intracardiac electrocardiogram presentation

Abstract

The invention is entitled "Intracardiac electrogram presentation." In one embodiment, a medical system is provided that includes a catheter to be inserted into a chamber of a heart of a living subject and including catheter electrodes to contact tissue at respective locations within the chamber of the heart, a display, and processing circuitry to receive signals from the catheter and, in response to the signals: sample respective voltage values of the signals at respective timing values; and render respective intracardiac electrograms (IEGMs) representing electrical activity in the tissue sensed by the catheter electrodes at the respective locations to the display, each of the IEGM renderings including a linear array of respective shapes related to and arranged in temporal order of respective ones of the timing values, fill of the respective shapes formatted in response to respective ones of the sampled voltage values of the respective ones of the signals sampled at the respective ones of the timing values.

Description

Technical Field

[0001] This invention relates to medical systems, and specifically, but not exclusively, to catheter-based systems. Background Technology

[0002] Many medical procedures involve placing probes, such as catheters, inside a patient's body. Position sensing systems have been developed to track such probes. Magnetic position sensing is one method known in the art. In magnetic position sensing, a magnetic field generator is typically placed at a known location outside the patient's body. A magnetic field sensor within the distal end of the probe responds to these magnetic fields to generate an electrical signal, which is processed to determine the coordinate position of the distal end of the probe. These methods and systems are described in U.S. Patents 5,391,199, 6,690,963, 6,484,118, 6,239,724, 6,618,612, and 6,332,089, in PCT International Patent Publication WO 1996 / 005768, and in U.S. Patent Application Publications 2002 / 006455, 2003 / 0120150, and 2004 / 0068178. Impedance- or current-based systems can also be used to track position.

[0003] Arrhythmia treatment surgery is a medical procedure in which these types of probes or catheters have proven extremely useful. Arrhythmias, and specifically atrial fibrillation, have always been a common and dangerous medical condition, especially in the elderly.

[0004] The diagnosis and treatment of cardiac arrhythmias involve mapping the electrical properties of cardiac tissue, particularly the endocardium and cardiac volume, and selectively ablating cardiac tissue by applying energy. Such ablation can stop or alter unwanted electrical signals propagating from one part of the heart to another. Ablation methods disrupt unwanted electrical pathways by creating a non-conductive ablation focus. Various forms of energy delivery for creating ablation focuses have been disclosed, including the use of microwaves, lasers, and more commonly, radiofrequency energy to create conduction blocks along the cardiac tissue walls. In a two-step procedure (mapping followed by ablation), electrical activity at various points within the heart is typically sensed and measured by advancing a catheter containing one or more electrical sensors into the heart and acquiring data at multiple points. This data is then used to select the target endocardial region to be ablated.

[0005] Electrode catheters have been widely used in medical practice for many years. They are used to stimulate and map electrical activity in the heart, as well as to ablate sites of abnormal electrical activity. In use, the electrode catheter is inserted into a major vein or artery, such as the femoral artery, and then guided to the desired cardiac chamber. A typical ablation procedure involves inserting a catheter with one or more electrodes at its distal end into the cardiac chamber. A reference electrode can be provided, typically taped to the patient's skin, or a second catheter positioned in or near the heart can be used to provide the reference electrode. RF (radio frequency) current is applied to the tip electrode of the ablation catheter, and the current flows through the surrounding medium (i.e., blood and tissue) to the reference electrode. The current distribution depends on the amount of contact between the electrode surface and the tissue compared to blood, which has a higher conductivity than tissue. Due to the resistance of the tissue, heating of the tissue occurs. The tissue is heated sufficiently to destroy the cells in the cardiac tissue, resulting in the formation of a non-conductive ablation focus within the cardiac tissue. Summary of the Invention

[0006] According to an embodiment of this disclosure, a medical system is provided, the medical system comprising: a catheter configured to be inserted into a chamber of the heart of a living subject and including catheter electrodes configured to contact tissue at corresponding locations within the heart chamber; a display; and processing circuitry configured to receive signals from the catheter and, in response to the signals, sample corresponding voltage values ​​of the signals at corresponding time-series values; and draw corresponding intracardiac electrogram (IEGM) presentation bars representing electrical activity in tissue sensed by the catheter electrodes at corresponding locations onto the display, each IEGM presentation bar including a linear array of corresponding shapes associated with and arranged in chronological order of the corresponding time-series values, the filler of the corresponding shapes being formatted in response to a corresponding sampled voltage value of a sampled voltage value of a signal sampled at the corresponding time-series value.

[0007] Additionally, according to embodiments of this disclosure, the processing circuit is configured to draw the corresponding IEGM rendering bar onto the display, wherein the fill of the corresponding shape is at least partially colored in response to the corresponding sampled voltage value of the sampled voltage value of the corresponding signal in the signal sampled at the corresponding timing value in the timing value.

[0008] Furthermore, according to an embodiment of this disclosure, the processing circuit is configured to draw the corresponding IEGM rendering bar onto the display, wherein the transparency of the fill of the corresponding shape is adjusted in response to the corresponding sampled voltage value of the sampled voltage value of the corresponding signal in the signal sampled at the corresponding timing value in the timing value.

[0009] Furthermore, according to embodiments of this disclosure, the processing circuit is configured to derive the value of an attribute of a corresponding signal in the signal in response to a corresponding sampled voltage value in the sampled voltage value and a corresponding timing value in the timing value; and to draw a corresponding IEGM rendering bar onto the display, wherein the fill of the corresponding shape is formatted according to a first format in response to the corresponding sampled voltage value of the corresponding signal in the signal sampled at the corresponding timing value in the timing value, and the fill of the corresponding shape in the shape is also formatted according to a second format in response to the derived value.

[0010] Furthermore, according to the embodiments of this disclosure, the attribute is the rate of change of the sampled voltage value.

[0011] Furthermore, according to the embodiments of this disclosure, the attribute is the classification of the corresponding signal in the signal.

[0012] Additionally, according to embodiments of this disclosure, the first formatting includes color formatting, and the second formatting includes transparency formatting.

[0013] Additionally, according to embodiments of this disclosure, the first formatting includes transparency formatting, and the second formatting includes color formatting.

[0014] Furthermore, according to embodiments of this disclosure, the processing circuitry is configured to draw a corresponding IEGM rendering bar with at least one additional marker onto a display, the additional marker being selected from any of the following: alphanumeric symbols, another symbol, lines, dots, time markers, maximum values ​​in the current data, and pacing spikes.

[0015] According to another embodiment of this disclosure, a medical method is also provided, the method comprising receiving a signal from a catheter configured to be inserted into a chamber of the heart of a living subject and including a catheter electrode configured to contact tissue at a corresponding location within the heart chamber; sampling a corresponding voltage value of the signal at a corresponding time value in response to the signal; and drawing corresponding intracardiac electrogram (IEGM) presentation bars representing electrical activity in tissue sensed by the catheter electrode at the corresponding location onto a display, each IEGM presentation bar including a linear array of corresponding shapes associated with and arranged in chronological order of the corresponding time value, the filler of the corresponding shape being formatted in response to a corresponding sampled voltage value of a sampled signal of the signal sampled at the corresponding time value.

[0016] Additionally, according to embodiments of this disclosure, drawing includes drawing a corresponding IEGM rendering bar onto a display, wherein the fill of the corresponding shape is at least partially colored in response to a corresponding sampled voltage value in the sampled voltage value of the corresponding signal in the signal sampled at the corresponding timing value in the timing value.

[0017] Additionally, according to embodiments of this disclosure, drawing includes drawing the corresponding IEGM rendering bar onto the display, wherein the transparency of the fill of the corresponding shape is adjusted in response to the corresponding sampled voltage value of the sampled voltage value of the corresponding signal in the signal sampled at the corresponding time value in the timing value.

[0018] Additionally, according to embodiments of this disclosure, the method includes deriving the value of an attribute of a corresponding signal in a signal in response to a corresponding sampled voltage value in a sampled voltage value and a corresponding timing value in a timing value, and wherein drawing includes drawing a corresponding IEGM rendering bar onto a display, wherein the fill of a corresponding shape is formatted according to a first format in response to a corresponding sampled voltage value in a signal sampled at a corresponding timing value in a timing value, and the fill of a corresponding shape in a shape is also formatted according to a second format in response to the derived value.

[0019] Furthermore, according to the embodiments of this disclosure, the attribute is the rate of change of the sampled voltage value.

[0020] Furthermore, according to the embodiments of this disclosure, the attribute is the classification of the corresponding signal in the signal.

[0021] Additionally, according to embodiments of this disclosure, the first formatting includes color formatting, and the second formatting includes transparency formatting.

[0022] Additionally, according to embodiments of this disclosure, the first formatting includes transparency formatting, and the second formatting includes color formatting.

[0023] Furthermore, according to embodiments of this disclosure, drawing includes drawing a corresponding IEGM rendering bar with at least one additional marker onto a display, the additional marker being selected from any of the following: alphanumeric symbols, another symbol, lines, dots, time markers, maximum values ​​in the current data, and pacing spikes.

[0024] According to another embodiment of this disclosure, a software product is also provided, comprising a non-transitory computer-readable medium storing program instructions that, when read by a central processing unit (CPU), cause the CPU to: receive a signal from a catheter configured to be inserted into a chamber of the heart of a living subject and including catheter electrodes configured to contact tissue at corresponding locations within the heart chamber; sample a corresponding voltage value of the signal at a corresponding timing value in response to the signal; and draw corresponding intracardiac electrogram (IEGM) presentation bars representing electrical activity in tissue sensed by the catheter electrodes at the corresponding locations onto a display, each IEGM presentation bar including a linear array of corresponding shapes associated with and arranged in chronological order of the corresponding timing value, the filler of the corresponding shape being formatted in response to a corresponding sampled voltage value of a sampled signal in the signal sampled at the corresponding timing value in the timing value. Attached Figure Description

[0025] The invention will be understood from the following detailed description taken in conjunction with the accompanying drawings, wherein:

[0026] Figure 1 A schematic diagram of a medical surgical system constructed and operated according to an embodiment of the present invention;

[0027] Figure 2 For use Figure 1 A schematic diagram of the conduits in the system;

[0028] Figure 3 For the reason Figure 1 A schematic diagram of the IEGM traces and IEGM rendering bars prepared by the system;

[0029] Figure 4 An illustration of multiple IGM display bars; and

[0030] Figure 5 For including Figure 1 The flowchart shows the steps in the system's operation method. Detailed Implementation

[0031] Overview

[0032] As previously mentioned, in a two-step procedure (map followed by ablation), electrical activity at various points in the heart is typically sensed and measured by advancing a catheter containing one or more electrodes into the heart and collecting data at multiple points. This data is then used to select the target area for ablation.

[0033] Specifically, electrical activity is typically visualized as an intracardiac electrogram (IEGM) trace for physician analysis to pinpoint the source of arrhythmias. Catheter electrodes that do not contact the tissues of the heart typically measure some electrical signals from the cardiac tissue and far-field signals. When the catheter electrode is in contact with cardiac tissue, the voltage value of the signal depends primarily on the tissue conductivity, while the far-field is secondary. Therefore, physicians are generally interested in analyzing the IEGM traces of electrodes that are in contact with the tissue.

[0034] For focal catheters with one or two electrodes, a single IEGM trace is typically displayed for physician analysis. Physicians can quickly determine whether the catheter electrode providing the signal is in contact with the tissue based on the form of the signal. However, multi-electrode catheters that simultaneously acquire electrical activity from different tissue locations can provide data from multiple IEGM traces to be displayed simultaneously on a single monitor. In some cases, the number of IEGM traces may be too large for physicians to easily determine which IEGM traces are provided by the electrode in contact with the tissue and which are not.

[0035] An example of a multi-electrode conduit is one with more than 48 electrodes, manufactured by Biosense Webster Inc., Irvine, CA, USA. The catheter. Octaray includes eight flexible arms located at the distal end of the shaft, each of which includes six electrodes. Some catheters may include more electrodes, such as, but not limited to, 120 electrodes.

[0036] In addition to determining electrode contact during the aforementioned mapping process, physicians performing ablation procedures also monitor electrode-tissue contact, as effective ablation typically requires adequate contact between the ablation electrode and the tissue. For a small number of electrodes, monitoring contact can be performed by presenting measurements of contact digitally or even graphically, such as impedance observed from the electrode or force on the electrode. However, as the number of active electrodes used in ablation procedures increases, it becomes increasingly difficult for physicians to monitor any parameter of a single electrode. This problem is exacerbated by the fact that, in most cases, the parameters measuring contact also change as contact changes.

[0037] Embodiments of the present invention address the aforementioned problems during medical procedures such as mapping or ablation procedures by presenting physicians with multi-channel color-formatted IEMG presentation bars instead of displaying IEMG traces (charts of voltage values ​​versus time). Each IEMG presentation bar utilizes colored shapes (e.g., rectangles, squares, ellipses, or any suitable shape) arranged in a linear array within the bar to represent samples of IEMG voltage values ​​of a signal (detected by a corresponding catheter electrode). These shapes are colored according to the sampled voltage values ​​and arranged in the presentation bar according to the temporal order of corresponding time values ​​associated with the sampled voltage values ​​encoded in the colored shapes. For example, each subsequent shape in the bar may correspond to the next time value of the acquired sample, and each shape is color-coded according to the sampled voltage value sampled at the time value associated with that shape.

[0038] Thus, the color coding of the linear array that presents the shape in the bar represents the voltage value in the signal detected by the corresponding catheter electrode.

[0039] Presentation bars can be displayed adjacent to each other on the monitor, allowing multiple IEGM presentation bars associated with multiple catheter electrodes to be displayed on a single screen. Prominent features and other characteristics of cardiac electrical activity can be collected from the bars, such as voltage values ​​with maxima and minima, peak spacing, and the rate of change of voltage values. For example, the rate of change of voltage is indicated by the width of the color bands in the bars. For instance, a color change on a single shape indicates a faster rate of change compared to color changes on several adjacent shapes.

[0040] In some implementations, an alternative formatting method can be used to format the shape, for example, by using different levels of transparency for the shape's fill.

[0041] In addition, or alternatively, the shape of the IEGGM rendering bar can be formatted to display another attribute of the signal, such as the rate of change of the corresponding signal or the gradation of the corresponding signal. When displaying different attributes of a signal in a single IEGGM rendering bar, one attribute can be represented using one formatting type (e.g., using different shading), and another attribute can be represented using a different formatting type (e.g., using different levels of transparency).

[0042] In some implementations: In addition to the IEGM rendering bar, IEGM traces may optionally be displayed.

[0043] Some embodiments include a medical system comprising a catheter inserted into a chamber of the heart of a living subject. The catheter includes electrodes that contact tissue at a corresponding location within the heart chamber. The medical system may include processing circuitry that receives signals from the catheter and, in response to the signals, samples a corresponding voltage value of the signals at a corresponding timing value.

[0044] The processing circuit optionally responds to the corresponding sampled voltage value in the sampled voltage values ​​and the corresponding timing value in the timing values ​​to derive the value of a corresponding signal attribute in the signal. This attribute may be the rate of change of the sampled voltage value or the gradation of the corresponding signal in the signal.

[0045] The processing circuitry, in response to a signal, plots corresponding intracardiac electrogram (IEGM) presentation bars on a display, representing electrical activity in tissue sensed by catheter electrodes at corresponding locations. Each IEGM presentation bar comprises a linear array of corresponding shapes associated with and arranged in chronological order of the corresponding time values. The filler of the corresponding shape is formatted in response to a corresponding sampled voltage value among the sampled voltage values ​​of the signals sampled at the corresponding time values. In some embodiments, the filler is formatted based on the sampled voltage value or based on another attribute (e.g., the rate of change or gradation of the voltage value), which depends on the sampled voltage value and the time value. Thus, the formatting of the IEGM presentation bar can represent the sampled amplitude, the rate of change of the sampled voltage value, and / or the gradation.

[0046] In some embodiments, the processing circuitry draws the corresponding IEGGM rendering bar onto the display, wherein the fill of the corresponding shape is at least partially colored in response to a corresponding sampled voltage value of the sampled voltage value of the corresponding signal in the signal sampled at the corresponding timing value. In other embodiments, the processing circuitry draws the corresponding IEGGM rendering bar onto the display, wherein the transparency of the fill of the corresponding shape is adjusted in response to a corresponding sampled voltage value of the sampled voltage value of the corresponding signal in the signal sampled at the corresponding timing value.

[0047] In some embodiments, the processing circuitry draws the corresponding IEGG rendering bar onto the display, wherein: the fill of the corresponding shape is formatted according to a first format in response to a corresponding sampled voltage value of a sampled voltage value of a signal sampled at a corresponding timing value in the timing values, and the fill of the corresponding shape is also formatted according to a second format in response to derived values ​​(e.g., representing another property of the signal, such as the rate of change or gradation of the voltage value). Therefore, at least some of these shapes can be formatted using both the first and second formats. For example, at least some of these shapes can be formatted using both color and transparency. The first and second formats can be selected from any suitable formatting scheme, such as, but not limited to, color formatting or transparency formatting. In some embodiments, the first formatting includes color formatting, and the second formatting includes transparency formatting. In other embodiments, the first formatting includes transparency formatting, and the second formatting includes color formatting.

[0048] In some implementations, the processing circuitry draws a corresponding IEGM rendering bar with at least one additional marker to the display, the additional marker being selected, by way of example, from any of the following: alphanumeric symbols, another symbol, lines, dots, time markers, maximum values ​​in the current data, and pacing spikes.

[0049] System Description

[0050] See now Figure 1 This is a schematic diagram of a medical surgical system 20 constructed and operated according to an embodiment of the present invention. See now. Figure 2 , it is used for Figure 1 A schematic diagram of the conduit 40 in system 20.

[0051] The medical surgical system 20 is used to determine the orientation of the catheter 40, such as in... Figure 1 In illustration 25 and in Figure 2 As seen in more detail below. The catheter 40 includes a shaft 22 and a plurality of flexible arms 54 (only some are labeled for simplicity) for insertion into a body part of a living subject (e.g., a chamber of the heart 26). The flexible arms 54 have corresponding proximal ends that are connected to the distal end of the shaft 22.

[0052] The conduit 40 includes an orientation sensor 53, which is positioned on the shaft 22 in a predefined spatial relationship relative to the proximal end of the flexible arm 54. The orientation sensor 53 may include a magnetic sensor 50 and / or at least one axial electrode 52. The magnetic sensor 50 may include at least one coil, such as, but not limited to, a biaxial or triaxial coil arrangement, to provide orientation data for position and orientation (including yaw). The conduit 40 includes a plurality of conduit electrodes 55 positioned at different corresponding locations along each flexible arm 54 (only some are labeled for simplicity). Figure 2 (In the middle). Typically, catheter 40 can be used to map electrical activity in the heart of a living subject using electrode 55, or to perform any other suitable function in a body part of a living subject. Electrode 55 is configured to contact tissue of the body part at a corresponding location within the body part (e.g., within a chamber of the heart).

[0053] The medical surgical system 20 can determine the orientation and orientation of the shaft 22 of the catheter 40 based on signals provided by the magnetic sensor 50 and / or shaft electrodes 52 (proximal electrode 52a and distal electrode 52b) mounted on the shaft 22 on either side of the magnetic sensor 50. At least some of the electrodes, including the proximal electrode 52a, distal electrode 52b, magnetic sensor 50, and electrode 55, are connected to various drive circuits in the console 24 via wires extending through the shaft 22 via the catheter connector 35. In some embodiments, at least two of the electrodes 55, shaft electrodes 52, and magnetic sensors 50 of each flexible arm 54 are connected to the drive circuitry in the console 24 via the catheter connector 35. In some embodiments, the distal electrode 52b and / or the proximal electrode 52a may be omitted.

[0054] Figure 2 The illustrations shown are chosen solely for clarity of concept. Other configurations of the axial electrode 52 and electrode 55 are also possible. Additional functionality may be included in the orientation sensor 53. For clarity, elements irrelevant to the embodiments disclosed in this invention, such as flushing ports, have been omitted.

[0055] The physician 30 navigates the catheter 40 to a target location in the body part (e.g., heart 26) of the patient 28 by manipulating the axis 22 and / or flexing from the sheath 23 using a manipulator 32 located near the proximal end of the catheter 40. The catheter 40 is inserted through the sheath 23, where the flexible arms 54 converge, and the flexible arms 54 are able to unfold and return to their intended functional shape only after the catheter 40 has retracted from the sheath 23. By housing the flexible arms 54 together, the sheath 23 also serves to minimize vascular trauma along its path to the target location.

[0056] The console 24 includes processing circuitry 41 (typically a general-purpose computer) and suitable front-end and interface circuitry 44 for generating signals in and / or receiving signals from surface electrodes 49 attached to the chest and back of the patient 28, or any other suitable skin surface, via wires passing through cable 39.

[0057] The console 24 also includes a magnetic induction subsystem. The patient 28 is placed in a magnetic field generated by a pad containing at least one magnetic field radiator 42, which is driven by a unit 43 disposed in the console 24. The magnetic field radiator 42 is configured to emit an alternating magnetic field to the area where a body part (e.g., heart 26) is located. The magnetic field generated by the magnetic field radiator 42 generates a direction signal in a magnetic sensor 50. The magnetic sensor 50 is configured to detect at least a portion of the emitted alternating magnetic field and provide the direction signal as a corresponding electrical input to processing circuitry 41.

[0058] In some embodiments, processing circuitry 41 uses orientation signals received from axial electrode 52, magnetic sensor 50, and electrode 55 to estimate the orientation of catheter 40 within an organ, such as a heart chamber. In some embodiments, processing circuitry 41 correlates the orientation signals received from electrodes 52, 55 with previously acquired magnetic position-calibration orientation signals to estimate the orientation of catheter 40 within the heart chamber. The orientation coordinates of axial electrode 52 and electrode 55 can be determined by processing circuitry 41 based on (among other inputs) the measured impedance or current distribution between electrodes 52, 55 and surface electrode 49. Console 24 drives display 27, which shows the distal end of catheter 40 within heart 26.

[0059] Methods utilizing current distribution measurements and / or orientation sensing of external magnetic fields are implemented in various medical applications, for example, in devices manufactured by Biosense Webster Inc. (Irvine, California). The system is implemented and described in detail in U.S. Patents 5,391,199, 6,690,963, 6,484,118, 6,239,724, 6,618,612, 6,332,089, 7,756,576, 7,869,865 and 7,848,787, PCT Patent Publication WO 96 / 05768, and U.S. Patent Application Publications 2002 / 0065455 A1, 2003 / 0120150 A1 and 2004 / 0068178 A1.

[0060] 3. The system employs a position tracking method based on active current positioning (ACL) impedance. In some embodiments, processing circuitry 41 is configured to use the ACL method to generate a mapping between an indication of impedance and the orientation in the magnetic coordinate system of magnetic field radiator 42 (e.g., a current-orientation matrix (CPM)). Processing circuitry 41 estimates the orientation of axial electrodes 52 and 55 by performing a lookup in the CPM.

[0061] The processing circuit 41 is typically programmed with software to perform the functions described herein. This software may be downloaded electronically to a computer via a network, or alternatively or additionally set and / or stored on a non-transitory tangible medium (such as magnetic storage, optical storage, or electronic storage).

[0062] For the sake of simplicity and clarity, Figure 1 Only elements relevant to the technology disclosed in this invention are shown. System 20 typically includes additional modules and elements that are not directly related to the technology disclosed in this invention, and therefore these additional modules and elements are derived from... Figure 1 The corresponding descriptions were intentionally omitted.

[0063] The catheter 40 described above includes eight flexible arms 54, each arm 54 having six electrodes. By way of example only, any suitable catheter may be used instead of catheter 40, such as catheters with a different number of flexible arms and / or a different number of electrodes on each arm, or catheters with different probe shapes such as balloon catheters, basket catheters, or lasso catheters.

[0064] The medical surgical system 20 can also use any suitable catheter, such as catheter 40 or different catheters, and any suitable ablation method to perform ablation of cardiac tissue. The console 24 may include an RF signal generator 34 configured to generate RF power applied by one or more electrodes of the catheter connected to the console 24 and one or more surface electrodes of the surface electrodes 49 to ablate the myocardium of the heart 26. The console 24 may include a pump (not shown) that pumps flushing fluid into a flushing channel to the distal end of the catheter performing ablation. The catheter performing ablation may also include a temperature sensor (not shown) for measuring the temperature of the myocardium during ablation and adjusting the ablation power and / or the flushing rate of the flushing fluid pump based on the measured temperature.

[0065] See now Figure 3 The reason for this Figure 1 A schematic diagram of the IEGM trace 60 and IEGM presentation strip 62 prepared by system 20. The IEGM trace 60 utilizes the catheter 40 ( Figure 2 A line graph of the signal received by one of the electrodes 55 shows the change in voltage value with respect to time.

[0066] To generate the IEGM rendering bar 62, the voltage values ​​of the received signal are sampled at appropriate time intervals. The voltage values ​​at the sampling time can be positive or negative. The time interval between samples can be any suitable value, for example, but not limited to, within the range of 1 millisecond to 50 milliseconds. The voltage values ​​sampled at the corresponding timing values ​​are then converted into color values. Color values ​​can be derived based on looking up color values ​​in a table that maps voltage value ranges to color values. Alternatively, a function can be used to calculate the color values, which takes voltage values ​​as input and outputs color values. Color values ​​can be defined using known color models such as RGB or based on a custom color model. The corresponding shape 64 of the IEGM rendering bar 62 is assigned to the corresponding timing value at which the signal is sampled. The corresponding shape 64 is then colored according to the corresponding color value derived from the corresponding sampled voltage value sampled at the corresponding timing value.

[0067] For example, the shapes 64-1 to 64-7 shown in Illustration 66 are assigned timing values ​​for 3900 ms, 3910 ms, 3920 ms, 3930 ms, 3940 ms, 3950 ms, and 3960 ms, respectively. The voltages sampled from the signal at 3900 ms, 3910 ms, 3920 ms, 3930 ms, 3940 ms, 3950 ms, and 3960 ms are equal to 1.2, 1.24, 1.3, 1.33, 1.31, 1.15, and 1.1, respectively. Color values ​​corresponding to red, red, dark red, dark red, dark red, orange, and orange are derived from the voltages 1.2, 1.24, 1.3, 1.33, 1.31, 1.15, and 1.1, respectively. The shapes 64-1 to 64-7 are then colored with the following colors: red, red, dark red, dark red, dark red, orange, and orange, respectively. It should be noted that two or more different voltages can be mapped to the same color. For example, voltages 1.2 and 1.24 are both mapped to red.

[0068] Shape 64 can be selected from any suitable shape, such as a rectangle or an oval. Shape 64 can have any suitable height, for example, from 1mm to 100mm, or even higher, depending on the display 27. Figure 1 The size of the shape 64 and the number of IEGG rendering bars 62 displayed simultaneously. The shape 64 can have any suitable width, for example, from a single pixel to 5mm, depending on the size of the monitor 27 and the distance between the monitor and the physician 30 (…). Figure 1 The distance between samples and the temporal interval between samples.

[0069] although Figure 3 The IEGM display bar 62 shown is in grayscale due to limitations of the patent drawings, but by way of example, the IEGM display bar 62 can be displayed in color on a display, with peaks displayed in red (arrow 68) and dark red (arrow 69), and valleys displayed in dark blue (arrow 70). Any suitable color coding can be used to represent voltage values ​​using any suitable color.

[0070] Prominent features and other characteristics of cardiac electrical activity can be collected from the IEGG presentation bar 62, such as voltage values ​​with maxima and minima, peak spacing, and the rate of change of voltage values. For example, the rate of change of voltage is indicated by the width of the color band in the bar. For example, a color change on a single shape 64 indicates a faster rate of change compared to color changes on several adjacent shapes 64.

[0071] In some implementations, an alternative formatting method (instead of using different colors) can be used to format shape 64, for example, by using different levels of transparency for the fill of shape 64. The fill of shape 64 can be a solid or patterned fill with a transparency level that is adjusted according to a voltage value associated with the shape.

[0072] See now Figure 4 This is a schematic diagram of multiple IEGG display bars 62. The IEGG display bars 62 represent the output from catheter 40 ( Figure 1 The signals received by the nineteen electrodes 55. The IEGM presentation bars 62 of channels 8, 11, 17 and 18 show more activity in the negative voltage range compared to the IEGM presentation bars 62 of other channels.

[0073] Figure 4 Also shown is illustration 72, which is for physician 30 ( Figure 1 Provides a lookup table between the various colors in the IEGM rendering bar 62 and their corresponding voltage values. For example, the top of the legend can be colored dark red, and the bottom of the legend can be colored dark blue.

[0074] The IEGM rendering bars 62 are displayed on the monitor in an adjacent manner, thereby allowing multiple IEGM rendering bars 62 to be displayed on a single screen.

[0075] In some implementations, instead of displaying voltage values ​​that change over time, the IEGM presentation bar 62 can display other properties of the signal, such as the rate of change of the corresponding signal or the gradation of the corresponding signal, by formatting shape 64 according to the values ​​of other properties.

[0076] In other implementations, in addition to displaying voltage values ​​that change over time, the IEGM presentation bar 62 may also display other properties of the signal, such as the rate of change of the corresponding signal or the gradation of the corresponding signal, by formatting the shape 64 with one formatting type (e.g., using different transparency levels) based on the values ​​of other attributes or by formatting the shape 64 with different formatting types (e.g., using different shading) based on the voltage values.

[0077] See now Figure 5 It includes Figure 1 The flowchart 74 shows the steps in the operation method of System 20.

[0078] catheter 40 ( Figure 1 ) is configured to be inserted into (box 76) the heart 26 of a living subject. Figure 1 The chamber of the heart 26 includes a catheter electrode 55 configured to contact tissue at a corresponding location within the chamber of the heart 26. Figure 2 ).

[0079] Processing circuit 41 ( Figure 1 The device is configured to receive a signal from the conduit 40 and, in response to the signal, sample the corresponding voltage value of the signal at the corresponding timing value (box 78).

[0080] Processing circuit 41 ( Figure 1 The signal is optionally configured to derive the value of an attribute of the corresponding signal in the signal (box 80) in response to the corresponding sampled voltage value in the sampled voltage value and the corresponding timing value in the timing value. This attribute may be, for example, the rate of change of the sampled voltage value, or the gradation of the corresponding signal in the signal.

[0081] Processing circuit 41 ( Figure 1 The device is configured to, in response to a signal, present a corresponding intracardiac electrogram (IEGM) representing electrical activity in the tissue sensed by the catheter electrode 55 at the corresponding location, displaying bar 62. Figure 3 Draw to (box 82) display 27 ( Figure 1 Each IEGGM rendering bar 62 includes a corresponding shape 64 associated with and arranged in chronological order of the corresponding timing value in the timing value. Figure 3 A linear array of ) . The filler of the corresponding shape 64 is formatted in response to the sampled voltage value of the corresponding signal in the signal sampled at the corresponding time value in the timing value.

[0082] Formatting may depend on the sampled voltage value or be based on the value of at least some of the sampled values. For example, formatting may be based on the rate of change of the sampled voltage value, or the gradation of the corresponding signal in the signal. Therefore, the IEGM presentation bar 62 can display the rate of change or gradation of the sampled voltage value.

[0083] In some implementations, processing circuit 41 ( Figure 1 ) is configured to draw the corresponding IEGM render bar 62 onto the monitor 27 ( Figure 1 ), wherein the filler of the corresponding shape 64 is at least partially colored in response to the corresponding sampled voltage value of the sampled voltage value of the corresponding signal in the signal sampled at the corresponding timing value in the timing value. In other embodiments, the processing circuit 41 ( Figure 1 ) is configured to draw the corresponding IEGM render bar 62 onto the monitor 27 ( Figure 1 The transparency of the filler of the corresponding shape 64 is adjusted in response to the sampling voltage value of the corresponding signal in the sampling voltage value of the corresponding signal in the corresponding timing value.

[0084] In some implementations, processing circuit 41 ( Figure 1 ) is configured to draw the corresponding IEGM render bar 62 onto the monitor 27 ( Figure 1The padding of the corresponding shape 64 is formatted according to a first format in response to a sampled voltage value of a sampled voltage value of a signal sampled at a corresponding timing value in the timing values, and the padding of the corresponding shape in shape 64 is also formatted according to a second format in response to an derived value (derived in the step of box 80). The first and second formats can be selected from any suitable formatting scheme, such as, but not limited to, color formatting or transparency formatting. In some embodiments, the first formatting includes color formatting, and the second formatting includes transparency formatting. In other embodiments, the first formatting includes transparency formatting, and the second formatting includes color formatting.

[0085] In some implementations, processing circuit 41 ( Figure 1 ) is configured to draw the corresponding IEGM rendering bar with at least one additional tag onto the display 27 ( Figure 1 The additional marker is selected from any of the following: alphanumeric symbols (e.g., Figure 4 The channel number), another symbol (e.g., Figure 4 Legend 72), lines (not shown), points (not shown), time markers ( Figure 4 (Time series value), maximum value in the current data (not shown), pacing spike (not shown).

[0086] As used herein, the term “about” or “approximately” for any numerical value or range indicates a suitable dimensional tolerance that allows a collection of parts or components to achieve the intended purpose as described herein. More specifically, “about” or “approximately” may refer to a range of ±20% of the enumerated values, for example, “about 90%” may refer to a range of values ​​from 71% to 99%.

[0087] For clarity, the various features of the invention described in the context of individual embodiments may also be provided in combination in a single embodiment. Conversely, for brevity, the various features of the invention described in the context of individual embodiments may also be provided individually or in any suitable sub-combination.

[0088] The above embodiments are cited by way of example, and the invention is not limited to the specific details shown and described above. Rather, the scope of the invention includes combinations and sub-combinations of the various features described above, as well as variations and modifications thereof, which should be apparent to those skilled in the art upon reading the above description, and which are not disclosed in the prior art.

Claims

1. A medical system comprising: A catheter configured to be inserted into a chamber of the heart of a living subject and including a catheter electrode configured to contact tissue at a corresponding location within the chamber of the heart; monitor; and Processing circuitry, configured to receive and respond to signals from the conduit: The voltage value of the signal at the corresponding time value is sampled; The values ​​of the corresponding signal attributes in the signal are derived in response to the corresponding sampled voltage value in the sampled voltage value and the corresponding timing value in the timing value; and The corresponding intracardiac electrogram (IEGM) presentation bars, representing the electrical activity in the tissue sensed by the catheter electrodes at the corresponding locations, are plotted onto the display. Each IGM presentation bar comprises a linear array of corresponding shapes associated with and arranged in chronological order of the corresponding time values, wherein: The filling material of the corresponding shape is formatted according to a first format in response to the sampled voltage value of the corresponding signal sampled at the corresponding time value in the timing value, and The filler of the corresponding shape in the shape is also formatted according to the second format in response to the exported value.

2. The system of claim 1, wherein the processing circuitry is configured to draw a corresponding IEGG rendering bar onto the display, wherein the fill of the corresponding shape is at least partially colored in response to the corresponding sampled voltage value of the sampled voltage value of the corresponding signal in the signal sampled at the corresponding timing value in the timing value.

3. The system of claim 1, wherein the processing circuitry is configured to draw a corresponding IEGG rendering bar onto the display, wherein the transparency of the filler of the corresponding shape is adjusted in response to the corresponding sampled voltage value of the sampled voltage value of the corresponding signal in the signal sampled at the corresponding timing value in the timing value.

4. The system according to claim 1, wherein the attribute is the rate of change of the sampled voltage value.

5. The system according to claim 1, wherein the attribute is a classification of the corresponding signal in the signal.

6. The system of claim 1, wherein the first formatting includes color formatting, and the second formatting includes transparency formatting.

7. The system of claim 1, wherein the first formatting includes transparency formatting, and the second formatting includes color formatting.

8. The system of claim 1, wherein the processing circuitry is configured to draw a corresponding IEGM rendering bar having at least one additional marker onto the display, the additional marker being selected from any of the following: alphanumeric symbols, another symbol, lines, dots, time markers, maximum values ​​in the current data, and pacing spikes.

9. A medical method comprising: Signals are received from a catheter configured to be inserted into a chamber of the heart of a living subject and include catheter electrodes configured to contact tissue at a corresponding location within the chamber of the heart. In response to the signal, the corresponding voltage value of the signal at the corresponding timing value is sampled; The values ​​of the corresponding signal attributes in the signal are derived in response to the corresponding sampled voltage value in the sampled voltage value and the corresponding timing value in the timing value; and The corresponding intracardiac electrogram (IEGM) presentation bars, representing the electrical activity in the tissue sensed by the catheter electrodes at the corresponding locations, are plotted onto a display. Each IGM presentation bar comprises a linear array of corresponding shapes associated with and arranged in chronological order of the corresponding time values, wherein: The filling material of the corresponding shape is formatted according to a first format in response to the sampled voltage value of the corresponding signal sampled at the corresponding time value in the timing value, and The filler of the corresponding shape in the shape is also formatted according to the second format in response to the exported value.

10. The method of claim 9, wherein the drawing comprises drawing a corresponding IEGM rendering bar onto the display, wherein the fill of the corresponding shape is at least partially colored in response to the corresponding sampled voltage value of the sampled voltage value of the corresponding signal in the signal sampled at the corresponding timing value in the timing value.

11. The method of claim 9, wherein the drawing includes drawing a corresponding IEGG rendering bar onto the display, wherein the transparency of the fill of the corresponding shape is adjusted in response to a corresponding sampled voltage value of a sampled voltage value of a signal sampled at the corresponding timing value in the timing value.

12. The method of claim 9, wherein the property is the rate of change of the sampled voltage value.

13. The method of claim 9, wherein the attribute is a classification of the corresponding signal in the signal.

14. The method of claim 9, wherein the first formatting includes color formatting, and the second formatting includes transparency formatting.

15. The method of claim 9, wherein the first formatting includes transparency formatting, and the second formatting includes color formatting.

16. The method of claim 9, wherein the drawing comprises drawing a corresponding IEGM rendering bar having at least one additional marker onto the display, the additional marker being selected from any of the following: alphanumeric symbols, another symbol, lines, dots, time markers, maximum values ​​in current data, and pacing spikes.

17. A software product comprising a non-transitory computer-readable medium storing program instructions therein, the instructions causing the CPU, when read by a central processing unit (CPU), to: Signals are received from a catheter configured to be inserted into a chamber of the heart of a living subject and include catheter electrodes configured to contact tissue at a corresponding location within the chamber of the heart. In response to the signal, the corresponding voltage value of the signal at the corresponding timing value is sampled; The values ​​of the corresponding signal attributes in the signal are derived in response to the corresponding sampled voltage value in the sampled voltage value and the corresponding timing value in the timing value; and The corresponding intracardiac electrogram (IEGM) presentation bars, representing the electrical activity in the tissue sensed by the catheter electrodes at the corresponding locations, are plotted onto a display. Each IGM presentation bar comprises a linear array of corresponding shapes associated with and arranged in chronological order of the corresponding time values, wherein: The filling material of the corresponding shape is formatted according to a first format in response to the sampled voltage value of the corresponding signal sampled at the corresponding time value in the timing value, and The filler of the corresponding shape in the shape is also formatted according to the second format in response to the exported value.

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