Methods, system and apparatus for the detection, diagnosis and treatment of biological rhythm disorders
Inventors
Narayan, Sanjiv M. • Sehra, Ruchir
Assignees
Topera Inc • Office of General Counsel of VA • University of California San Diego UCSD
Publication Number
US-8700140-B2
Publication Date
2014-04-15
Expiration Date
2031-04-06
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Abstract
System, assembly and method are provided to facilitate reconstruction of cardiac information representing a complex rhythm disorder associated with a patient's heart to indicate a source of the heart rhythm disorder. The complex rhythm disorder can be treated by application of energy to modify the source of the rhythm disorder.
Core Innovation
The present invention discloses systems, assemblies and methods that facilitate reconstruction of cardiac information representing a complex rhythm disorder associated with a patient's heart to indicate a source of the heart rhythm disorder. The complex rhythm disorder can then be treated by applying energy to modify the source of the disorder. This approach represents an advance over prior art by directly identifying and locating causes (targets) for complex heart rhythm disorders such as atrial fibrillation (AF), ventricular fibrillation (VF), and polymorphic ventricular tachycardia (VT), including electrical rotors and focal beats, which may stay stationary or transiently appear or move.
The problem solved by this innovation arises from the difficulty in identifying and locating causes of complex biological rhythm disorders, especially heart rhythm disorders, using existing tools and methods. Prior methods and systems often provide data that require practitioner interpretation but fail to directly identify and locate the cause of the disorder, particularly for complex rhythm disorders like AF and VF. This complicates treatment efforts such as ablation, which is often empiric, lengthy, and imprecise, sometimes damaging large portions of cardiac tissue without reliably terminating the arrhythmia. The invention addresses these challenges by employing multi-location sensing with variable spatial resolution, signal processing algorithms that classify signals into high and low confidence, activation onset determination within acceptance windows, and ordering activation onsets to reveal discernible activation trails such as rotors or focal beat patterns.
Claims Coverage
The patent contains multiple independent claims directed to systems, assemblies, and methods for reconstructing cardiac information related to complex rhythm disorders to identify and locate their sources.
Classification of cardiac signals into high and low confidence
The system receives cardiac information signals during a complex rhythm disorder, classifies them into high and low confidence signals separated by a confidence threshold, and determines activation onsets associated with low confidence signals within an acceptance window.
Ordering activation onsets to indicate the source
Activation onsets associated with both high and low confidence signals are ordered based on at least one of temporal, spatial, and phase information and output as ordered to indicate the source of the complex cardiac rhythm disorder.
Use of vectors to determine activation onsets for low confidence signals
Activation onsets of low confidence signals are determined using vectors connecting at least two discernible activation onsets, refined by properties such as beat shape, polarity, and surrounding activation patterns.
Expert system integration for template matching and acceptance window determination
An expert system is used to perform template matching with beat types and to determine the acceptance window using factors including action potential duration, conduction velocity, frequency, fiber angle, vector information, and anatomical factors.
Signal pre-processing and filtering
The system removes baseline wander and noise, filters the cardiac information signals, and disregards signals based on signal-to-noise ratio, template matching, frequency, and amplitude criteria.
Catheter assembly with plurality of sensors
An assembly comprising a catheter with multiple sensors to collect cardiac information signals, operatively coupled to a computing device with a computer-readable medium storing instructions to perform the classification, activation onset determination, ordering, and output of activation onsets to indicate the source.
Method of reconstructing cardiac information
A method including receiving cardiac signals from multiple sensors during a complex rhythm disorder, classifying signals into high and low confidence, determining activation onsets for low confidence signals within acceptance windows, ordering activation onsets based on temporal, spatial or phase information, and outputting them to indicate a source of the disorder.
The claims collectively cover inventive features involving classification of signals by confidence, determining activation onsets using vectors and acceptance windows informed by physiological and anatomical data, ordering of activations to reveal sources of complex rhythm disorders, integration of expert system-based template matching, and utilization of catheter assemblies for signal acquisition, forming a comprehensive system and method for identifying and localizing sources of complex cardiac rhythm disorders.
Stated Advantages
Direct identification and localization of causes for complex heart rhythm disorders that were previously difficult or impossible to detect, including electrical rotors and focal beat sources.
Enables targeted treatment, such as focused ablation at the identified sources, potentially reducing procedure duration and tissue damage compared to empiric ablation methods.
Use of high and low confidence signal classification improves accuracy of activation onset detection under variable signal quality conditions.
Adaptive spatial resolution of sensing and intelligent signal processing allows efficient data acquisition and analysis during minimally invasive or surgical procedures.
Visual and auditory display formats facilitate practitioner understanding of the activation trails and source locations, enhancing clinical decision-making.
Capability for both real-time and offline review modes, enabling planning, intra-procedure guidance, and post-procedure assessment.
Documented Applications
Identification, diagnosis, and treatment of complex heart rhythm disorders including atrial fibrillation (AF), ventricular fibrillation (VF), polymorphic ventricular tachycardia (VT), atrial tachycardia (AT), supraventricular tachycardia (SVT), atrial flutter (AFL), premature atrial complexes/beats (PAC), premature ventricular complexes/beats (PVC), and inappropriate sinus tachycardia or sinus node reentry.
Minimally invasive and surgical interventions such as catheter-based ablation therapy guided by the identified sources in the heart.
Diagnosis and treatment of electrical and contractile disorders in organs such as the brain (e.g., epilepsy or seizure focus identification), central and peripheral nervous systems, smooth muscle of gastrointestinal and genitourinary systems.
Use in planned procedures, intraoperative guidance, and post-procedure analysis including review of stored data from electrograms or implanted devices.
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