# US 11,439,357 B2 · Integrated assessment of electrical activation and myocardial strain

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- Number: US 11,439,357 B2
- Document ID: US11439357B2
- Status: Granted
- Kind: B2
- Application number: 16/774,325
- Filed: 2020-01-28
- Published: 2020-05-21
- Granted: 2022-09-13
- Earliest claimed: 2017-06-05
- Assignees: Biosense Webster (Israel) Ltd.
- Applicants: Biosense Webster (Israel) Ltd.
- Inventors: Francesco Maffessanti; Angelo Auricchio; Hanspeter Fischer; Frits W. Prinzen
- Web page: https://patentgrep.com/patent/US11439357B2

## CPC

- A61B 5/7282: {Event detection, e.g. detecting unique waveforms indicative of a medical condition (cough events A61B5/0823; seizures A61B5/4094; sleep apnoea A61B5/4818)}
- A61B 5/062: {using magnetic field}
- A61B 5/1104: {induced by stimuli or drugs (A61B5/1102 takes precedence)}
- A61B 5/1107: {Measuring contraction of parts of the body, e.g. organ or muscle}
- A61B 5/283: Invasive
- A61B 5/6852: {Catheters}
- G16H 20/40: relating to mechanical, radiation or invasive therapies, e.g. surgery, laser therapy, dialysis or acupuncture
- G16H 40/63: for local operation
- G16H 50/20: for computer-aided diagnosis, e.g. based on medical expert systems
- G16H 20/17: delivered via infusion or injection
- G16H 30/20: for handling medical images, e.g. DICOM, HL7 or PACS
- G16H 40/20: for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms
- A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D)
- G16H: HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA

## Abstract

A method for anatomical diagnosis includes measuring, using a catheter that includes a position sensor and an electrode, over multiple cycles of a beating heart, electrical activity and mechanical motion at a plurality of locations contacted by the catheter on a heart wall within a chamber of the heart. Based on the measured mechanical motion, a magnitude of a mechanical strain is computed over the cycles at the locations. In one embodiment, the computed strain is used in identifying a group of the locations at which the magnitude of the mechanical strain is below a predefined strain threshold and a voltage of the electrical activity is below a predefined voltage threshold as a locus of scar tissue. In another embodiment, a pathological condition of the heart is identified based on a characteristic of the mechanical strain computed over the left ventricle during the diastolic phase.

## Claims

### Claim 1

A method for treating a pathological condition in a heart, comprising:
measuring, using a catheter comprising a position sensor and an electrode, over multiple cycles of a beating heart, mechanical motion and electrical signals at a plurality of locations on a heart wall within a left ventricle of the heart;
based on the mechanical motion, computing a mechanical strain of a diastolic phase of at least one of the cycles;
based on the electrical signals, determining an electrical activity of the heart;
identifying a pathological condition of the heart based on the electrical activity and the mechanical strain;
identifying loci of viable tissue based on the electrical activity and the mechanical strain; and
placing at least one pacing electrode or injecting a therapeutic substance in the loci of viable tissue.

### Claim 2 (depends on 1)

The method according to claim 1, wherein the step of measuring the mechanical motion comprises measuring trajectories of the plurality of locations while a distal end of the catheter is held in contact with the heart wall at each of the plurality of locations, and
wherein the step of computing the mechanical strain comprises calculating, based on the trajectories, changes in distance between neighboring locations of the plurality of locations over the cycles of the heart.

### Claim 3 (depends on 2)

The method according to claim 2, wherein the step of calculating the changes in distance comprises determining a first distance between coordinates of the plurality of locations measured during a diastolic phase of the heart and a second distance between the coordinates measured during a systolic phase of the heart, and calculating a difference between the first distance and the second distance.

### Claim 4 (depends on 2)

The method according to claim 2, wherein the mechanical strain comprises a circumferential strain, a longitudinal strain, or an area strain.

### Claim 5 (depends on 1)

The method according to claim 1, wherein the step of identifying the pathological condition comprises finding, based on the mechanical strain, a difference between a time of maximal local strain and a time of maximal global volume of the left ventricle.

### Claim 6 (depends on 1)

The method according to claim 1, wherein the step of identifying the pathological condition comprises calculating, based on the mechanical strain, a fraction of the diastolic phase during which the left ventricle is relaxing.

### Claim 7 (depends on 1)

The method according to claim 1, further comprising determining a time of activation of the heart wall in the left ventricle from the electrical activity, and
wherein the step of identifying the pathological condition comprises comparing a maximal relaxation of the left ventricle and the mechanical strain at the time of activation.

### Claim 8

A method for anatomical diagnosis, comprising:
measuring, using a catheter comprising a position sensor, over multiple cycles of a beating heart, mechanical motion at a plurality of locations contacted by the catheter on a heart wall within a left ventricle of the heart;
based on the measured mechanical motion, computing a mechanical strain at a diastolic phase of the cycles at the locations; and
identifying a group of the locations at which a peak timing of the mechanical strain is not synchronous.

### Claim 9 (depends on 8)

The method according to claim 8, and comprising measuring an intracardiac pressure in the left ventricle, and applying the measured intracardiac pressure, together with the mechanical strain, in diagnosing a pathological condition of the heart.

### Claim 10

A system for treating a pathological condition in a heart, comprising:
a catheter having a distal end configured for insertion into a chamber of a beating heart, the catheter comprising a position sensor and an electrode;
a display; and
a processor, which is configured to:
receive position signals from the position sensor over multiple cycles of the beating heart, from a plurality of locations contacted by the catheter on a heart wall within a left ventricle of the heart,
receive electrical signals from the electrode over multiple cycles of the beating heart, from the plurality of locations,
compute, based on the position signals, a mechanical strain at a diastolic phase of the multiple cycles,
determine, based on the electrical signals, an electrical activity of the heart,
identify, based on the mechanical strain and the electrical activity, a feature of diagnostic interest; and
display the feature of diagnostic interest on the display.

### Claim 11 (depends on 10)

The system according to claim 10, wherein the processor is further configured to compute, using the position signals, trajectories of the plurality of locations while the catheter is held in contact with the heart wall at each of the plurality of locations, and to compute the mechanical strain by calculating, based on the trajectories, changes in distance between neighboring locations of the plurality of locations over the cycles of the heart.

### Claim 12 (depends on 11)

The system according to claim 11, wherein the processor is further configured to compute a first distance between coordinates of the plurality of locations measured during a diastolic phase of the heart and a second distance between the coordinates measured during a systolic phase of the heart, and a difference between the first distance and the second distance.

### Claim 13 (depends on 11)

The system according to claim 11, wherein the mechanical strain comprises a circumferential strain, a longitudinal strain, or an area strain.

### Claim 14 (depends on 10)

The system according to claim 10, wherein the processor is further configured to find, based on the mechanical strain, a difference between a time of a maximal local strain and a time of a maximal global volume of the left ventricle.

### Claim 15 (depends on 10)

The system according to claim 10, wherein the processor is further configured to calculate, based on the mechanical strain, a fraction of the diastolic phase during which the left ventricle is relaxing.

### Claim 16 (depends on 10)

The system according to claim 10, wherein the processor is further configured to determine, based on the electrical activity, a time of activation of the heart wall in the left ventricle.

### Claim 17 (depends on 10)

The system according to claim 10, wherein the feature of diagnostic interest includes a scar.

### Claim 18

A computer software product, comprising a non-transitory computer-readable medium in which program instructions are stored, which instructions, when read by a computer, cause the computer to receive signals output by a catheter having a distal end inserted into a chamber of a beating heart and including a position sensor and an electrode, and to determine, responsively to position signals received from the position sensor and electrical signals received from the electrode over multiple cycles of the beating heart, mechanical motion at a plurality of locations contacted by the catheter on a heart wall within a left ventricle of the heart and electrical activity of the heart, and to compute, based on the mechanical motion, a mechanical strain at a diastolic phase of the cycles at the locations, and to identify a pathological condition of the heart based on the electrical activity and the mechanical strain.