# US 11,027,135 B2 · Assessing intra-cardiac activation patterns

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- Number: US 11,027,135 B2
- Document ID: US11027135B2
- Status: Granted
- Kind: B2
- Application number: 15/966,523
- Filed: 2018-04-30
- Published: 2018-08-30
- Granted: 2021-06-08
- Earliest claimed: 2011-05-03
- Assignees: Medtronic, Inc.
- Applicants: Medtronic, Inc.
- Inventors: Subham Ghosh; Jeffrey M. Gillberg; Robert W. Stadler
- Web page: https://patentgrep.com/patent/US11027135B2

## CPC

- A61N 1/3684: {for stimulating the heart at multiple sites of the ventricle or the atrium}
- A61B 5/02: Detecting, measuring or recording for evaluating the cardiovascular system, e.g. pulse, heart rate, blood pressure or blood flow
- A61B 5/05: Detecting, measuring or recording for diagnosis by means of electric currents or magnetic fields; Measuring using microwaves or radio waves (measuring movement of the entire body or parts thereof A61B5/11; detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof A61B5/24)
- A61B 5/282: Holders for multiple electrodes (for introduction into the body A61B5/287)
- A61B 5/339: Displays specially adapted therefor
- A61B 5/349: Detecting specific parameters of the electrocardiograph cycle
- A61B 5/367: Electrophysiological study [EPS], e.g. electrical activation mapping or electro-anatomical mapping
- A61B 5/742: {using visual displays (displays for heart-related electrical signals, e.g. ECG, A61B5/339)}
- A61N 1/0476: {Array electrodes (including any electrode arrangement with more than one electrode for at least one of the polarities)}
- A61N 1/0484: {Garment electrodes worn by the patient}
- A61N 1/3627: {for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy}
- A61N 1/3682: {with a variable atrioventricular delay}
- A61N 1/36842: {Multi-site stimulation in the same chamber}
- A61N 1/36843: {Bi-ventricular stimulation}
- A61N: ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY (measurement of bioelectric currents A61B; surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body A61B18/00; anaesthetic apparatus in general A61M; incandescent lamps H01K; infrared radiators for heating H05B)
- A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D)

## Abstract

Techniques for evaluating cardiac electrical dyssynchrony are described. In some examples, an activation time is determined for each of a plurality of torso-surface potential signals. The dispersion or sequence of these activation times may be analyzed or presented to provide variety of indications of the electrical dyssynchrony of the heart of the patient. In some examples, the locations of the electrodes of the set of electrodes, and thus the locations at which the torso-surface potential signals were sensed, may be projected on the surface of a model torso that includes a model heart. The inverse problem of electrocardiography may be solved to determine electrical activation times for regions of the model heart based on the torso-surface potential signals sensed from the patient.

## Claims

### Claim 1

A system comprising:
a display; and
a processing unit configured to:
receive torso-surface potential signals from a plurality of electrodes, wherein the received torso-surface potential signals comprise torso-surface potential signals sensed during delivery of cardiac therapy to a patient in accordance with a plurality of different therapy parameter settings,
for each therapy parameter setting, determine, for each electrode of the plurality of electrodes, a torso-surface activation time based on the torso-surface potential signal sensed from the respective electrode during delivery of cardiac therapy in accordance with the respective therapy parameter setting, and
present, via the display, indications of the torso-surface activation times for the plurality of therapy parameter settings.

### Claim 2 (depends on 1)

The system of claim 1, wherein the plurality of therapy parameter settings comprises a plurality of electrode positions.

### Claim 3 (depends on 1)

The system of claim 1, wherein the plurality of therapy parameter settings comprises a plurality of electrode configurations.

### Claim 4 (depends on 1)

The system of claim 1, wherein each therapy parameter setting of the plurality of therapy parameter settings defines a timing of pacing pulses.

### Claim 5 (depends on 1)

The system of claim 1, wherein the cardiac therapy comprises cardiac resynchronization therapy.

### Claim 6 (depends on 1)

The system of claim 1, wherein the processing unit is configured to present the indications of the torso-surface activation times by at least presenting a graphical indication of the torso-surface activation times via the display.

### Claim 7 (depends on 6)

The system of claim 6, wherein the graphical indication comprises an activation map.

### Claim 8 (depends on 7)

The system of claim 7, wherein the activation map comprises an isochrone map.

### Claim 9 (depends on 8)

The system of claim 8, wherein the isochrone map comprises graded colors, wherein each color represents a degree of electrical dyssynchrony of a heart of the patient.

### Claim 10 (depends on 7)

The system of claim 7, wherein the activation map comprises a three-dimensional map that indicates electrical activity over a surface of a torso or a heart.

### Claim 11 (depends on 6)

The system of claim 6, wherein the graphical indication comprises an animation of electrical activation of a heart.

### Claim 12 (depends on 1)

The system of claim 1, wherein the processing unit is configured to present the indications of the torso-surface activation times by at least displaying indices indicative of a temporal distribution of the torso-surface activation times via the display.

### Claim 13 (depends on 1)

The system of claim 1, wherein the processing unit is configured to present the indications of the torso-surface activation times by at least presenting indices indicative of a spatial distribution of the torso-surface activation times via the display.

### Claim 14 (depends on 1)

The system of claim 1, wherein the processing unit is configured to determine at least one index of electrical dyssynchrony of the heart based on the torso-surface activation times, and present the indications of the torso-surface activation times by at least presenting the at least one index of electrical dyssynchrony via the display.

### Claim 15 (depends on 1)

The system of claim 1, further comprising the plurality of electrodes.

### Claim 16

A system comprising:
a plurality of electrodes; and
a processing unit configured to:
receive a torso-surface potential signal from each electrode of the plurality of electrodes, wherein the received torso-surface potential signals comprise torso-surface potential signals sensed during delivery of cardiac therapy to a patient in accordance with each therapy parameter setting of a plurality of different therapy parameter settings,
for each therapy parameter setting, determine, for each electrode of the plurality of electrodes, a torso-surface activation time based on the torso-surface potential signal sensed from the respective electrode during delivery of cardiac therapy in accordance with the respective therapy parameter setting, and
present, via a display, indications of the torso-surface activation times for the plurality of therapy parameter settings.

### Claim 17 (depends on 16)

The system of claim 16, wherein the processing unit is configured to present the indications of the torso-surface activation times by at least presenting a graphical indication of the torso-surface activation times via the display.

### Claim 18 (depends on 16)

The system of claim 16, wherein the processing unit is configured to determine at least one index of electrical dyssynchrony of the heart based on the torso-surface activation times, and present the indications of the torso-surface activation times by at least presenting the at least one index of electrical dyssynchrony via the display.

### Claim 19

A method comprising:
receiving, by a processing unit, torso-surface potential signals from a plurality of electrodes distributed on a torso of a patient, wherein the received torso-surface potential signals comprise torso-surface potential signals sensed during delivery of cardiac therapy to the patient in accordance with a plurality of different therapy parameter settings;
for each therapy parameter setting, determining, by the processing unit and for each electrode of the plurality of electrodes, a torso-surface activation time based on the torso-surface potential signal sensed from the respective electrode during delivery of cardiac therapy in accordance with the respective therapy parameter setting; and
presenting, by the processing unit, indications of the torso-surface activation times for the plurality of therapy parameter settings via a display.

### Claim 20 (depends on 19)

The method of claim 19, wherein the plurality of therapy parameter settings comprises a plurality of electrode positions within a heart of a patient.

### Claim 21 (depends on 19)

The method of claim 19, wherein the plurality of therapy parameter settings comprises a plurality of electrode configurations.

### Claim 22 (depends on 19)

The method of claim 19, wherein each therapy parameter setting of the plurality of therapy parameter settings defines a timing of pacing pulses delivered to a heart of the patient.

### Claim 23 (depends on 19)

The method of claim 19, wherein the cardiac therapy comprises cardiac resynchronization therapy.

### Claim 24 (depends on 19)

The method of claim 19, wherein presenting the indications of the torso-surface activation times comprises presenting a graphical indication of the torso-surface activation times via the display.

### Claim 25 (depends on 24)

The method of claim 24, wherein the graphical indication comprises an activation map.

### Claim 26 (depends on 25)

The method of claim 25, wherein the activation map comprises an isochrone map.

### Claim 27 (depends on 26)

The method of claim 26, wherein the isochrone map comprises graded colors, wherein each color represents a degree of electrical dyssynchrony of a heart of the patient.

### Claim 28 (depends on 26)

The method of claim 26, wherein the activation map comprises a three-dimensional map that indicates electrical activity over a surface of a torso or a heart.

### Claim 29 (depends on 25)

The method of claim 25, wherein the graphical indication comprises an animation of electrical activation.

### Claim 30 (depends on 19)

The method of claim 19, wherein displaying indications of the torso-surface activation times comprises displaying indices indicative of a temporal distribution or a spatial distribution of the torso-surface activation times.