System and method for reconstructing cardiac activation information
Inventors
Narayan, Sanjiv • Briggs, Carey Robert
Assignees
US Department of Veterans Affairs • Topera Inc • University of California San Diego UCSD
Publication Number
US-9398883-B2
Publication Date
2016-07-26
Expiration Date
2031-08-24
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Abstract
An example method of representing cardiac information associated with a heart rhythm disorder includes accessing a plurality of neighboring cardiac signals obtained from a patient. The method also includes eliminating far-field activations from the plurality of neighboring cardiac signals using one or more divergence criteria that define local activations in the plurality of neighboring cardiac signals, the divergence criteria being associated with divergence among the plurality of neighboring cardiac signals. The method further includes constructing a clinical representation of local activations in the plurality of neighboring cardiac signals.
Core Innovation
The invention relates to a system and method for reconstructing cardiac activation information, specifically activation onset times associated with heart rhythm disorders. It addresses the challenge of identifying local electrical activations in complex heart rhythm disorders where signals are characterized by multiple deflections and superimposed far-field activations. Conventional methods fail with complex rhythm disorders like atrial fibrillation, ventricular fibrillation, and polymorphic ventricular tachycardia because activation patterns change beat to beat and lack identifiable earliest activation sites.
The method involves accessing a plurality of neighboring cardiac signals from a patient and eliminating far-field activations using one or more divergence criteria associated with divergence among the neighboring signals. By analyzing pairs of cardiac signals and detecting points of change in their derivatives beyond a threshold, local activation onsets can be assigned. This reconstruction enables the accurate identification of sources or causes of complex heart rhythm disorders, which can facilitate effective targeted treatment such as ablation.
Claims Coverage
The claims include two independent claims covering methods to process cardiac information and to treat heart rhythm disorders by reconstructing local activations from cardiac signals.
Method of processing cardiac information by eliminating far-field activations to identify local activations
Accessing a plurality of neighboring cardiac signals obtained from a patient; eliminating far-field activations from these signals using divergence criteria associated with divergence among the signals; and constructing a clinical representation of the local activations.
Determination of activation onset based on divergence of derivatives in signal pairs
Processing pairs of cardiac signals to determine a point of change where a derivative of one signal diverges with respect to the derivative of the other; assigning an activation onset time at this point to define local activation; using various orders of derivatives; evaluating slope, amplitude, timing, and shape; optionally forming a composite signal; selecting points with the largest ratio values representing divergence above a noise threshold.
Iterative processing of multiple pairs of cardiac signals to define multiple local activations and construct clinical representation
Iteratively accessing pairs of cardiac signals, performing processing and assigning for each pair to identify multiple local activations in a first signal across pairs; constructing the clinical representation based on these activations to indicate the source of a cardiac rhythm disorder; and optionally presenting the clinical representation to facilitate treatment.
Divergence criteria include signal characteristics and repeatability to differentiate local and far-field activations
The divergence criteria comprise signal divergence among neighboring signals, signal amplitude or voltage, cycle length (rate), upstroke velocity (dV/dt), frequency components, and signal repeatability over time.
Method of treating heart rhythm disorder using reconstructed local activations
Accessing neighboring cardiac signals, eliminating far-field activations using divergence criteria to identify local activations, constructing a clinical representation of these local activations, and using this representation to treat the heart rhythm disorder.
The independent claims collectively cover methods for reconstructing local cardiac activation by eliminating far-field signals through derivative divergence analysis of paired cardiac signals, constructing clinical representations such as rotors or focal sources, and applying this information to treat heart rhythm disorders effectively.
Stated Advantages
Ability to reliably identify and represent local activation by eliminating far-field activations, enabling accurate detection of rotor and focal sources associated with complex rhythm disorders.
Facilitation of direct targeting of the sources for therapy, improving treatment outcomes.
Capability to reconstruct cardiac activation information rapidly while a sensing device is in or near the patient, enabling immediate treatment.
Requires relatively few steps to reconstruct activation onset times amid complex and indiscernible activation patterns.
Documented Applications
Reconstruction of cardiac activation information associated with heart rhythm disorders, including complex rhythm disorders such as atrial fibrillation (AF), ventricular fibrillation (VF), and polymorphic ventricular tachycardia (VT).
Identification and localization of sources or causes of heart rhythm disorders to guide treatment, particularly ablation of cardiac tissue to ameliorate or cure the disorder.
Treatment of heart rhythm disorders using the clinical representation constructed from reconstructed local activations.
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