System and method for reconstructing cardiac signals associated with a complex rhythm disorder
Inventors
Narayan, Sanjiv • Sehra, Ruchir
Assignees
US Department of Veterans Affairs • Topera Inc • Office of General Counsel of VA • University of California San Diego UCSD
Publication Number
US-9241667-B2
Publication Date
2016-01-26
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 invention provides systems, assemblies and methods to reconstruct cardiac information representing complex rhythm disorders associated with a patient's heart to indicate the source of the disorder. It enables the identification and location of localized causes of these disorders, such as electrical rotors and focal beats, which may remain in approximately the same location or transiently appear or move within the heart.
The problem addressed is the inability of prior art to identify and locate causes for complex heart rhythm disorders like atrial fibrillation (AF), ventricular tachycardia (VT), and ventricular fibrillation (VF). Existing diagnostic and mapping tools fail to directly reveal the source of such disorders, leading to empirical and often extensive ablation procedures with limited success rates and risks to patients.
The invention overcomes these limitations by employing a system that receives cardiac signals from multiple sensors spatially arranged within the heart, classifies these signals based on confidence levels, determines activation onsets including those difficult to discern, and orders these activation times to reconstruct activation trails. This approach directly identifies and localizes causes of complex rhythm disorders, facilitating targeted treatment such as ablation to modify or eliminate the source.
Claims Coverage
The patent includes one independent system claim, one independent assembly claim, and one independent method claim. Each claim covers the reconstruction of cardiac signals related to complex rhythm disorders using computational techniques that classify and analyze signals from multiple sensors to identify activation onsets and localize the source of the disorder.
Complex rhythm signal classification and activation onset determination
Identifying discernible beats on high-confidence signals adjacent to low-confidence signals and determining activation onsets for non-discernible beats on low-confidence signals using spatial and temporal analysis, including computation of a time vector crossing the non-discernible beat and defining an acceptance time interval based on physiological constraints.
Use of confidence thresholds to classify signals
Separating cardiac signals into high-confidence and low-confidence categories based on the proportion of discernible beats and identifiable activation onsets, enabling focused analysis of difficult signal segments.
Integration of activation onset determination with physiologic properties
Defining time intervals for activation onsets based on prior activation timing and predetermined properties like action potential duration, conduction velocity, fiber orientation, and anatomical considerations.
Reconciliation and refinement of activation onsets
Advancing time intervals and reconciling selected activation onsets with adjacent beats to improve accuracy, including updating activation times based on comparisons across adjacent signals.
System assembly with multi-sensor catheter and computing device
A catheter comprising multiple sensors spatially associated with the heart, operatively coupled with a computing device that executes instructions to perform the signal classification, vector computation, time interval definition, and activation onset assignment.
Generation of clinical representations
Using the assigned activation onsets to generate clinical representations of the complex rhythm disorder to guide diagnosis and treatment.
Together, these inventive features provide a comprehensive computational and system approach for reconstructing cardiac signals from complex rhythm disorders by classifying signals, computing activation onsets even when signals are noisy or complex, and thereby identifying and localizing arrhythmia sources to guide targeted therapy.
Stated Advantages
The invention identifies and locates localized causes of complex cardiac rhythm disorders that prior art methods failed to detect, including rotors and focal sources.
It allows for targeted and minimally invasive treatment such as ablation, reducing the amount of tissue ablated and improving treatment success.
The system can analyze signals with multiple deflections and complex activation patterns by classifying signal quality and employing vector-based computations across sensors.
The invention facilitates real-time or offline analysis and can handle irregular activation sequences characteristic of disorders like atrial fibrillation.
Adaptive sensor configurations and electronic switching increase spatial resolution and effective coverage for accurate source identification.
Documented Applications
Detecting, diagnosing, and treating complex heart rhythm disorders including atrial fibrillation, ventricular tachycardia, and ventricular fibrillation via minimally invasive or surgical ablation targeting identified sources.
Identifying and localizing electrical rotors and focal beats as sources for these rhythm disorders within the heart chambers.
Applying the methods and systems to simpler rhythms such as focal atrial tachycardias, premature atrial and ventricular beats, and sinus node reentry to streamline diagnosis and treatment.
Using offline or stored data analysis to evaluate prior electrophysiologic studies and guide future treatment planning.
Potentially diagnosing and treating rhythm disorders of other biological systems involving electrical impulse generation or propagation, such as the brain (epilepsy), peripheral nervous system (tumors), skeletal muscle, and smooth muscle (gastrointestinal or genitourinary systems).
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