Method and determination of cardiac activation from electrograms with multiple deflections

A medical system, comprising:

• a medical device including a plurality of electrodes;
• a control unit in communication with the plurality of electrodes, the control unit operable to:
• transmit radiofrequency energy between the plurality of electrodes when the plurality of electrodes is positioned proximate a target tissue region;
• record an electrogram signal from the plurality of electrodes proximate the target tissue region;
• count a number of deflections in the recorded electrogram signal for a predetermined amount of time;
• identify a deflection time for each of the counted number of deflections;
• identify a most negative slope between each of the identified deflections times;
• correlate each of the identified most negative slopes to a possible activation time;
• associate each possible activation time to a corresponding electrode from the plurality of electrodes;
• calculate a spatial voltage gradient at each corresponding electrode for each possible activation time;
• identify the greatest spatial voltage gradient;
• and
• correlate the greatest spatial voltage gradient to an activation time.

A medical system, comprising:

• a medical device including a plurality of electrodes spaced substantially equidistant from an adjacent electrode;
• a control unit in communication with the plurality of electrodes, the control unit operable to:
• transmit radiofrequency energy between the plurality of electrodes when the plurality of electrodes are positioned proximate cardiac tissue;
• record an electrogram signal from the plurality of electrodes proximate the target tissue region;
• count a number of deflections with a negative slope in the recorded electrogram signal for a predetermined amount of time;
• identify a deflection time for each of the counted number of deflections;
• identify a most negative slope between each of the identified deflections times;
• correlate each of the identified most negative slopes to a possible activation time;
• associate each possible activation time to a corresponding electrode from the plurality of electrodes;
• calculate a spatial voltage gradient at each corresponding electrode for each possible activation time;
• identify the greatest spatial voltage gradient;
• and
• correlate the greatest spatial voltage gradient to an activation time.