Real-time evaluation of rejection filters during cardiac mapping

Abstract

Real-time assessment of reject filters during cardiac mapping. A system is disclosed that includes a display and a processor. The processor is configured to (a) receive a plurality of electrophysiology (EP) signals acquired by a plurality of electrodes of a multi-electrode catheter in contact with tissue of a heart chamber, (b) reject one or more of the EP signals using a set of rejection criteria, and further process the EP signals that are not rejected, and (c) visualize to a user on the display: (i) a current setting of the rejection criteria, and (ii) a rejection effectiveness of each of the rejection criteria at the current setting.

Description

Technical Field

[0001] The present invention relates generally to cardiac electrophysiology (EP) mapping, and more particularly to a graphical user interface (GUI) for cardiac EP mapping. Background Technology

[0002] Various techniques for visually analyzing electrophysiological (EP) data are reported in patent literature. For example, U.S. Patent 8,478,393 describes a method for visualizing electrophysiological data representing electrical activity on the surface of an organ over a period of time. In response to a user selection, an interval within that time period is chosen. In response to the user's selection of the interval, a visual representation of the physiological information for the user-selected interval is generated by applying at least one method to the data. This visual representation is spatially represented on a graphical representation of a predetermined region on the surface of the organ. Summary of the Invention

[0003] The embodiments of the present invention described below provide a system including a display and a processor. The processor is configured to (a) receive multiple electrophysiological (EP) signals acquired by multiple electrodes of a multi-electrode catheter in contact with tissue of the heart chamber, (b) reject one or more EP signals among the EP signals using a set of rejection criteria, and further process the EP signals that were not rejected, and (c) visualize to a user on the display: (i) the current settings of the rejection criteria, and (ii) the rejection validity of each rejection criterion under the current settings.

[0004] In some implementations, the system also includes an input device, and the processor is configured to receive user input via the input device, which in response to visualized rejection validity, reconfigure the settings of one or more rejection criteria among the rejection criteria.

[0005] In some implementations, the processor is configured to visualize rejection validity by plotting at least some of the EP signals and to mark rejected EP signals with a flag indicating the rejection criteria used to reject the EP signals.

[0006] In other embodiments, the processor is configured to visualize rejection effectiveness by graphically displaying multiple electrodes of the multi-electrode conduit, and for rejected EP signals, to visualize rejection effectiveness by marking the electrodes used to acquire the rejected EP signals with a label indicating the rejection criteria used to reject the EP signals.

[0007] In one embodiment, the processor is further configured to graphically show the orientation of the multiple electrodes relative to the anatomical structures of the heart chamber.

[0008] In some implementations, the processor is configured to visualize rejection validity in real time. In other implementations, the processor is configured to use the same graphical features to visualize a given rejection criterion and the validity of that rejection.

[0009] In one implementation, the graphic features include one or more of the following: color and pattern.

[0010] According to another embodiment of the invention, a method is further provided, comprising receiving multiple electrophysiological (EP) signals acquired by multiple electrodes of a plurality of electrode catheters in contact with tissue of the heart chamber. One or more EP signals are rejected using a set of rejection criteria, and the unrejected EP signals are further processed. Visualized to the user on a display are: (i) the current settings of the rejection criteria and (ii) the rejection validity of each rejection criterion under the current settings.

[0011] According to another embodiment of the invention, a computer software product is also provided, the product comprising a tangible non-transitory computer-readable medium therein storing program instructions that, when read by a processor in a computing system, cause the processor to: (a) receive a plurality of electrophysiological (EP) signals acquired by a plurality of electrodes of a multi-electrode catheter in contact with tissue of the heart chamber; (b) reject one or more of the EP signals using a set of rejection criteria, and further process the EP signals that were not rejected; and (c) visualize to a user on a display: (i) the current settings of the rejection criteria and (ii) the rejection validity of each of the rejection criteria under the current settings. Attached Figure Description

[0012] The invention will be more fully understood through the following detailed description of embodiments thereof, taken in conjunction with the accompanying drawings, wherein:

[0013] Figure 1 This is a schematic diagram of an electrophysiological (EP) mapping system including different possible multi-electrode catheters according to an exemplary embodiment of the present invention;

[0014] Figure 2 According to an exemplary embodiment of the present invention Figure 1 A schematic diagram of the graphical user interface (GUI) of an electrophysiological (EP) mapping system; and

[0015] Figure 3 For illustrative purposes, an exemplary embodiment of the present invention is shown for use. Figure 2 A flowchart of a method for real-time differentiation of filters using a graphical user interface (GUI). Detailed Implementation

[0016] Overview

[0017] Probe-based (e.g., catheter-based) cardiac diagnostic and therapeutic systems can measure multiple intracardiac electrophysiological (EP) signals, such as electrograms (EGM), during invasive procedures. Such systems use multiple electrodes (hereinafter also referred to as “distal electrodes”) mounted at the distal end of the probe to acquire multiple intracardiac signals. In most cases, the analysis of the acquired EP signals is performed (automatically) in a continuous mode to enable the processing of large amounts of EP information.

[0018] Automation of analysis typically involves automatically applying rejection criteria (e.g., using automated “filtering” to avoid using “wrong” channels (e.g., irrelevant, too noisy) at any given time). Therefore, the physician performing the procedure needs to set “good” filtering criteria so that only “good” (e.g., relevant, stable) channels are analyzed. Measured and filtered signals can be analyzed in real time to provide physicians with visual cardiac information, such as 3D mapping of pathological electrical patterns within the patient’s heart. 3D mapping can be used to support corrective medical procedures, such as in-situ ablation (e.g., using the same catheter). In addition, or alternatively, the measured and filtered signals can then be analyzed, for example, offline.

[0019] More specifically, to reduce the time required for endocardial mapping (e.g., acquiring ventricular EGM signals), catheters carrying a large number of electrodes (e.g., 256), such as basket catheters, can be used. The acquired signals should generally undergo rejection criteria to remove potentially incorrect (e.g., unstable) or irrelevant signals (e.g., acquired from the blood pool rather than the chamber surface). For a large number of electrodes, rejection criteria can be applied automatically by setting the levels of individual filter scales shown on the display. However, it can be difficult for physicians to determine whether the filter settings are appropriate or whether too many signals are being rejected.

[0020] The embodiments of the invention described below provide a real-time visual assessment of the effectiveness of rejection criteria. In some embodiments, a graphical user interface (GUI) provides a preferences window that displays different rejection criteria (e.g., filters with adjustable scales) that can be adjusted by the physician. Another GUI window displays EP signals acquired by the corresponding electrodes of a multi-electrode catheter. Whenever a filter rejects an acquired EP signal, the signal is marked by a unique graphic (e.g., color) representing, for example, the scale of the filter whose EP signal was rejected.

[0021] In another embodiment, a third window of the GUI displays electrodes associated with the anatomical surface being mapped. The electrodes are patterned (e.g., colored) by the disclosed GUI, which has a unique pattern of the same filters and corresponding rejected EP signals. In other words, when a filter rejects an acquired EP signal, the electrode used to acquire the signal is marked by the unique pattern of the filter that rejected the signal.

[0022] Alternatively, the validity of the rejection criteria can be visualized to physicians in any other suitable manner.

[0023] All or part of the visualization methods described above allow physicians to investigate and modify the filter scale (e.g., toggle the level of the filter scale) to easily optimize filter settings. Therefore, the disclosed techniques allow for the visualization in real time of how each filter standard affects the signals to be used for mapping and those signals that will not be used.

[0024] In some implementations, rejection criteria (e.g., filter scaling limits) can be modified by toggling a threshold or a range (e.g., by toggling a lower and upper limit) to generate criteria for signal rejection. The processor of the calibration system compares the real-time value of each data point (e.g., annotated signal) with the toggled criteria and uses it accordingly to reject or accept the data point.

[0025] For example, in one embodiment, any captured data points with a bipolar voltage amplitude value below the toggle's signal amplitude threshold (e.g., below 0.1 mV) are filtered out (i.e., rejected), while the acquiring electrode pair, channel, and waveform are assigned the same color as the corresponding filter. In a second embodiment, any captured data points with a cycle length outside the toggle's range (e.g., between 600 ms and 900 ms) are filtered out, and the electrodes, channel, and waveform are assigned the same color as the filter.

[0026] In the third embodiment, any data point captured using the standard toggle is considered an outlier (e.g., outside the toggle range of pre-specified parameters from data points from surrounding electrodes) and is filtered out, and the electrodes, channels, and waveforms are assigned the same color as the corresponding filters. In the fourth embodiment, the current position of any captured data point located at a toggle value (e.g., 2 mm) greater than the previous position of the electrode is filtered out, and the electrodes, channels, and waveforms currently being captured are assigned the same color as the corresponding filters.

[0027] Other rejection criteria (e.g., filtering) can also be used to reject data points in real time using similar visualizations for rejection. These additional filtering criteria include unstable local activation time (LAT) values, weak physical contact between the electrode and tissue, and low measurement impedance (e.g., blood impedance rather than tissue impedance). After rejection, the corresponding electrode and signal are assigned the same color as the rejection filter.

[0028] In one embodiment, the disclosed GUI visualizes to the user on a display: (i) the current settings of the rejection criteria and (ii) the rejection validity of each rejection criterion under the current settings. The processor can visualize rejection validity by plotting at least some of the EP signals and marking rejected EP signals with tags indicating the rejection criteria used to reject the EP signals. Similarly, the processor can visualize rejection validity by graphically displaying multiple electrodes of a multi-electrode catheter and, for rejected EP signals, marking the electrodes used to acquire the rejected EP signals with tags indicating the rejection criteria used to reject the EP signals.

[0029] For example, icons in the GUI summarize the actions of different filters; for instance, a "funnel" icon is used to "pour" filter statistics (e.g., pouring them into a "measuring tube" icon). Information about the validity of the funnel icon is encoded in two parts: one part shows how many channels the user has filtered by which filters (represented by the colored portion of the funnel, which is graphically encoded as the corresponding filter color), and the other part shows the primary filter using encoded text attached to the filtered channels.

[0030] In another implementation, the color bar on the GUI uses the same graphic (e.g., color) of the filter to show the percentage of data points that passed through each filter type for a given filter.

[0031] In some implementations, physicians use input devices such as computer mice to reconfigure settings for one or more rejection criteria in response to visualized rejection validity, for example, by changing the range within the signal in a filter scale to accept and further process it.

[0032] By providing a GUI that includes a set of filter scales that can be adjusted in real time (e.g., toggled), physicians can optimize the quality of analysis in situ (during EP mapping), thereby improving the diagnostic quality of invasive procedures.

[0033] System Description

[0034] Figure 1This is a schematic illustration of an electrophysiological (EP) mapping system 10 comprising various possible multi-electrode catheters according to an exemplary embodiment of the present invention. System 10 can be configured to analyze substantially any physiological parameter or combination of such parameters. In the description herein, by way of example, it is assumed that the signal being analyzed is a cardiac electrophysiological potential-time relationship. To adequately characterize such a relationship, the signals at various locations must be temporally referenced to each other, such as during LAT mapping generation. This temporal reference is accomplished by measuring relative to a reference time (e.g., a moment) (such as the start of each QRS complex of an ECG reference signal (i.e., the start of each heartbeat)). A method for generating a LAT mapping is described in U.S. Patent 9,050,011, cited above.

[0035] As described above, system 10 includes a multi-electrode conduit, which, among many possible options, can be a basket conduit 14 or a multi-arm conduit 114 (e.g., PentaRay). TM Both catheters are shown in Figure 37. The following description is collectively referred to as the catheter option “catheter 14 / 114”, which means that the embodiments described below are applicable to any of these multi-electrode catheter types.

[0036] The multi-electrode catheter 14 / 114 is inserted by physician 32 through the patient's vascular system into a chamber or vascular structure of the heart 12. Physician 32 contacts the distal end 18 / 118 of the catheter with the wall tissue 19 of the heart chamber 21 at the target tissue site for EP mapping (e.g., by pressing the distal end against the wall tissue). The catheter typically includes a handle 20 with suitable controls to allow physician 32 to manipulate, position, and orient the distal end of the catheter 14 as required for EP mapping.

[0037] The multi-electrode catheter 14 / 114 is coupled to a control console 24, which allows physician 32 to observe and adjust catheter function. To assist 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 provide position, orientation, and direction signals to a processor 22 located in the control console 24. The processor 22 can perform several processing functions as described below. Specifically, electrical signals can be transmitted via cable 31 from electrodes 16 / 116 located at or near the distal end 18 / 118 of the catheter 14 / 114, between the heart 12 and the control console 24. Pacing signals and other control signals can be transmitted from the control console 24 to the heart 12 via cable 31 and electrodes 16 / 116.

[0038] The console 24 includes a monitor 29 driven by the processor 22. Signal processing circuitry in the electrical interface 34 typically receives, amplifies, analog-filters, and digitizes signals from catheters 14 / 114 to generate multiple digital signals, including those generated by the aforementioned sensing electrodes 16 / 116. The digitized signals are received and used by the console 24 and the positioning system to calculate the position and orientation of catheters 14 / 114, and to analyze the EP signals from electrodes 16 / 116 in further detail below.

[0039] During the EP mapping procedure, a tracking system is used to track the intracardiac location of the distal electrodes 16 / 116 such that each of the acquired EP signals can be associated with a known intracardiac location. An example of such a tracking system is the Active Current Location (ACL) described in U.S. Patent Application 8,456,182, which has been assigned to the assignee of this patent application and the disclosure of which is incorporated herein by reference. In the ACL system, the processor estimates the corresponding location of the distal electrodes 16 / 116 based on impedance measured between each of the distal electrodes 16 / 116 and a plurality of surface electrodes 30 coupled to the patient's skin and wiredly connected (35) to the console 24. The processor can then associate any electrophysiological signals received from the distal electrodes 16 / 116 with the location of the acquired signals.

[0040] In an alternative embodiment, position measurement can also be accomplished by applying a voltage gradient between the pairs of surface electrodes 30 and using the potential gradient obtained by measuring the distal electrode 16 / 116.

[0041] In some embodiments, in addition to or instead of the ACL tracking subsystem, system 10 includes a magnetic positioning tracking subsystem that determines the position and orientation of a magnetic sensor 33 at the distal end of catheter 14 / 114 by generating a magnetic field in a predefined workspace using field generating coil 28 and sensing these fields at the catheter. Since electrodes 16 / 116 have known positions on arms 15 / 115 and known relationships with each other, the position of each electrode in the heart becomes known once catheter 14 / 114 is magnetically tracked in the heart. 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 this patent application, and the disclosure of which is incorporated herein by reference.

[0042] Based on the EP signal from electrodes 16 / 116 with tracking positions, an electroactivation mapping can 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 this patent application and whose disclosures are incorporated herein by reference.

[0043] Processor 22 operates system 10 using software stored in memory 25. This software may be downloaded to processor 22, for example, electronically via a network, or alternatively, it may be provided and / or stored on a non-transitory tangible medium such as magnetic storage, optical storage, or electronic storage. Specifically, processor 22 runs the software disclosed herein, including... Figure 3 The dedicated algorithm enables processor 22 to perform the disclosed steps, as further described below.

[0044] Processor 22 includes a signal processing unit 42 configured to digitally filter multi-channel signals and extract corresponding annotation parameters from the signals. The digital filter of unit 42 may use an input device such as a computer mouse 43, a keyboard, and a touch display, and uses a graphical user interface (GUI) 44 for diagnostics to accept or reject electrogram signals based on the diagnostic level of the digital filter. Figure 2 As shown. For example, examples of filter levels toggled include cycle length, LAT stability, and minimum signal voltage.

[0045] Figure 1 The exemplary examples shown are chosen solely for clarity of concept. Other types of EP sensing geometries may also be employed, such as the balloon catheter including electrode segments described in U.S. Patent Application 16 / 708285, filed December 9, 2019, entitled Catheter with Plurality of Sensing Electrodes Used as Ablation “Electrodes”, the disclosure of which is incorporated herein by reference.

[0046] Other types of catheters can also be used, such as The catheter (manufactured by Biosense-Webster) can be used in a similar manner to other types of electrodes, such as those used for ablation, to acquire intracardiac electrophysiological signals.

[0047] System 10 typically includes additional modules and components that are not directly related to the disclosed technology, and therefore these additional modules and components are derived from... Figure 1The corresponding descriptions are intentionally omitted. The elements of system 10 and the methods described herein can be further applied, for example, to the ablation of tissues of the heart 12.

[0048] Real-time regional filtering during cardiac mapping

[0049] Figure 2 According to an exemplary embodiment of the present invention Figure 1 A schematic diagram of the graphical user interface (GUI) 44 of the electrophysiological (EP) mapping system 10. In the illustrated embodiment, the GUI 44 includes a filter scale 55 that can be adjusted by the user during EP mapping.

[0050] In the illustrated implementation, GUI 44 displays three windows (52, 54, and 56). Window 52 shows a basket-shaped catheter 14 within chamber 21, which is used for EP mapping of the wall tissue of chamber 21 to, for example, detect arrhythmogenic tissue. The catheter is shown with its multiple electrodes oriented relative to the anatomy of the heart chamber. As shown, some of the catheter's electrodes are coded with unique graphics, the same codes used by the filters in window 54.

[0051] Window 54 displays a user preference menu including different filter scales 55, with the corresponding filter names appearing on the left. The corresponding checkboxes allow the user to activate or deactivate each filter.

[0052] Each enabled filter has a color-coded name (51) and a unique graphic (e.g., codes 540, 542, 544, and 546). Electrodes with filtered signals are encoded with the unique graphic of the filter (e.g., codes 520, 522, 524, and 526), ​​as can be seen by way of example in the following embodiments:

[0053] The electrode, coded by pattern 520, causes the acquired signal to be rejected by the minimum voltage filter coded by pattern 540.

[0054] The electrode, encoded by pattern 522, causes the acquired signal to be rejected by a loop length range filter encoded as 542.

[0055] The acquisition signal from the electrode encoded by Figure 524 was rejected by an unstable LAT value filter encoded as 544.

[0056] The acquisition signal of the electrode encoded by graphic 526 is rejected by the unstable electrode position filter encoded by 546.

[0057] Window 56 displays the acquired electrorecord 66 and the filtered electrorecords, which are assigned the same graphical codes as the filters that rejected them (e.g., via codes 560, 562, 564, and 566). As seen in window 56, electrorecords are typically annotated at or near the QRST complex of the heartbeat captured by the electrorecords, by points graphically coded at the locations where analysis is performed on the electrorecord portions.

[0058] In one implementation, the user receives a summary of filter actions at any given time, selected via pressing icon 57 in the preferences menu, in the form of icon 67. As shown, icon 67 has a funnel icon 68 through which filter statistics are “poured” (“poured” into a measurement tube icon, not shown). The information in the funnel icon 68 is encoded in two parts: the first part shows the user how many channels are filtered by which filter, indicated by the number of colored portions of the funnel (the two shown: 69a, 69b, this part is graphically encoded as being identical to the corresponding filter); the second part shows the main filter, indicated by coded text, such as “LAT Stability” for the main filtered channel 69b.

[0059] Figure 2 This is an example presented solely to illustrate the implementation scheme. Actual GUIs are typically much more complex, including many icons and graphics omitted here for simplicity. Similarly, GUI 44 often includes various types of menus and overlapping information omitted for simplification.

[0060] Figure 3 To illustrate the use of the embodiment according to the present invention Figure 2 The flowchart illustrates a method for real-time differentiation of filters using a graphical user interface (GUI). This flowchart describes the workflow, including adjusting the scale of a given filter; however, it should be understood that the user can adjust several filters while investigating the relative contribution of each filter to the total count of the filtered channels.

[0061] According to the presented implementation scheme, the algorithm performs the following process, which begins after the physician 32 inserts the basket catheter 14 into the target tissue location in the heart chamber 21. At the target tissue location, at GUI operation step 80, the physician 32 opens the preferences window 54 on the display 29.

[0062] Next, at the filter menu check step 82, physician 32 checks whether the required filter is enabled. At the filter enable step 84, if the filter is not enabled, physician 32 enables the filter by selecting it (e.g., by clicking a checkbox). At the filter scale toggle step 86, depending on the type of filter (e.g., threshold-based or acceptable range-based filtering), physician 32 adjusts (e.g., dial) one or more limits.

[0063] Next, at channel filtering check step 88, the physician 32 investigates the filtering results. The physician may, for example, investigate the location of tissue affected by the filter operation and the number of channels.

[0064] For example, in electrode filtering check step 90, the physician checks the identification (e.g., location) of electrodes filtered by a given filter in window 52 of GUI 44. These electrodes are easily identifiable because they are encoded by the same graphical code (e.g., color) as the filter, such as... Figure 2 As stated above.

[0065] At scaling adjustment step 94, if physician 32 observes through viewing window 52 that at least a portion of the filtering electrode is actually in the proper position and presumes that a valid signal is being acquired, physician adjusts one or more limits of the filter scale to make the filter less aggressive.

[0066] However, if the physician identifies on window 52 that the filtered electrodes are in the correct position (e.g., they are immersed in blood), the process continues to step 92. At channel filtering check step 92, the physician checks the absolute number or proportion of electrodes filtered out by the filter.

[0067] At scaling adjustment step 94, if physician 32 finds, by looking at icon 67 or by looking at window 56, that at least a portion of the filtered channels is too large and / or the waveform is valid, then physician adjusts one or more limits of the filter scale to make the filter less aggressive.

[0068] The process then returns to step 90 for the physician to verify that the adjusted filter scale does not adversely affect the electrode's filtration.

[0069] The process ends when the physician finds that the identification of the filtered electrodes and the number of channels (e.g., the number of electrodes) are sufficiently optimized.

[0070] Figure 3 The exemplary flowchart was chosen solely for clarity of concept. In an alternative implementation, for example, a physician adjusts the scale of at least one additional filter and investigates the cumulative filtering effect of the two filters.

[0071] It should be understood that the above embodiments are cited by way of example, and the invention is not limited to what has been specifically 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 will occur to those skilled in the art upon reading the above description and which are not disclosed in the prior art. Documents incorporated herein by reference are considered an integral part of this application, except that if any terminology defined in such incorporated documents conflicts with the definitions expressly or implicitly given in this specification, only the definitions in this specification shall be considered.

Claims

1. A cardiac diagnostic and treatment system, comprising: monitor; and Processor, the processor being configured to: It receives multiple electrophysiological signals, i.e., EP signals, acquired by multiple electrodes of a multi-electrode catheter in contact with the tissue of the heart chamber; One or more of the EP signals are rejected using a set of rejection criteria, and the EP signals that are not rejected are further processed. as well as The display visualizes to the user: (i) the current setting of the rejection criteria and (ii) the rejection validity of each rejection criterion under the current setting.

2. The system of claim 1, further comprising an input device, wherein the processor is configured to receive user input via the input device, the user input reconfiguring the settings of one or more of the rejection criteria in response to visualized rejection validity.

3. The system of claim 1, wherein the processor is configured to visualize the rejection validity by plotting at least some of the EP signals, and to mark rejected EP signals with a label indicating a rejection criterion for rejecting the EP signals.

4. The system of claim 1, wherein the processor is configured to visualize the rejection validity by graphically displaying the plurality of electrodes of the multi-electrode conduit and, for rejected EP signals, marking the electrodes used to acquire the rejected EP signals with labels indicating rejection criteria for rejecting the EP signals.

5. The system of claim 4, wherein the processor is further configured to graphically illustrate the orientation of the plurality of electrodes relative to the anatomical structure of the cardiac chamber.

6. The system of claim 1, wherein the processor is configured to visualize the validity of the rejection in real time.

7. The system of claim 1, wherein the processor is configured to use the same graphical features to visualize a given rejection criterion and the rejection validity of the given rejection criterion.

8. The system of claim 7, wherein the graphic features include one or more of the following: color and pattern.

9. A computer software product comprising a tangible, non-transitory computer-readable medium storing program instructions therein, the instructions, when read by a processor of a computing system, causing the processor to: It receives multiple electrophysiological signals, i.e., EP signals, acquired by multiple electrodes of a multi-electrode catheter in contact with the tissue of the heart chamber; One or more EP signals are rejected using a set of rejection criteria, and the EP signals that are not rejected are further processed; and Visualize to the user on the display: (i) the current settings of the rejection criteria and (ii) the rejection validity of each of the rejection criteria under the current settings.

10. The computer software product of claim 9, wherein when the instruction is read by a processor in a computing system, the processor further causes the processor to receive user input via an input device, the user input reconfiguring the settings of one or more of the rejection criteria in response to a visualized rejection validity.

11. The computer software product of claim 9, wherein visualizing the denial effectiveness comprises: At least some of the EP signals are plotted, and the rejected EP signals are marked with a flag indicating the rejection criteria used to reject the EP signals.

12. The computer software product of claim 9, wherein visualizing the denial effectiveness comprises: The plurality of electrodes of the multi-electrode conduit are illustrated graphically, and for rejected EP signals, the electrodes used to acquire the rejected EP signals are marked with a label indicating the rejection criteria used to reject the EP signals.

13. The computer software product of claim 12, wherein the plurality of electrodes are graphically represented as follows: The orientation of the plurality of electrodes relative to the anatomical structure of the heart chamber is illustrated graphically.

14. The computer software product of claim 9, wherein visualizing the denial effectiveness comprises: This allows for real-time visualization of the validity of the rejection.

15. The computer software product of claim 9, wherein visualizing the denial effectiveness comprises: The same graphical features are used to visualize a given rejection criterion and the validity of the rejection based on that criterion.

16. The computer software product of claim 15, wherein the graphic features include one or more of the following: color and pattern.

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