# US 2019/0167137 A1 · Double bipolar configuration for atrail fibrillation annotation

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- Number: US 2019/0167137 A1
- Document ID: US20190167137A1
- Status: Published application
- Kind: A1
- Application number: 16/267,877
- Filed: 2019-02-05
- Published: 2019-06-06
- Earliest claimed: 2014-01-29
- Assignees: Biosense Webster (Israel) Ltd.
- Applicants: Biosense Webster (Israel) Ltd.
- Inventors: Meir Bar-Tal; Richard P.M. Houben; Yaniv Ben Zriham; Assaf Pressman; Roy Urman; Shmuel Auerbach
- Web page: https://patentgrep.com/patent/US20190167137A1

## CPC

- A61B 5/361: Detecting fibrillation
- A61B 5/287: Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
- A61B 5/308: for electrocardiography [ECG]
- A61B 5/346: Analysis of electrocardiograms
- A61B 5/352: Detecting R peaks, e.g. for synchronising diagnostic apparatus; Estimating R-R interval
- A61B 5/7203: {for noise prevention, reduction or removal}
- A61B 5/7221: {Determining signal validity, reliability or quality (preventing, reducing or removing noise induced by motion artefacts A61B5/7207; noise originating from a therapeutic or surgical apparatus A61B5/7217)}
- A61B 5/7235: {Details of waveform analysis (detecting specific parameters of the electrocardiograph cycle A61B5/349)}
- A61B 5/726: {using Wavelet transforms}
- A61B 34/20: Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
- A61B 18/1492: {having a flexible, catheter-like structure, e.g. for heart ablation (A61B18/1477 takes precedence)}
- A61B 2018/0016: {Energy applicators arranged in a two- or three dimensional array}
- A61B 2018/00267: {having a basket shaped structure}
- A61B 2018/00839: {Bioelectrical parameters, e.g. ECG, EEG}
- A61B 2034/2051: {Electromagnetic tracking systems}
- A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D)

## Abstract

Catheterization of the heart is carried out by inserting a probe having electrodes into a heart of a living subject, recording a bipolar electrogram and a unipolar electrogram from one of the electrodes at a location in the heart, and defining a window of interest wherein a rate of change in a potential of the bipolar electrogram exceeds a predetermined value. An annotation is established in the unipolar electrogram, wherein the annotation denotes a maximum rate of change in a potential of the unipolar electrogram within the window of interest. A quality value is assigned to the annotation, and a 3-dimensional map is generated of a portion of the heart that includes the annotation and the quality value thereof.

## Claims

### Claim at position 1

1-19. (canceled)

### Claim 20

A method of determining quality of an annotation comprising:
identifying an annotation; and
estimating a quality of the annotation based on one or more parameters selected from:
an amount and type of filtering required to determine the annotation;
a position of a unipolar electrode generating its signal;
a location in the heart from where a signal was acquired;
a timing of the annotation; or
whether the annotation is at or close to a time where a signal adjustment has been made;
assigning a value to the quality based on the on one or more parameters;
wherein the numerical value of the quality may be upgraded or downgraded based on the likelihood that the one or more parameters indicates an annotation.

### Claim 21 (depends on 20)

The method of claim 20, wherein for the parameter a position of a unipolar electrode generating its signal, the value is downgraded when, from a position of a first electrode, it is considered physiologically unlikely that a signal from the first electrode will comprise an annotation.

### Claim 22 (depends on 20)

The method of claim 20, further comprising:
checking an inter-annotation distance, quality of a neighboring annotation and a timing of neighboring spatial annotations;
adjusting the value of the quality based on the check.

### Claim 23 (depends on 22)

The method of claim 22, wherein if a first electrode is surrounded by a plurality of second electrodes that are generating annotations with a high quality value, then the quality value of an annotation from the first electrode is increased.

### Claim 24 (depends on 22)

The method of claim 22, wherein if a first electrode is surrounded by a plurality of second electrodes generating annotations with a low quality, then the quality of the given electrode annotation may be decreased.

### Claim 25 (depends on 22)

The method of claim 22, wherein if a first electrode is surrounded by plurality of second electrodes generating annotations significantly outside a predetermined physiological range, then the quality of the given electrode is decreased.

### Claim 26 (depends on 20)

The method of claim 20, further comprising evaluating the quality of an annotation with respect to a statistic describing other annotations.

### Claim 27 (depends on 26)

The method of claim 26, wherein the statistic comprises a histogram of temporal cycle lengths of each annotation; and wherein annotations lying within predefined bounds of the histogram are considered to be valid, and those outside the bounds are considered to be erroneous.