Method for treating complex rhythm disorders
Inventors
Narayan, Sanjiv • Rappel, Wouter-Jan
Assignees
US Department of Veterans Affairs • Office of General Counsel of VA • University of California San Diego UCSD
Publication Number
US-8838222-B2
Publication Date
2014-09-16
Expiration Date
2029-10-09
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Abstract
A method of treating a complex rhythm disorder of a human heart includes identifying a region of a wall of the heart having an activation trail that is rotational or radially emanating, where the activation trail is indicative of the complex rhythm disorder and is based on activation times associated with one or more activations of the heart. A portion of the region is selected based on the activation trail and modified to affect the activation trail.
Core Innovation
The invention provides a method, system, and devices for identifying, locating, and treating complex heart rhythm disorders by detecting activation trails that are rotational or radially emanating on a region of the heart wall. These activation trails are based on activation times associated with one or more activations of the heart and are indicative of the rhythm disorder. Once such a region is identified, a portion is selected and modified to affect the activation trail, thereby treating the disorder.
The method includes sensing biological activation signals from multiple locations using one or more sensors, collecting data comprising sensor locations and activation times, and analyzing this data to identify and locate causes such as electrical rotors, focal beats, or dispersed activation patterns. The invention allows adaptive spatial resolution of sensing, use of advanced signal processing methods including phase mapping and frequency domain analyses, and visual or auditory displays to aid diagnosis and treatment. Treatment may include ablation or other means directed precisely at the localized cause.
The problem being solved addresses the difficulty in current methods to identify and localize causes of complex heart rhythm disorders such as atrial fibrillation (AF), ventricular fibrillation (VF), and ventricular tachycardia (VT). Prior art techniques fail to locate sustained localized sources of these complex arrhythmias, resulting in empiric and often extensive ablation procedures with limited success and significant complications. The invention overcomes these by providing a direct means to detect and locate the core regions sustaining these arrhythmias and enabling targeted, effective minimally invasive therapy.
Claims Coverage
The patent claims encompass several independent inventive features focused on identifying and treating heart rhythm disorders by detecting activation trails and modifying regions of the heart based on these activations.
Method to identify heart regions with rotational or radial activation trails
A method of treating a complex rhythm disorder by identifying regions of the heart wall having activation trails that are rotational or radially emanating, based on activation times, then selecting and modifying a portion of this region to affect the activation trail.
Arranging activation times to identify spatial activation trails
Accessing activation signals from spatially disposed sensors and arranging activation times by sequences based on timing, signal shape, spatial relationships, or phase to identify activation trails indicative of rhythm disorder causes.
Analysis and approximation of activation trails
Analyzing activation signals for parameters such as rate, regularity, amplitude, duration, and location to approximate activation trails representing rotors or focal sources.
Construction of voltage-time tracings with inserted physiological patterns
Constructing voltage-time tracings of activation signals and inserting physiological patterns like unipolar, bipolar, or monophasic action potential representations at activation times to aid visualization and analysis.
Identification and targeting of core regions within activation trails
Identifying core regions around which activation revolves or from which it emanates, selecting portions of these regions or adjacent areas, and modifying them to treat the rhythm disorder by isolating, migrating, or ablating these areas.
Generation and display of activation trail representations
Generating visual or auditory representations of activation trails and core regions to assist practitioners in diagnosis and targeted treatment.
The claims collectively cover methods for detecting, analyzing, and visually representing activation trails of heart rhythm disorders through sensor data, identifying core pathological regions, and methods for modifying these regions to treat complex arrhythmias, including atrial fibrillation, ventricular fibrillation, and ventricular tachycardia.
Stated Advantages
Provides direct identification and localization of causes for complex heart rhythm disorders, enabling targeted treatment.
Enables minimally invasive diagnosis and treatment, reducing the extent of ablation and associated complications.
Allows for real-time or offline analysis with adaptive sensor configurations for optimized spatial resolution.
Facilitates visual and auditory representation of activation trails aiding clinical decision-making.
Improves treatment success rates, including acute termination of atrial fibrillation by targeting localized sources.
Supports creation of databases and expert systems to enhance diagnosis by comparing to stored patterns.
Documented Applications
Diagnosis and treatment of complex heart rhythm disorders including atrial fibrillation (AF), ventricular fibrillation (VF), and ventricular tachycardia (VT).
Treatment of simpler cardiac rhythm disorders such as atrial tachycardia (AT), supraventricular tachycardia (SVT), atrial flutter (AFL), premature atrial complexes/beats (PAC), premature ventricular complexes/beats (PVC), and sinus node reentry.
Minimally invasive or surgical ablation therapy targeted at localized electrical rotors or focal beats causing arrhythmias.
Use in electrophysiologic studies to identify and treat localized sources in human heart chambers during arrhythmias.
Application to other biological rhythm disorders beyond the heart, including electrical disorders of brain and nervous system (e.g., epilepsy), smooth muscle disorders of gastrointestinal and genitourinary systems, and detection of tumors.
Non-medical uses such as locating sources of seismic events or energy sources combined with radar or sonar.
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