the time-axis the plural electrocardiogram signals in association with at least one of the one or more AFCL values; and

b. a second window configured to display a map that coordinates at least one determined AFCL value with the corresponding locations within the heart of the respective intracardiac electrodes.

18. The electrophysiology system of claim 17, wherein the first and second windows are presented on the same display.

53. The electrophysiology system of claim 17, wherein the one or more AFCL values comprises at least one of:

(a) an average of the one or more AFCL values, (b) a maximum of the one or more AFCL values, and (c) a minimum of the one or more AFCL values.

19. An ablation and mapping procedure, comprising the steps of:

percutaneously advancing a catheter into at least one of the atria, the catheter having multiple electrodes supported along a distal portion thereof;

associating in a memory of a machine one or more locations of the electrodes within the at least one of the atria;

capturing electrocardiogram signals associated with at least one electrode of the catheter at one or more of the locations;

for at least a portion of the captured electrocardiogram signals, calculating one or more discrete atrial fibrillation cycle length (AFCL) values;

coordinating the calculated discrete AFCL values with respective locations of the multiple electrodes to define a set of data points;

extrapolating from the set of data points a continuous isochronal representation of AFCL; and

;

outputting the extrapolated representation on a display.

20. The method of claim 19, including the additional step of correlating the AFCL values with respective colors and displaying the extrapolated representation in color.

21. The method of claim 19, wherein the step of calculating one or more discrete AFCL values comprises:

applying a finite impulse response (FIR) filter to the captured electrocardiogram signals so as to output successive locations along a time-axis of the respective electrocardiogram signals of one or more activation signals detected therein, and

determining an absolute difference in time of the output successive locations along the time-axis.

54. The method of claim 19, wherein calculating one or more discrete AFCL values comprises calculating one or more discrete AFCL values in real-time.

55. The method of claim 19, wherein calculating one or more discrete AFCL values comprises calculating one or more discrete AFCL values with respect to one or more previously captured electrocardiogram signals.

22. An electrophysiology system, comprising:

a monitor operative to display electrophysiology data;

an input configured to accept signals from plural cardiac leads;

a processor configured to receive the signals from the input and to influence the electrophysiology data displayable on the monitor;

software executable by the processor and configured to operate upon signals from the plural cardiac leads so as to determine at least one value representative of an atrial fibrillation cycle length (AFCL) and cause information related to the at least one value to be displayed on the monitor.

23. The electrophysiology system of claim 22, further comprising an interface manager that accepts inputs from an operator and programmatically causes a change in the at least one value representative of an AFCL.

24. The electrophysiology system of claim 23, wherein the monitor displays electrocardiogram signals and wherein the software is further configured to annotate respective electrocardiogram signals with one or more associated values representative of an AFCL.

25. The electrophysiology system of claim 24, wherein the electrophysiology data comprises respective electrocardiogram signals and wherein the software associates said respective electrocardiogram signals with annotations of plural AFCL data at locations corresponding to detected locations of activation signals, and wherein the inputs from the operator include an insertion, deletion and movement of one of the detected locations.

26. The electrophysiology system of claim 22, wherein the software comprises a finite impulse response (FIR) filter which operates upon the signals from the input so as to output a location along a time-axis of the electrocardiogram signals of one or more activation signals detected therein and to determine the at least one value representative of AFCL.

27-51. -51. (canceled)