# US 11,076,914 B2 · Systems and methods for ablating tissue > Agents: this data is available as JSON from the patentgrep API and MCP server — see https://patentgrep.com/llms.txt - Number: US 11,076,914 B2 - Document ID: US11076914B2 - Status: Granted - Kind: B2 - Application number: 16/411,546 - Filed: 2019-05-14 - Published: 2019-08-29 - Granted: 2021-08-03 - Earliest claimed: 2014-10-30 - Assignees: Kardium Inc. - Applicants: Kardium Inc. - Inventors: Daniel Robert Weinkam; Daniel Martin Reinders; Darrell Anthony Harrington; Douglas Wayne Goertzen; Michael Hermann Weber - Web page: https://patentgrep.com/patent/US11076914B2 ## CPC - A61B 18/1492: {having a flexible, catheter-like structure, e.g. for heart ablation (A61B18/1477 takes precedence)} - A61B 5/283: Invasive - A61B 5/287: Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS] - A61B 5/339: Displays specially adapted therefor - A61B 5/349: Detecting specific parameters of the electrocardiograph cycle - A61B 5/352: Detecting R peaks, e.g. for synchronising diagnostic apparatus; Estimating R-R interval - A61B 5/4848: {Monitoring or testing the effects of treatment, e.g. of medication} - A61B 5/6853: {with a balloon} - A61B 5/6858: {with a distal basket, e.g. expandable basket} - A61B 5/7285: {for synchronizing or triggering a physiological measurement or image acquisition with a physiological event or waveform, e.g. an ECG signal} - A61B 5/743: {Displaying an image simultaneously with additional graphical information, e.g. symbols, charts, function plots} - A61B 5/7275: {Determining trends in physiological measurement data; Predicting development of a medical condition based on physiological measurements, e.g. determining a risk factor} - A61B 5/7445: {Display arrangements, e.g. multiple display units} - A61B 18/16: Indifferent or passive electrodes for grounding - A61B 2018/0016: {Energy applicators arranged in a two- or three dimensional array} - A61B 2018/00214: {Expandable means emitting energy, e.g. by elements carried thereon} - A61B 2018/0022: {Balloons} - A61B 2018/00267: {having a basket shaped structure} - A61B 2018/00351: {Heart} - A61B 2018/00357: {Endocardium} - A61B 2018/00577: {Ablation} - A61B 2018/00642: {with feedback, i.e. closed loop control} - A61B 2018/00839: {Bioelectrical parameters, e.g. ECG, EEG} - A61B 2018/00988: {Means for storing information, e.g. calibration constants, or for preventing excessive use, e.g. usage, service life counter} - A61B 2018/124: {switching the output to different electrodes, e.g. sequentially} - A61B 2090/061: {for measuring dimensions, e.g. length} - A61B 2505/05: Surgical care - A61N 1/056: {Transvascular endocardial electrode systems} - A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D) - 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) ## Abstract Intra-cardiac voltage data display systems display a plurality of data sets derived at least from intra-cardiac voltage data sampled by an electrode. In some embodiments, at least some of the data sets are derived from a portion of the intra-cardiac voltage data that excludes an excludable portion of the intra-cardiac voltage data having a relationship with an occurrence of a particular cardiac event to facilitate identification of the existence of a transmural lesion in tissue adjacent the electrode. In some embodiments, the particular cardiac event is the occurrence of an R wave in the cardiac cycle, and the excludable portion is a V wave in the cardiac cycle. ## Claims ### Claim 1 An intra-cardiac voltage data display system comprising: a data processing device system; an input-output device system communicatively connected to the data processing device system; and a memory device system communicatively connected to the data processing device system and storing a program executable by the data processing device system, the program comprising: data reception instructions configured to cause reception of intra-cardiac voltage data via the input-output device system, the intra-cardiac voltage data sampled by an electrode over a period of time comprising a plurality of cardiac cycles that includes at least a first cardiac cycle and a second cardiac cycle other than the first cardiac cycle, the second cardiac cycle occurring after the first cardiac cycle; display instructions configured to cause the input-output device system to display a plurality of data sets including a concurrently displayed first data set and a concurrently displayed second data set; and data derivation instructions configured to derive the first data set at least in part from the intra-cardiac voltage data sampled by the electrode during a first time in the first cardiac cycle, and from the intra-cardiac voltage data sampled by the electrode during a second time in the first cardiac cycle, the second time occurring after the first time, wherein the data derivation instructions are configured to derive the second data set only from particular data, the particular data excluding at least some of the intra-cardiac voltage data sampled by the electrode during the second time in the first cardiac cycle, and the particular data including at least some of the intra-cardiac voltage data sampled by the electrode during the first time in the first cardiac cycle and at least some of the intra-cardiac voltage data sampled by the electrode during the second cardiac cycle. ### Claim 2 (depends on 1) The intra-cardiac voltage display system of claim 1 wherein the data derivation instructions are configured to derive the first data set at least in part from at least part of the intra-cardiac voltage data sampled by the electrode during the second cardiac cycle. ### Claim 3 (depends on 1) The intra-cardiac voltage display system of claim 1 wherein the concurrently displayed first data set comprises at least a portion of an intra-cardiac electrogram. ### Claim 4 (depends on 1) The intra-cardiac voltage display system of claim 1 wherein the concurrently displayed first data set comprises at least a portion of a monophasic intra-cardiac electrogram. ### Claim 5 (depends on 3) The intra-cardiac voltage display system of claim 3 wherein the displayed portion of the intra-cardiac electrogram comprises a particular biphasic portion of the portion of the intra-cardiac electrogram derived from at least some of the intra-cardiac voltage data sampled by the electrode during the first cardiac cycle, and a particular monophasic portion of the portion of the intra-cardiac electrogram derived from the at least part of the intra-cardiac voltage data sampled by the electrode during the second cardiac cycle. ### Claim 6 (depends on 3) The intra-cardiac voltage display system of claim 3 wherein the displayed portion of the intra-cardiac electrogram comprises a first monophasic portion of the portion of the intra-cardiac electrogram derived from at least some of the intra-cardiac voltage data sampled by the electrode during the first cardiac cycle, and a second monophasic portion of the portion of the intra-cardiac electrogram derived from the at least part of the intra-cardiac voltage data sampled by the electrode during the second cardiac cycle. ### Claim 7 (depends on 6) The intra-cardiac voltage display system of claim 6 wherein an amplitude of the first monophasic portion of the portion of the intra-cardiac electrogram is greater than an amplitude of the second monophasic portion of the portion of the intra-cardiac electrogram. ### Claim 8 (depends on 2) The intra-cardiac voltage display system of claim 2 wherein the data derivation instructions are configured to derive the first data set at least in part from a particular portion of the intra-cardiac voltage data sampled by the electrode during the second cardiac cycle, and wherein the particular data excludes the particular portion of the intra-cardiac voltage data sampled by the electrode during the second cardiac cycle. ### Claim 9 (depends on 1) The intra-cardiac voltage display system of claim 1 wherein the particular data excludes a maximum absolute value of the intra-cardiac voltage data sampled by the electrode during the first cardiac cycle. ### Claim 10 (depends on 1) The intra-cardiac voltage display system of claim 1 wherein the particular data excludes at least some of a portion of the intra-cardiac voltage data sampled by the electrode during an occurrence of ventricular systole in the first cardiac cycle. ### Claim 11 (depends on 1) The intra-cardiac voltage display system of claim 1 wherein the concurrently displayed second data set includes data representative of a maximum absolute value of the intra-cardiac voltage data sampled by the electrode during the first time in the first cardiac cycle. ### Claim 12 (depends on 1) The intra-cardiac voltage display system of claim 1 wherein the concurrently displayed second data set includes data representative of a difference between two values of the intra-cardiac voltage data sampled by the electrode during the first time in the first cardiac cycle. ### Claim 13 (depends on 1) The intra-cardiac voltage display system of claim 1 wherein the concurrently displayed second data set includes data representative of a difference between a maximum value of the intra-cardiac voltage data sampled by the electrode during the first time in the first cardiac cycle and a minimum value of the intra-cardiac voltage data sampled by the electrode during the first time in the first cardiac cycle. ### Claim 14 (depends on 1) The intra-cardiac voltage display system of claim 1 wherein the concurrently displayed second data set includes data derived from (a) a minimum value of the intra-cardiac voltage data sampled by the electrode during the first time in the first cardiac cycle; (b) a maximum value of the intra-cardiac voltage data sampled by the electrode during the first time in the first cardiac cycle; or both (a) and (b). ### Claim 15 (depends on 1) The intra-cardiac voltage display system of claim 1 wherein the concurrently displayed second data set comprises first data representative of a difference between two values of the intra-cardiac voltage data sampled by the electrode during the first cardiac cycle and second data representative of a difference between two values of the intra-cardiac voltage data sampled by the electrode during the second cardiac cycle. ### Claim 16 (depends on 1) The intra-cardiac voltage display system of claim 1 wherein the program comprises activation instructions configured to cause a transmission of energy sufficient for tissue ablation at least during the sampling of the intra-cardiac voltage data by the electrode during each of at least the first cardiac cycle and the second cardiac cycle. ### Claim 17 (depends on 16) The intra-cardiac voltage display system of claim 16 wherein the concurrently displayed first data set comprises at least a portion of an intra-cardiac electrogram. ### Claim 18 (depends on 17) The intra-cardiac voltage display system of claim 17 wherein the program comprises: identification instructions configured to identify a duration from a time from a start of the tissue ablation to a time of a maximum voltage peak in at least the portion of the intra-cardiac electrogram; tissue thickness determination instructions configured to determine a thickness of tissue subject to the tissue ablation based at least upon a comparison of the identified duration with a predetermined threshold; and thickness indication instructions configured to output a tissue-thickness indication via the input-output device system indicating a result of the determination of the thickness of the tissue. ### Claim 19 (depends on 16) The intra-cardiac voltage display system of claim 16 wherein the program comprises: identification instructions configured to identify a duration from a time from a start of the tissue ablation to a time of a maximum voltage peak in at least a portion of the second data set; tissue thickness determination instructions configured to determine a thickness of tissue subject to the tissue ablation based at least upon a comparison of the identified duration with a predetermined threshold; and thickness indication instructions configured to output a tissue-thickness indication via the input-output device system indicating a result of the determination of the thickness of the tissue. ### Claim 20 (depends on 16) The intra-cardiac voltage display system of claim 16 wherein the program comprises: identification instructions configured to identify a curve-slope from a time of a maximum voltage peak in at least a portion of the second data set to a time indicating a beginning of a pre-plateau transitional region in at least the portion of the second data set; tissue thickness determination instructions configured to determine a thickness of tissue subject to the tissue ablation based at least upon a comparison of the identified curve-slope with a predetermined curve-slope; and thickness indication instructions configured to output a tissue-thickness indication via the input-output device system indicating a result of the determination of the thickness of the tissue. ### Claim 21 (depends on 1) The intra-cardiac voltage display system of claim 1 wherein the display instructions are configured to cause the input-output device system to concurrently display the second data set at least by displaying (a) the data included in the second data set and derived at least in part from the at least some of the intra-cardiac voltage data sampled by the electrode during the second cardiac cycle sequentially after (b) the data included in the second data set and derived at least in part from the intra-cardiac voltage data sampled by the electrode during the first time in the first cardiac cycle while continuing to display (b) to cause both (a) and (b) to be concurrently displayed. ### Claim 22 (depends on 1) The intra-cardiac voltage display system of claim 1 wherein the display instructions are configured to cause the input-output device system to display an intra-cardiac electrogram concurrently with at least the concurrently displayed second data set, the intra-cardiac electrogram derived from at least a portion of the intra-cardiac voltage data sampled by the electrode, and the intra-cardiac electrogram undergoing a biphasic to monophasic transformation during the display of the concurrently displayed second data set. ### Claim 23 (depends on 1) The intra-cardiac voltage display system of claim 1 wherein the display instructions are configured to cause the input-output device system to display a monophasic intra-cardiac electrogram concurrently with at least the concurrently displayed second data set, the monophasic intra-cardiac electrogram comprising a plurality of portions, each portion of the monophasic intra-cardiac electrogram corresponding to a respective particular cardiac event occurring in a respective one of the plurality of cardiac cycles, the particular cardiac events being a same cardiac event, and amplitudes of the particular cardiac events, as represented in the monophasic intra-cardiac electrogram by the plurality of portions, decreasing over a span including at least the first cardiac cycle and the second cardiac cycle. ### Claim 24 (depends on 1) The intra-cardiac voltage display system of claim 1 wherein the program comprises: cardiac event identification instructions configured to identify a respective occurrence of a particular cardiac event in each respective one of the plurality of cardiac cycles; and data identification instructions configured to identify, for each respective one of the plurality of cardiac cycles, a particular portion of the intra-cardiac voltage data sampled during the respective one of the plurality of cardiac cycles, each particular portion of the intra-cardiac voltage data sampled by the electrode during the respective one of the plurality of cardiac cycles comprising some but not all of the intra-cardiac voltage data sampled by the electrode during the respective one of the plurality of cardiac cycles, each particular portion of the intra-cardiac voltage data identified in accordance with a predetermined temporal relationship with the occurrence of the particular cardiac event identified in the respective one of the plurality of cardiac cycles, and wherein the particular data excludes at least some of each identified particular portion of the intra-cardiac voltage data sampled by the electrode during the respective one of the first cardiac cycle and the second cardiac cycle. ### Claim 25 (depends on 1) The intra-cardiac voltage display system of claim 1 wherein the display instructions are configured to cause the input-output device system to concurrently display the concurrently displayed first data set and the concurrently displayed second data set. ### Claim 26 (depends on 1) The intra-cardiac voltage display system of claim 1 wherein the display instructions are configured to cause the input-output device system to display the concurrently displayed first data set and the concurrently displayed second data set in a superimposed configuration. ### Claim 27 (depends on 1) The intra-cardiac voltage display system of claim 1 wherein each of the plurality of data sets comprises a respective one of a plurality of voltage magnitude sets. ### Claim 28 (depends on 27) The intra-cardiac voltage display system of claim 27 wherein each respective one of the plurality of voltage magnitude sets is frequency-weighted. ### Claim 29 (depends on 1) The intra-cardiac voltage display system of claim 1 wherein the intra-cardiac voltage data is sampled by the electrode while the electrode is positioned at a same location in an intra-cardiac cavity during each of the plurality of cardiac cycles in the period of time. ### Claim 30 An intra-cardiac voltage data display system comprising: a data processing device system; an input-output device system communicatively connected to the data processing device system; and a memory device system communicatively connected to the data processing device system and storing a program executable by the data processing device system, wherein the data processing device system is configured by the program at least to: receive intra-cardiac voltage data via the input-output device system, the intra-cardiac voltage data sampled by an electrode over a period of time comprising a plurality of cardiac cycles that include at least a first cardiac cycle and a second cardiac cycle other than the first cardiac cycle, the second cardiac cycle occurring after the first cardiac cycle; cause the input-output device system to display a plurality of data sets including a concurrently displayed first data set and a concurrently displayed second data set; derive the first data set at least in part from the intra-cardiac voltage data sampled by the electrode during a first time in the first cardiac cycle, and from the intra-cardiac voltage data sampled by the electrode during a second time in the first cardiac cycle, the second time occurring after the first time; and derive the second data set only from particular data, the particular data excluding at least some of the intra-cardiac voltage data sampled by the electrode during the second time in the first cardiac cycle, and the particular data including at least some of the intra-cardiac voltage data sampled by the electrode during the first time in the first cardiac cycle and at least some of the intra-cardiac voltage data sampled by the electrode during the second cardiac cycle. ### Claim 31 An intra-cardiac voltage data display method executed by a data processing device system according to a program stored by a memory device system communicatively connected to the data processing device system, the data processing device system further communicatively connected to an input-output device system, and the method comprising: receiving intra-cardiac voltage data via the input-output device system, the intra-cardiac voltage data sampled by an electrode over a period of time comprising a plurality of cardiac cycles that include at least a first cardiac cycle and a second cardiac cycle other than the first cardiac cycle, the second cardiac cycle occurring after the first cardiac cycle; causing the input-output device system to display a plurality of data sets including a concurrently displayed first data set and a concurrently displayed second data set; deriving the first data set at least in part from the intra-cardiac voltage data sampled by the electrode during a first time in the first cardiac cycle, and from the intra-cardiac voltage data sampled by the electrode during a second time in the first cardiac cycle, the second time occurring after the first time; and deriving the second data set only from particular data, the particular data excluding at least some of the intra-cardiac voltage data sampled by the electrode during the second time in the first cardiac cycle, and the particular data including at least some of the intra-cardiac voltage data sampled by the electrode during the first time in the first cardiac cycle and at least some of the intra-cardiac voltage data sampled by the electrode during the second cardiac cycle. ### Claim 32 One or more non-transitory computer-readable storage mediums storing a program executable by one or more data processing devices of a data processing device system communicatively connected to an input-output device system, the program comprising: data reception instructions configured to cause reception of intra-cardiac voltage data via the input-output device system, the intra-cardiac voltage data sampled by an electrode over a period of time comprising a plurality of cardiac cycles that include at least a first cardiac cycle and a second cardiac cycle other than the first cardiac cycle, the second cardiac cycle occurring after the first cardiac cycle; display instructions configured to cause the input-output device system to display a plurality of data sets including a concurrently displayed first data set and a concurrently displayed second data set; and data derivation instructions configured to derive the first data set at least in part from the intra-cardiac voltage data sampled by the electrode during a first time in the first cardiac cycle, and from the intra-cardiac voltage data sampled by the electrode during a second time in the first cardiac cycle, the second time occurring after the first time, wherein the data derivation instructions are configured to derive the second data set only from particular data, the particular data excluding at least some of the intra-cardiac voltage data sampled by the electrode during the second time in the first cardiac cycle, and the particular data including at least some of the intra-cardiac voltage data sampled by the electrode during the first time in the first cardiac cycle and at least some of the intra-cardiac voltage data sampled by the electrode during the second cardiac cycle.