Medical apparatus for diagnostic and site determination of cardiac arrhythmias and methods

A method for improved detection of fractionated signals for site determination of cardiac arrhythmias within a heart of a subject comprising:

• receiving, recording, and processing electrocardiogram (ECG) signals in the form of bipolar and unipolar ECGs associated with respective cardiac tissue locations based on sensing locations of respective distal end sensors and electrodes of a catheter;
• with respect to a cardiac tissue area of study for which unipolar ECGs are recorded that include signals from a plurality of successive heartbeats corresponding to locations within the cardiac tissue area of study, detecting the fractionated signals comprising Fractionated Unipolar ECG Signal Complexes (FUESCs) from among the unipolar ECGs by:
• determining bipolar activity windows from a bipolar ECG comprising a first unipolar ECG and a second unipolar ECG and defining a series of complexes of the first unipolar ECG that each correspond to a respective bipolar activity window;
• determining a plurality of complex level parameters with respect to the complexes of the first unipolar ECG with respect to a plurality of successive bipolar activity windows;
• calculating a plurality of complex level ratings based on at least one of the plurality of complex level parameters;
• calculating a quality of annotation measurement (QoA) with respect to the complexes of the first unipolar ECG using a plurality of parameters that include at least one of the plurality of complex level parameters and at least one of the plurality of complex level ratings;
• determining an evidence annotation measurement (EVI) with respect to the complexes of the first unipolar ECG using at least one of the plurality of complex level parameters and at least one of the plurality of complex level ratings;
• and
• calculating a final score with respect to the complexes of the first unipolar ECG based on the QoA and the EVI of each complex such that a complex of the first unipolar ECG is determined to be a FUESC upon a condition that its final score is at least a predetermined threshold;
• and
• wherein the FUESCs are automatically identified, based upon the detection of the fractionated signals, for the site determination of the cardiac arrhythmias for treatment by ablation, as a cardiac tissue site that includes respective locations corresponding to a predetermined number of unipolar ECGs that include a predetermined number of FUESCs, and
• responsive to the determination of said cardiac tissue site, controlling and delivering ablation energy to the cardiac tissue site via the catheter.

A tangible non-transitory computer-readable medium in which program instructions are stored for improved detection of fractionated signals for site determination of cardiac arrhythmias, which, when read by a processor, cause the processor to:

• process electrocardiogram (ECG) signals in the form of bipolar and unipolar ECGs associated with respective cardiac tissue locations based on sensing locations of respective distal end sensors and electrodes of a catheter;
• with respect to unipolar ECGs of a cardiac tissue area of study that include signals from a plurality of successive heartbeats corresponding to locations within the cardiac tissue area of study, detect the fractionated signals comprising Fractionated Unipolar ECG Signal Complexes (FUESCs) from among the unipolar ECGs by:
• determining bipolar activity windows from a bipolar ECG comprising a first unipolar ECG and a second unipolar ECG and defining a series of complexes of the first unipolar ECG that each correspond to a respective bipolar activity window;
• determining a plurality of complex level parameters with respect to the complexes of the first unipolar ECG with respect to a plurality of successive bipolar activity windows;
• calculating a plurality of complex level ratings based on at least one of the plurality of complex level parameters;
• calculating a quality of annotation measurement (QoA) with respect to the complexes of the first unipolar ECG using a plurality of parameters that include at least one of the plurality of complex level parameters and at least one of the plurality of complex level ratings;
• determining an evidence annotation measurement (EVI) with respect to the complexes of the first unipolar ECG using at least one of the plurality of complex level parameters and at least one of the plurality of complex level ratings;
• and
• calculating a final score with respect to the complexes of the first unipolar ECG based on the QoA and the EVI of each complex such that a complex of the first unipolar ECG is determined to be a FUESC upon a condition that its final score is at least a predetermined threshold;
• and
• a wherein the FUESCs are automatically identified, based upon the detection of the fractionated signals, for the site determination of the cardiac arrhythmias for treatment by ablation, as a cardiac tissue site that includes respective locations corresponding to a predetermined number of unipolar ECGs that include a predetermined number of FUESCs, and
• responsive to the determination of said cardiac tissue site, controlling and delivering ablation energy to the cardiac tissue site via the catheter.