# US 2018/0020916 A1 · Systems, Devices, Components and Methods for Detecting the Locations of Sources of Cardiac Rhythm Disorders in a Patient's Heart

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- Number: US 2018/0020916 A1
- Document ID: US20180020916A1
- Status: Published application
- Kind: A1
- Application number: 15/548,671
- Filed: 2016-09-07
- Published: 2018-01-25
- Earliest claimed: 2015-09-07
- Assignees: Ablacon Inc.
- Applicants: Ablacon Inc.
- Inventors: Peter Ruppersberg
- Web page: https://patentgrep.com/patent/US20180020916A1

## CPC

- A61B 5/0006: {ECG or EEG signals}
- A61B 5/287: Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
- A61B 5/327: Generation of artificial ECG signals based on measured signals, e.g. to compensate for missing leads
- A61B 5/339: Displays specially adapted therefor
- A61B 5/341: Vectorcardiography [VCG]
- A61B 5/346: Analysis of electrocardiograms
- A61B 5/367: Electrophysiological study [EPS], e.g. electrical activation mapping or electro-anatomical mapping
- A61B 5/6852: {Catheters}
- A61B 5/6857: {with a distal pigtail shape}
- A61B 5/6858: {with a distal basket, e.g. expandable basket}
- A61B 5/6859: {with multiple distal splines}
- A61B 5/742: {using visual displays (displays for heart-related electrical signals, e.g. ECG, A61B5/339)}
- A61B 18/1492: {having a flexible, catheter-like structure, e.g. for heart ablation (A61B18/1477 takes precedence)}
- A61B 2018/00267: {having a basket shaped structure}
- A61B 2018/00351: {Heart}
- A61B 2018/00357: {Endocardium}
- A61B 2018/00577: {Ablation}
- A61B 2018/00839: {Bioelectrical parameters, e.g. ECG, EEG}
- A61B 2018/1437: {whereby the windings of the spiral touch each other such as to create a continuous surface}
- A61B 2018/1467: {using more than two electrodes on a single probe}
- A61B 2090/065: {for measuring contact or contact pressure}
- A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D)

## Abstract

Disclosed are various examples and embodiments of systems, devices, components and methods configured to detect a location of a source of at least one cardiac rhythm disorder in a patient's heart. In some embodiments, electrogram signals are acquired from inside a patient's heart, and subsequently normalized, adjusted and/or filtered, followed by generating a two-dimensional (2D) spatial map, grid or representation of the electrode positions, processing the amplitude-adjusted and filtered electrogram signals to generate a plurality of three-dimensional electrogram surfaces corresponding at least partially to the 2 D grid, one surface being generated for each or selected discrete times, and processing the plurality of three-dimensional electrogram surfaces through time to generate a velocity vector map corresponding at least partially to the 2 D grid. The resulting velocity vector map is configured to reveal the location of the source of the at least one cardiac rhythm disorder, which may be, by way of example, an active rotor in a patient's myocardium and atrium.

## Claims

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### Claim 52

A system for detecting a location of a source of at east one cardiac rhythm disorder in a patient's heart, comprising:
at least one computing device comprising at least one non-transitory computer readable medium configured to store instructions executable by at least one processor for determining the source and location of the cardiac rhythm disorder in the patient's heart, the computing device being configured to: (a) receive electrogram signals; (b) normalize and/or adjust amplitudes of the electrogram signals; (c) assign predetermined positions of electrodes on a mapping electrode assembly to their corresponding electrogram signals; (c) provide or generate a two-dimensional (2D) spatial map of the electrode positions; (d) for each or selected discrete times over which the electrogram signals are being processed, process the amplitude-adjusted electrogram signals to generate a plurality of three-dimensional electrogram surfaces corresponding at least partially to the 2D map, one surface being generated for each such time, and (e) process the plurality of three-dimensional electrogram surfaces through time to generate a velocity vector map corresponding at least partially to the 2D map, the velocity vector map being configured to reveal the location of the source of the at least one cardiac rhythm disorder.

### Claim 53 (depends on 52)

The system of claim 52, wherein at least portions of the electrogram surfaces generated by the computing device are configured to correspond to estimated wave shapes or wavefront.

### Claim 54 (depends on 52)

The system of claim 52, wherein the electrogram surfaces are generated by the computing device using Green's function.

### Claim 55 (depends on 52)

The system of claim 52, wherein the electrogram surfaces are generated by the computing device using a two-dimensional bi-harmonic spline interpolation function.

### Claim 56 (depends on 52)

The system of claim 52, wherein the vector map generated by the computing device comprises arrows or colors representative of directions of electrical potential propagation.

### Claim 57 (depends on 52)

The system of claim 52, wherein the vector map generated by the computing device comprises arrows or colors having attributes representative of velocities of electrical potential propagation.

### Claim 58 (depends on 52)

The system of claim 52, wherein the vector map generated by the computing device is configured to reveal the at least one cardiac rhythm disorder as an active rotor at the location.

### Claim 59 (depends on 52)

The system of claim 52, wherein the vector map generated by the computing device is configured to reveal a location of a passive rotor in the patient's heart.

### Claim 60 (depends on 52)

The system of claim 52, wherein the vector map generated by the computing device is configured to reveal a location of a focal point in the patient's heart.

### Claim 61 (depends on 52)

The system of claim 52, wherein the vector map generated by the computing device is configured to reveal a location of a breakthrough point in the patient's heart.

### Claim 62 (depends on 52)

The system of claim 52, wherein the velocity vector map is generated by the computing device using at least one optical flow analysis technique.

### Claim 63 (depends on 62)

The system of claim 62, wherein the at least one optical flow analysis technique is selected from the group consisting of a Horn-Schunck method, a Buxton-Buston method, a Black-Jepson method, a phase correlation method, a block-based method, a discrete optimization method, a Lucas-Kanade method, and a differential method of estimating optical flow.

### Claim 64 (depends on 52)

The system of claim 52, wherein the plurality of electrogram signals are processed by the computing device to generate an averaged electrogram signal, and the averaged electrogram signal is subtracted from each of the individual electrogram signals to generate artifact- or far-field adjusted individual electrogram signals.

### Claim 65 (depends on 64)

The system of claim 64, wherein the artifact-adjusted individual electrogram signals are processed by the computing device with a high-pass filter to remove DC offsets.

### Claim 66 (depends on 65)

The system of claim 65, wherein the high-pass filter applied by the computing device removes frequencies below between about 5 Hz and about 20 Hz.

### Claim 67 (depends on 52)

The system of claim 52, wherein interpolated or estimated values are generated by the computing device for positions in between the measured or calculated grid values corresponding to one or more of the electrogram signals, the plurality of smoothed electrogram surfaces, and the velocity vector map.

### Claim 68 (depends on 52)

The system of claim 52, wherein a representative amplitude value is generated by the computing device for each individual electrogram signal, and the representative amplitude value generated for each electrogram signal is stored for later use in image backgrounds that show low signal amplitude areas of the 2D representation, the low signal amplitude areas being indicative of one or more of valve artifacts, poor electrode contact, and fibrotic areas of the heart.

### Claim 69 (depends on 52)

The system of claim 52, wherein the electrode positions in the 2D representation are modified by the computing device based upon navigational or positional data corresponding to measured or sensed actual electrode positions.

### Claim 70 (depends on 69)

The system of claim 69, wherein the navigational data are provided to the computing device by a medical navigation system, a computed tomography scanner, a magnetic resonance image scanner, or an X-ray fluoroscopy system.

### Claim 71 (depends on 52)

The system of claim 52, further comprising an electrophysiological data acquisition device configured to receive and condition the signals provided by the electrodes to provide as an output therefrom the electrogram signals.

### Claim 72 (depends on 52)

The system of claim 52, further comprising a screen or monitor operably connected to the computing device and configured to display one or more electrogram signals received from the data acquisition device, the normalized or amplitude-adjusted electrogram signals, the predetermined positions of the electrodes on a catheter, the 2D representation of the electrode positions, the plurality of three-dimensional smoothed electrogram surfaces, and the velocity vector map.

### Claim 73 (depends on 52)

The system of claim 52, further comprising an ablation system comprising an ablation catheter, the ablation catheter being configured for ablating the patient's heart at the location and source of the cardiac rhythm disorder indicated by the velocity vector map.

### Claim 74 (depends on 52)

The system of claim 52, further comprising a catheter configured for insertion inside the patient's body and heart, the catheter comprising at a distal end thereof the mapping electrode assembly comprising a plurality of electrodes for sensing and acquiring from different locations inside the patient's heart the electrogram signals, each electrode having a predetermined position on the mapping electrode assembly associated therewith.

### Claim 75 (depends on 74)

The system of claim 74, wherein the catheter further comprises a force sensor located at the distal tip thereof, the force sensor being configured to engage an interior wall of the patient's heart and indicate when the interior wall has been engaged by the force sensor.

### Claim 76 (depends on 52)

The system of claim 52, wherein the catheter is a basket catheter.