Analyze multi-electrode catheter signals to determine electrophysiological (EP) wave propagation vectors

Abstract

The present invention is entitled "Analyzing Multi-Electrode Catheter Signals to Determine Electrophysiological (EP) Wave Propagation Vectors". The present invention discloses a method comprising receiving a plurality of electrophysiological (EP) signals acquired by a plurality of electrodes of a multi-electrode catheter in contact with tissue in a region of a cardiac chamber, and corresponding tissue locations at which the electrodes acquired the EP signals. The region is divided into two segments. Using the EP signals acquired by the electrodes, the local activation time (LAT) of the corresponding tissue locations is calculated, and: a first segment having a smaller average LAT value of the two segments and a second segment having a larger average value of the two segments are found. A first representative location in the first segment and a second representative location in the second segment are determined. A propagation vector indicating the propagation of the EP wave that has generated the EP signal is calculated between the first representative location and the second representative location. The propagation vector is presented to a user.

Description

Technical Field

[0001] The present invention relates generally to electrophysiological mapping, and particularly to cardiac electrophysiological mapping. Background Art

[0002] Invasive cardiac techniques for mapping the electrophysiological (EP) properties of cardiac tissue have been previously proposed in the patent literature. For example, U.S. Patent Application Publication No. 2017 / 0311833 describes an effective system for diagnosing arrhythmias and guiding catheter therapy that allows for the measurement, classification, analysis, and mapping of spatial EP patterns within the body. The effective system can also guide arrhythmia therapy and update the map as therapy is delivered. The effective system can use a medical device with a high-density sensor having a known spatial configuration for collecting EP data and positioning data. In addition, the effective system can use an electronic control system to calculate and provide a user with a variety of metrics, derivative metrics, high-definition (HD) maps, HD composite maps, and general visual aids for associating with a geometric anatomical model shown on a display device.

[0003] As another example, U.S. patent application publication 2017 / 0042449 describes a system for determining EP data, the system comprising an electronic control unit configured to: acquire electrophysiological signals from multiple electrodes of one or more catheters; select at least one electrode clique from the multiple electrodes to determine multiple local electric field data points; determine the positions and orientations of the multiple electrodes; process electrophysiological signals from at least one cluster in a complete set of bipolar clusters to derive local electric field data points associated with the at least one electrode cluster; derive at least one orientation-independent signal from the at least one electrode cluster from information content corresponding to a weighted portion of the electrogram signal; and display or output catheter orientation-independent EP information to a user or process.

[0004] U.S. Patent Application Publication No. 2018 / 0153426 describes a method and system for mapping an anatomical structure, the method and system comprising sensing activation signals of intrinsic physiological activity using a plurality of mapping electrodes disposed in or near the anatomical structure, each mapping electrode of the plurality of mapping electrodes having an electrode location. A vector field map is generated to identify a characteristic pattern and a location in the vector field map based on at least one vector field template, the vector field map representing a propagation direction of the activation signal at each electrode location. A target location of the identified characteristic pattern is identified based on the corresponding electrode location. Summary of the Invention

[0005] An embodiment of the present invention provides a method comprising receiving (i) a plurality of electrophysiological (EP) signals acquired by a plurality of electrodes of a multi-electrode catheter in contact with tissue in a region of a cardiac chamber, and (ii) corresponding tissue locations at which the electrodes acquired the EP signals. The region is divided into two segments. Using the EP signals acquired by the electrodes, the local activation time (LAT) of the corresponding tissue locations is calculated, and: a first segment having a smaller average LAT value of the two segments and a second segment having a larger average value of the two segments are found. A first representative location in the first segment and a second representative location in the second segment are determined. A propagation vector indicating the propagation of the EP wave that has generated the EP signal is calculated between the first representative location and the second representative location. The propagation vector is presented to a user.

[0006] In some embodiments, presenting the propagation vector includes superimposing an arrow on a map of the cardiac chamber. In other embodiments, superimposing the arrow includes using a graphical characteristic of the arrow to indicate a velocity of the EP wave between a first representative location and a second representative location.

[0007] In some embodiments, the graphical characteristics of the arrow include one or more of: color, length, width, and a graphical pattern (such as a gradient or dashed line).

[0008] In one embodiment, the method further comprises calculating an additional propagation vector of the reentrant EP wave if a reentrant EP wave is detected.

[0009] In another embodiment, the method further comprises superimposing additional arrows on the map of the cardiac chamber.In another embodiment, superimposing additional arrows comprises using graphical properties of the additional arrows to indicate at least one of: a LAT difference and a reentrant cycle time of the reentrant EP wave.

[0010] In some embodiments, determining the first representative location includes determining the tissue location having the smallest LAT value among the tissue locations in the first segment, and wherein determining the second representative location includes determining the tissue location having the largest LAT value among the tissue locations in the second segment.

[0011] In some embodiments, determining the first representative location includes calculating a first centroid of the tissue location in the first segment, and wherein determining the second representative location includes calculating a second centroid of the tissue location in the second segment.

[0012] In one embodiment, calculating the first centroid includes calculating a first weighted average of tissue positions in the first segment using two or more of the LAT values ​​of the first segment as weights, and wherein calculating the second centroid includes calculating a second weighted average of tissue positions in the second segment using two or more of the LAT values ​​of the second segment as weights.

[0013] According to another embodiment of the present invention, a system is also provided, which includes an interface and a processor. The interface is configured to receive (i) multiple electrophysiological (EP) signals acquired by multiple electrodes of a multi-electrode catheter in contact with tissue in a region of a cardiac chamber, and (ii) corresponding tissue positions where the electrodes acquire EP signals. The processor is configured to: (a) divide the region into two segments; (b) calculate local activation time (LAT) values ​​of corresponding tissue positions using the EP signals acquired by the electrodes, and find the first segment with a smaller average LAT value in the two segments and the second segment with a larger average value in the two segments; (c) determine a first representative position in the first segment and a second representative position in the second segment; (d) calculate a propagation vector indicating the propagation of the EP wave that has generated the EP signal between the first representative position and the second representative position; and (e) present the propagation vector to a user.

[0014] The present invention will be more fully understood through the following detailed description of embodiments of the present invention in conjunction with the accompanying drawings, in which: BRIEF DESCRIPTION OF THE DRAWINGS

[0015] Figure 1 is a schematic illustration of an electrophysiological (EP) mapping system including different possible multi-electrode catheters according to an embodiment of the present invention;

[0016] Figure 2A and Figure 2B For contacting tissue and measuring electrophysiological (EP) signals according to an embodiment of the present invention Figure 1 a schematic distal view of an electrode of one of the catheters;

[0017] Figure 3 According to another embodiment of the present invention, a device for contacting tissue and measuring electrophysiological (EP) signals Figure 1 a schematic distal view of an electrode of one of the catheters; and

[0018] Figure 4 The flowchart schematically illustrates a method and algorithm for estimating and presenting propagation vectors of electrophysiological (EP) waves according to an embodiment of the present invention. DETAILED DESCRIPTION

[0019] Overview

[0020] Intracardiac electrophysiology (EP) mapping is a catheter-based method that is sometimes used to characterize cardiac EP wave propagation abnormalities, such as those that lead to arrhythmias. In a typical catheter-based procedure, the distal end of a catheter, including a plurality of sensing electrodes, is inserted into the heart to sense a set of data points including measurement locations on the wall tissue of a cardiac chamber and a corresponding set of EP signals from which an EP mapping system can generate a map of the cardiac chamber, such as an EP map.

[0021] Specifically, for diagnosis, the propagation direction of the EP wave at a certain area of ​​the wall tissue may also be required. The propagation direction of the heart wave can be obtained by generating a specific EP timing map of the area of ​​the heart cavity, called a local activation time (LAT) map.

[0022] However, determining the propagation vectors of EP waves in a cardiac chamber for any given region is a time-consuming process. Typically, it is necessary to calculate the LAT for multiple locations around the region and then derive the vectors from the LAT and the orientation of the locations. Embodiments of the present invention described below provide efficient methods for acquiring EP data and automatically calculating such propagation vectors for a region in a cardiac chamber in real time.

[0023] Among other features, the methods disclosed herein can be used in a particular manner with various types of multi-electrode catheters, such as basket catheters or multi-arm catheters (e.g., PentaRay manufactured by Biosense-Webster). TM or OctaRay TM The multi-electrode catheter is brought into contact with (e.g., pressed against) tissue at a region of the cardiac chamber so that its "pole" (e.g., the distal end to which the spine of the basket is connected, or the distal end from which the multiple arms originate) is located over the selected cardiac tissue region, and the electrodes on the spine / arms are brought into contact with wall tissue at the tissue region of the cardiac chamber to acquire EP signals.

[0024] In one embodiment, to calculate the propagation vector, the processor first divides the cardiac tissue region where the electrode is located into two segments (e.g., arbitrarily) using a virtual plane containing the axis of the catheter. Then, using the EP signal acquired from each electrode, the processor calculates the LAT value at the electrode position (i.e., the corresponding tissue position) in each segment to find the first segment with the smaller average LAT value of the two segments and the second segment with the larger average LAT value of the two segments.

[0025] The processor then determines a first representative position in the first segment and a second representative position in the second segment. The processor calculates a propagation vector indicating the propagation of the EP wave that generated the EP signal between the first representative position and the second representative position and presents the propagation vector to the user.

[0026] In one embodiment, for a segment with a lower average LAT value, the processor finds the location with the minimum LAT value. For a segment with a higher average LAT value, the processor finds the location with the maximum LAT value. Based on the known displacement (distance and direction) between the two locations and the corresponding known time difference in the LAT values, the processor calculates the propagation (e.g., velocity) vector (rate and direction) of the EP wave. The processor can then draw an arrow corresponding to the vector on the map of the cardiac chamber. The length of the arrow, its color, or graphic pattern (e.g., gradient or shading pattern) can be set to correspond to the velocity.

[0027] In another embodiment, instead of calculating the velocity vector from the minimum in the LAT values ​​at the segment with the lower average LAT value to the maximum in the LAT values ​​at the segment with the higher average LAT value, the processor calculates a vector between the centroid wall tissue location with the lower average LAT value and the centroid wall tissue location with the higher average LAT value. To do this, the processor performs a centroid calculation in a first segment of a first wall tissue location with the lower average LAT value and performs a centroid calculation in a second segment of a second wall tissue location with the higher average LAT value. The processor then calculates a centroid propagation vector between the first centroid location and the second centroid location of the EP wave that may generate the EP signal and presents the centroid propagation vector to the user. The centroid calculation typically includes calculating a weighted average of each centroid location using two or more LAT values ​​for each segment as weights.

[0028] In some clinical situations, such as in reentrant arrhythmias, the velocity vector oscillates in direction (backward and forward) when the catheter is in a roughly fixed position. This often occurs when the catheter is at a junction where the waves actually alternate in direction, for example, due to the waves encountering abnormal unidirectional propagation blocking tissue. In this case, the processor calculates an additional vector and can display these two vectors on the screen as two arrows that are distinguished by different brightness / thickness / length / color according to the relative magnitude of the EP waves.

[0029] Typically, the processor is programmed in software containing specific algorithms that enable the processor to perform each of the processor-related steps and functions described above.

[0030] The disclosed systems and methods for efficient derivation and clear presentation of the propagation direction of EP waves can improve catheter-based arrhythmia diagnosis and treatment protocols.

[0031] System Description

[0032] Figure 1Schematic illustration of an electrophysiological (EP) mapping system 10 including different possible multi-electrode catheters according to an embodiment of the present invention. The system 10 can be configured to analyze essentially any physiological parameter or combination of such parameters. In the description herein, it is assumed, by way of example, that the signals analyzed are intracardiac electrocardiogram potential-time relationships. In order to fully characterize such relationships, the signals at various locations need to be referenced to each other in time, such as is accomplished during LAT map generation. Time referencing is accomplished by measuring relative to a reference time (e.g., instant in time), such as the start of each QRS complex of an ECG reference signal (i.e., the start of each heartbeat). Methods for generating LAT maps are described in the aforementioned U.S. Patent No. 9,050,011.

[0033] As described above, the system 10 includes a multi-electrode catheter, which may be a basket catheter 14 or a multi-arm catheter 114 (eg, a PentaRay TM catheter), both of which are Figure 1 37. The following description will refer to the above catheter options collectively as "catheters 14 / 114," meaning that the embodiments described below are applicable to any of these multi-electrode catheter types. Each catheter tip 14, 114 extends along a longitudinal axis LL.

[0034] The multi-electrode catheter 14 / 114 is inserted by a physician 32 through the patient's vascular system into a chamber or vascular structure of the heart 12. The physician 32 brings the distal tip 18 / 118 of the catheter into contact with the wall tissue 19 of the cardiac chamber 21 at the EP mapping target tissue site (e.g., by pressing the tip distally against the wall tissue). The catheter typically includes a handle 20 having suitable control devices that enable the physician 32 to steer, position, and orient the distal end of the catheter as needed for EP mapping.

[0035] The multi-electrode catheter 14 / 114 is coupled to the console 24 so that the physician 32 can observe and adjust the function of the catheter. To assist the physician 32, the distal portion of the catheter may include various sensors, such as a contact force sensor (not shown) and a magnetic sensor 33 / 133 that provides position, direction, and orientation signals to the processor 22 located in the console 24. The processor 22 may perform several processing functions as described below. Specifically, electrical signals may be transmitted back and forth between the heart 12 and the console 24 via the cable 34 from the electrodes 16 / 116 located at or near the distal end 18 of the catheter 14 / 114. Pacing signals and other control signals may be transmitted from the console 24 to the heart 12 via the cable 34 and the electrodes 16 / 116.

[0036] The console 24 includes a monitor 29 driven by the processor 22. Signal processing circuitry in the electrical interface 34 typically receives, amplifies, filters, and digitizes signals from the catheter 14 / 114, including signals generated by the aforementioned sensors and the plurality of sensing electrodes 16. The digitized signals are received and used by the console 24 and the positioning system to calculate the position and orientation of the catheter 14 / 114 and to analyze EP signals from the electrodes 16 / 116, as described in further detail below.

[0037] During the disclosed procedures, the relative positions of the electrodes 16 / 116 are tracked. Tracking can be performed using, for example, a 3D imager manufactured by Biosense-Webster. 3 system. Such a system measures the impedance between the electrodes 16 / 116 and a plurality of external electrodes 30 coupled to the patient's body. For example, three external electrodes 30 may be coupled to the patient's chest and another three external electrodes may be coupled to the patient's back. (For ease of illustration, Figure 1 Only one chest electrode is shown. ) Wire connections 35 connect the console 24 to the body surface electrodes 30 and other components of the positioning subsystem for measuring the position and orientation coordinates of the catheter 14 / 114. The method of tracking the position of the electrode 16 based on electrical signals (called active current location (ACL)) is implemented in various medical applications, such as in the above 3 system. Details of the ACL subsystem and method are provided in U.S. Patent No. 8,456,182, which is assigned to the assignee of the present patent application and the disclosure of which is incorporated herein by reference and a copy is provided in the Appendix.

[0038] In some embodiments, in addition to or in lieu of the ACL tracking subsystem, system 10 includes a magnetic positioning tracking subsystem that determines the position and orientation of magnetic sensor 33 at the distal end of catheter 14 / 114 by generating magnetic fields in a predefined workspace using field generating coils 28 and sensing these fields at the catheter. Because electrodes 16 / 116 have known positions on arms 15 / 115 and have known relationships to each other, once catheter 14 / 114 is magnetically tracked in the heart, the position of each of electrodes 16 / 116 in the heart becomes known. Suitable magnetic positioning tracking subsystems are described in U.S. Patents 7,756,576 and 7,536,218, which are assigned to the assignee of the present patent application and whose disclosures are incorporated herein by reference and copies are provided in the Appendix.

[0039] Based on the EP signals from electrodes 16 / 116 having tracked positions, an electrical activation map may be prepared according to the methods disclosed in U.S. Patents 6,226,542, 6,301,496, and 6,892,091, which are assigned to the assignee of the present patent application and whose disclosures are incorporated herein by reference and copies are provided in the Appendix.

[0040] The processor 22 operates the system 10 using software stored in the memory 25. The software may be downloaded to the processor 22 in electronic form over a network, for example, or alternatively or in addition, the software may be provided and / or stored on a non-transitory tangible medium such as magnetic, optical, or electronic memory. Specifically, the processor 22 executes the software disclosed herein, including Figure 4 , which enables the processor 22 to perform the disclosed steps, as further described below.

[0041] Figure 1 The exemplary illustrations shown are chosen solely for conceptual clarity. Other types of EP sensing geometries may also be employed, such as the balloon catheter including electrode segments described in U.S. patent application Ser. No. 16 / 708,285, filed Dec. 9, 2019, entitled “Catheter with Plurality of Sensing Electrodes Used as Ablation Electrodes” (Attorney Docket No. BIO6163USNP), the disclosure of which is incorporated herein by reference (a copy is provided in the Appendix).

[0042] The system 20 typically includes additional modules and elements that are not directly related to the technology disclosed in the present invention and therefore the additional modules and elements are not directly related to the technology disclosed in the present invention. Figure 1 The elements of system 20 and the methods described herein may further be applied to, for example, control ablation of tissue of heart 12 .

[0043] Analyzing multi-electrode catheter signals to determine EP wave propagation vectors

[0044] Figure 2A and Figure 2B For contacting tissue and measuring electrophysiological (EP) signals according to an embodiment of the present invention Figure 1 Schematic distal views of electrodes 16 / 116 of one of the catheters of FIG. These figures further illustrate tissue 50 as viewed in a distal direction from a location proximal to the spine or arms on the axis LL of the catheter and distal portions 40 of the spines or arms 15 / 115 of the catheter 14 / 114 pressed against the tissue 50. The spines or arms 15 / 115 are coupled together at the distal tips 18 / 118 of the catheters.

[0045] In some embodiments, the processor 22 divides the spine / arm into two segments using a virtual plane 55 that includes the axis LL of the catheter. The processor 22 may select the segment, i.e., the plane 55, arbitrarily or according to a selection criterion. For example, the virtual plane 55 is configured to intersect with the central longitudinal axis LL of the catheter and may not intersect with any of the spines or arms of the catheter 14 or 114. The processor then calculates the LAT value at the electrode position in each segment using the EP signal acquired from each electrode 16 / 116. The processor 22 then finds which of the two segments (S1 or S2) is characterized by a lower average LAT value (e.g., has a lower average LAT value in the two segments), and which segment is characterized by a higher average LAT value (e.g., has a higher average value in the two segments).

[0046] exist Figure 2A In the embodiment shown, a virtual plane 55 divides the spine or arm into two segments: a first segment S1 having a lower average LAT value and another segment or second segment S2 having a higher average LAT value. The first segment S1 is determined by the processor to find the minimum LAT value, and its location is determined to be at point 60 (which may be the location of a sensing electrode on the spine or arm of the catheter 14 or 114). For the other segment or second segment S2 having a higher average LAT value, the processor finds the maximum LAT value and its location 66 (which may be the location of a sensing electrode on the spine or arm of the catheter 14 or 114). Locations 60 and 66 are referred to herein as "representative locations" because each of them represents its entire corresponding segment with a single data point.

[0047] Based on the known displacement (distance and direction) and the known time (difference in LAT values) between the two representative locations, the processor calculates the velocity vector (speed and direction) of the EP wave 100 that generates the signal as it propagates through the tissue beneath the catheter. The processor can then draw an arrow 65 corresponding to the vector on a map of the cardiac chamber and display it on the display screen 29. The length of the arrow 65 and / or its color can be set to correspond to the speed.

[0048] exist Figure 2B In the embodiment shown, rather than calculating the velocity vector from the minimum in the LAT values ​​at the segment with the lower average LAT value to the maximum in the LAT value at the segment with the higher average LAT value, the vector is calculated between the centroid positions of the lower average LAT value and the higher average LAT value, where the centroid position is found using the following formula:

[0049] Formula 1

[0050] exist Figure 2BIn , by way of example, for each centroid position, i = 1, 2. That is, the centroid wall tissue position 70 is calculated by Equation 1 using the LAT values ​​and the corresponding positions 68 and 72, and the centroid wall tissue position 80 is calculated using the LAT values ​​and the corresponding positions 78 and 82. The processor may then draw an arrow 75 corresponding to the vector between positions 70 and 80. Thus, in Figure 2B In the example of , the centroids of the two segments (positions 70 and 80) are used as representative positions. In alternative embodiments, the processor 22 may select representative positions in the two segments in any other suitable manner.

[0051] Figure 2A and Figure 2B The illustrations in FIG. 1 are conceptual and are given by way of example. The actual catheter structure may vary. For example, the number of ridges or arms may be greater than shown.

[0052] Figure 3 According to another embodiment of the present invention, a device for contacting tissue and measuring electrophysiological (EP) signals Figure 1 Schematic distal view of the electrode 16 / 116 of one of the catheters. Catheter 14 / 114 is arranged with Figure 2A and Figure 2B Same as CT, but the catheter is placed at a different tissue location where EP wave reflection occurs.

[0053] As mentioned above, in the case of reentrant arrhythmias, the velocity vector at this area may oscillate in direction (backward and forward). This typically occurs in situations where the catheter is at a junction where the EP wave 100 actually alternates in direction, for example, due to the wave encountering abnormal unidirectional propagation blocking tissue 52. In this case, the two EP wave vectors (one being the incident EP wave 100 and the other being the reentrant EP wave 102) may be displayed on the screen as two corresponding arrows 95 and 97, each having a different brightness / thickness / length / color depending on the relative magnitude of the EP waves. Figure 3 In, use Figure 2B A corresponding vector points from the center of mass position 90 to the center of mass position 99 , and another vector points from the center of mass position 91 to the center of mass position 97 .

[0054] Figure 4 A flow chart schematically illustrates a method and algorithm for estimating and presenting a propagation vector of an electrophysiological (EP) wave 100, according to an embodiment of the present invention. According to the presented embodiment, the algorithm performs the following process, which begins at a catheter placement step 400 where the physician 30 presses the catheter 14 / 114 against a region of cardiac tissue to bring portions of the electrodes 16 / 116 into contact with the tissue.

[0055] Then, at a measurement step 402 , the system 10 measures the electrode location on the wall tissue 19 of the heart chamber 21 and the corresponding EP signal set at that location generated by the EP wave 100 .

[0056] Next, at a region division step 404 , the processor 22 arbitrarily divides the region into two sections.

[0057] Next, at a LAT calculation step 406 , processor 22 calculates the LAT value at each electrode location.

[0058] Next, the processor 22 calculates the average LAT value for each segment at an average LAT calculation step 408. Typically, the average LAT value for one segment is lower than for another segment.

[0059] Next, at the average LAT position calculation step 410, the processor 22 uses Figure 2B The method described calculates the centroid locations of the lower mean LAT value and the upper mean LAT value.

[0060] At a vector calculation step 414 , using the centroid position, processor 22 calculates the centroid EP wave propagation vector of EP wave 100 .

[0061] Finally, at a propagation vector presentation step 410, processor 22 superimposes (eg, draws) arrows corresponding to the vectors on the map of the cardiac chambers, as shown in FIG. Figure 1 29. The length of the arrow 65 or 75 and / or its color can be set to correspond to the speed.

[0062] Figure 4 The exemplary flow chart shown in is chosen solely for the purpose of conceptual clarity. This embodiment also includes additional steps of the algorithm, such as operating other sensors mounted on the catheter (such as contact force sensors), which have been intentionally omitted from the disclosure herein in order to provide a more simplified flow chart.

[0063] It should be understood that the above embodiments are cited by way of example, and the present invention is not limited to what is specifically shown and described above. On the contrary, the scope of the present invention includes combinations and subcombinations of the various features described above, as well as variations and modifications thereof, which will occur to those skilled in the art upon reading the above description and which are not disclosed in the prior art. The documents incorporated by reference into this patent application are considered to be an integral part of this application, except that if any term defined in these incorporated documents conflicts with a definition explicitly or implicitly given in this specification, only the definition in this specification should be considered.

Claims

1. A method for electrophysiological mapping, comprising: receiving (i) a plurality of electrophysiological signals acquired by a plurality of electrodes of a multi-electrode catheter in contact with tissue in the region of a cardiac chamber, and (ii) corresponding tissue locations at which the electrodes acquired the electrophysiological signals; dividing the area into two sections; calculating the local activation time value of the corresponding tissue position using the electrophysiological signal acquired by the electrode, and finding a first segment having a smaller average local activation time value among the two segments and a second segment having a larger average value among the two segments; determining a first representative position in the first segment and a second representative position in the second segment; calculating a propagation vector between the first representative position and the second representative position indicating propagation of an electrophysiological wave that has generated the electrophysiological signal; as well as The propagation vector is presented to the user in graphical form.

2. The method according to claim 1, wherein Presenting the propagation vectors includes superimposing arrows on a map of the cardiac chamber.

3. The method according to claim 2, wherein: Superimposing the arrow includes using a graphical characteristic of the arrow to indicate a rate of the electrophysiological wave between the first representative location and the second representative location.

4. The method according to claim 3, wherein: The graphical characteristics of the arrow include one or more of: color, length, width, or graphical pattern. 5 . The method according to claim 1 , and comprising calculating an additional propagation vector of the reentrant electrophysiological wave if the reentrant electrophysiological wave is detected.

6. A method according to claim 5 and comprising superimposing additional arrows on the map of the cardiac chamber.

7. The method according to claim 6, wherein: Superimposing the additional arrow includes using graphical characteristics of the additional arrow to indicate at least one of: a local activation time difference and a reentry cycle time of the reentrant electrophysiological wave.

8. The method according to claim 1, wherein Determining the first representative position includes determining a tissue position having a minimum local activation time value among the tissue positions in the first segment, and wherein determining the second representative position includes determining a tissue position having a maximum local activation time value among the tissue positions in the second segment.

9. The method according to claim 1, wherein Determining the first representative position includes calculating a first center of mass of the tissue position in the first segment, and wherein determining the second representative position includes calculating a second center of mass of the tissue position in the second segment.

10. The method according to claim 9, wherein: Calculating the first centroid includes calculating a first weighted average of the tissue positions in the first segment using two or more of the local activation time values ​​of the first segment as weights, and calculating the second centroid includes calculating a second weighted average of the tissue positions in the second segment using two or more of the local activation time values ​​of the second segment as weights.

11. A system for electrophysiological mapping, comprising: an interface configured to receive (i) a plurality of electrophysiological signals acquired by a plurality of electrodes of a multi-electrode catheter in contact with tissue in the region of a cardiac chamber, and (ii) corresponding tissue locations at which the electrodes acquired the electrophysiological signals; and a processor configured to: dividing the area into two sections; calculating the local activation time value of the corresponding tissue position using the electrophysiological signal acquired by the electrode, and finding a first segment having a smaller average local activation time value among the two segments and a second segment having a larger average value among the two segments; determining a first representative position in the first segment and a second representative position in the second segment; calculating a propagation vector between the first representative position and the second representative position indicating propagation of an electrophysiological wave that has generated the electrophysiological signal; as well as The propagation vector is presented to a user.

12. The system according to claim 11, wherein The processor is configured to present the propagation vector by superimposing an arrow on a map of the cardiac chamber.

13. The system according to claim 12, wherein: The processor is configured to use the graphical properties of the arrow to indicate a rate of the electrophysiological wave between the first representative location and the second representative location.

14. The system according to claim 13, wherein: The graphical characteristics of the arrow include one or more of: color, length, width, or graphical pattern.

15. The system according to claim 11, wherein The processor is further configured to calculate an additional propagation vector of the reentrant electrophysiological wave when a reentrant electrophysiological wave is detected.

16. The system according to claim 15, wherein: The processor is further configured to superimpose additional arrows on the map of the cardiac chamber.

17. The system according to claim 16, wherein: The processor is configured to use the graphical properties of the additional arrows to indicate at least one of: a local activation time difference and a reentry cycle time of the reentrant electrophysiological wave.

18. The system according to claim 11, wherein: The processor is configured to determine the first representative position by determining the tissue position having the minimum local activation time value among the tissue positions in the first segment, and to determine the second representative position by determining the tissue position having the maximum local activation time value among the tissue positions in the second segment.

19. The system according to claim 11, wherein: The processor is configured to determine the first representative location by calculating a first centroid of the tissue location in the first section, and to determine the second representative location by calculating a second centroid of the tissue location in the second section.

20. The system of claim 19, wherein: The processor is configured to calculate the first centroid by calculating a first weighted average of the tissue positions in the first segment using two or more of the local activation time values ​​of the first segment as weights, and to calculate the second centroid by calculating a second weighted average of the tissue positions in the second segment using two or more of the local activation time values ​​of the second segment as weights.

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