Identifying suspected atrial fibrillation trigger sites based on correlation of signals from multiple electrodes.

Abstract

To improve the visualization of the spatial location of suspected triggers for atrial fibrillation in the electroanatomical map of the heart. [Solution] A composite correlation score associated with a selected spatial location within the heart is determined based on a plurality of individual correlation values, each based on the correlation between the signal associated with a selected electrode located at the selected spatial location and the signal associated with another of the plurality of electrodes when the selected electrode is located at the selected spatial location. Composite correlation scores associated with other selected spatial locations in the heart are determined in the same manner. An electroanatomical map of the heart is displayed depicting information representing the composite correlation scores determined for the selected spatial locations, and this information includes information indicating that the spatial location is a suspected trigger for AF.

Description

Technical Field

[0001] The present invention relates to anatomical mapping. More specifically, the present invention relates to improving the visualization of the spatial location in an electroanatomical map of the heart that represents a suspected trigger for atrial fibrillation.

Background Art

[0002] Atrial fibrillation (AF) occurs when the electrical signals of the heart become disordered, resulting in an irregular and often rapid heartbeat. This can be due to abnormal electrical activity in the atria of the heart, the upper chambers of the heart. Ablation is a medical procedure used to treat AF. The goal of ablation is to restore a normal heart rhythm by targeting and interfering with the abnormal electrical signals that cause AF.

[0003] In catheter ablation, the catheter is inserted through a blood vessel, usually in the groin, and passed to the heart. Once the catheter is placed in a predetermined position, it delivers energy to a specific area of heart tissue. This energy helps to excise the tissue, disrupt the abnormal electrical signals, and restore a normal rhythm.

Summary of the Invention

Problems to be Solved by the Invention

[0004] Some catheter ablation procedures employ techniques for the generation and analysis of electroanatomical maps of the heart. For example, in electrophysiology (EP) procedures such as catheter-based radio frequency (RF) ablation, an anatomical map of the heart chamber is generated and used. In relation to catheter ablation procedures that employ electroanatomical maps of the heart, there is a need for more accurate automated techniques to identify the spatial location on the anatomical map corresponding to suspected triggers of AF as ablation candidates during the procedure. [Means for solving the problem]

[0005] A technique is disclosed for identifying one or more spatial locations corresponding to suspected triggers of AF in the human heart. This technique is performed during an ablation procedure using a catheter with multiple electrodes positioned within the heart. The electrodes collect electrical signals from spatial locations within the heart as the catheter moves within the heart during the procedure. According to this technique, at least one composite correlation score is determined associated with a selected spatial location within the heart. The at least one composite correlation score is based on a plurality of individual correlation values, each individual correlation value based on the correlation between at least one signal associated with a selected electrode positioned at the selected spatial location and at least one signal associated with another of the plurality of electrodes when the selected electrode is positioned at the selected spatial location. At least one composite correlation score is determined for each of the plurality of other selected spatial locations within the heart in the same manner. An electroanatomical map of the heart is displayed, which spatially depicts information representing the composite correlation score determined for each of the selected spatial locations. Information representing the composite correlation score displayed on the electroanatomical map for at least one of the selected spatial locations indicates that at least one of the selected spatial locations corresponds to a suspected trigger for AF.

[0006] In some examples, each individual correlation value is based on the correlation between a first frequency-modulated signal associated with a selected electrode located at a selected spatial position and a second frequency-modulated signal associated with another of several electrodes when the selected electrode is located at a selected spatial position.

[0007] In some cases, at least one composite correlation score corresponds to the average of several individual correlation values.

[0008] In some examples, each individual correlation value is also based on the correlation between a first amplitude-modulated signal associated with a selected electrode located at a selected spatial position and a second amplitude-modulated signal associated with another of several electrodes when the selected electrode is located at a selected spatial position.

[0009] In some examples, two electroanatomical maps of the heart are displayed (for example, side by side). The first map spatially depicts information representing a first composite correlation score determined for each of the selected spatial locations. The first composite correlation score for each of the selected spatial locations is based on a plurality of first individual correlation values, each based on the correlation between frequency-modulated signals. The second map spatially depicts information representing a second composite correlation score determined for each of the selected spatial locations. The second composite correlation score for each of the selected spatial locations is based on a plurality of second individual correlation values, each based on the correlation between amplitude-modulated signals.

[0010] In some examples, at least one signal associated with a selected electrode located at a selected spatial position is generated by collecting a first electrical signal from the selected electrode and applying at least far-field reduction and bandpass filtering to the first electrical signal.

[0011] In some examples, at least one signal associated with a selected electrode located at a selected spatial position is generated by collecting a first electrical signal from the selected electrode, applying signal processing to the first electrical signal to generate a second electrical signal, and converting the second electrical signal to a binary signal.

[0012] In some examples, each individual correlation value is based on a linear correlation between at least one signal derived from a selected electrode positioned at a selected spatial location and at least one signal derived from another of multiple electrodes when the selected electrode is positioned at the selected spatial location.

[0013] In some examples, information representing the composite correlation score displayed on the electroanatomical map for at least one of the selected spatial locations indicates that at least one of the selected spatial locations corresponds to a suspected trigger for AF if the spatial location has a corresponding composite correlation score above a threshold.

[0014] According to one or more embodiments, the exemplary embodiments described above can be implemented as methods, apparatus, systems, and / or computer program products. [Brief explanation of the drawing]

[0015] A more detailed understanding can be obtained from the following explanation, which is given as an example in conjunction with the attached drawings, where similar reference numbers in the drawings indicate similar elements. [Figure 1] This describes exemplary catheter-based electrophysiological mapping and ablation systems in one or more embodiments. [Figure 2] This is a block diagram of an exemplary system for remotely monitoring and communicating biometric data, according to one or more embodiments. [Figure 3] This is a system diagram of an exemplary computing environment communicating with a network, according to one or more embodiments. [Figure 4A] This is a block diagram of an exemplary device that can implement one or more features of the present disclosure in one or more embodiments. [Figure 4B] An example of a linear catheter containing multiple electrodes that can be used to map the cardiac region is shown. [Figure 5] An example of a balloon catheter is shown, which includes multiple splines (for example, 12 splines in the specific example in Figure 5) and multiple electrodes on each spline, which include electrodes. [Figure 6] An example of a loop catheter (also called a lasso catheter) containing multiple electrodes that can be used to map the cardiac region is shown. [Figure 7] An example of a flat multi - electrode catheter that can be used to map the cardiac region is shown according to one example. [Figure 8] One embodiment of a technique for generating a composite correlation score based on electrical signals from a multi - electrode catheter is depicted according to one example. [Figure 9] One embodiment of a technique for generating a composite correlation score based on electrical signals from a multi - electrode catheter is depicted according to a further example. [Figure 10] One embodiment of a technique for generating a composite correlation score based on electrical signals from a multi - electrode catheter is depicted according to a further example. [Figure 11] One example illustrates the generation of a binary signal based on a frequency - modulated signal associated with a catheter electrode. [Figure 12] One example illustrates the generation of a binary signal based on an amplitude - modulated signal associated with a catheter electrode. [Figure 13] One example illustrates a technique for identifying individual correlation values based on frequency - modulated signals associated with two different electrodes of a multi - catheter electrode. [Figure 14] An example of an electroanatomical map depicting composite correlation scores determined for multiple spatial positions within the heart is illustrated according to an example. [Figure 15] A method according to one or more embodiments is depicted.

Best Mode for Carrying Out the Invention

[0016] Disclosed herein is a method and / or system for identifying one or more spatial positions corresponding to suspected triggers of AF in a human heart and displaying the identified spatial positions as part of an electroanatomical mapping of the heart. The method and / or system includes processor - executable code or software that is necessarily rooted in the process operations and hardware processing of a medical device apparatus for performing and using the anatomical mapping.

[0017] Refer to Figure 1, which shows an exemplary system shown as System 10 (e.g., a medical device and / or catheter-based electrophysiological mapping and ablation system) that can implement one or more features of the subject matter of this specification according to one or more embodiments. System 100, in whole or in part, can be used to collect information (e.g., biometric data) and / or to implement techniques as described herein. In some examples, such techniques are implemented using processor-executable code or software stored in the memory of System 10 and necessarily rooted in the process operation of System 10 and the processing hardware of System 10.

[0018] Figure 1 illustrates a recorder 11, a heart 12, a catheter 14, a model or anatomical map 20, an electrograph 21, a spline 22, a patient 23, a physician 24 (representing any medical professional, technician, clinician, operator, clinical support specialist, clinical account specialist, healthcare worker, etc.), a location pad 25, one or more electrodes 26, a display device 27, a distal tip 28, a sensor 29, a coil 32, a patient interface unit (PIU) 30, an electrode skin patch 38, an ablation energy generator 50, and a workstation 55. It should be further noted that each element and / or item of the system 10 represents one or more of its elements and / or items. The exemplary system 10 shown in Figure 1 implements the embodiments disclosed herein. Embodiments of this disclosure can also be similarly applied using other system components and settings. Additionally, system 10 may include additional components, such as elements for sensing electrical activity, wired or wireless connectors, processing and display devices, or other components.

[0019] System 10 includes a plurality of catheters 14 that are percutaneously inserted by a physician 24 into the cardiac chambers or vascular structures of the heart 12 through the patient's vascular system. Typically, a delivery sheath catheter is inserted into the left or right atrium near a desired location within the heart 12. The plurality of catheters can then be inserted into the delivery sheath catheter to reach the desired location. The plurality of catheters 14 may include a catheter dedicated to sensing intracardiac electrogram (IEGM) signals, a catheter dedicated to ablation, and / or a catheter dedicated to both sensing and ablation. An exemplary catheter 14 configured to sense IEGM is illustrated herein. To sense a target site in the heart 12, the physician 24 brings the distal end 28 of the catheter 14 into contact with the heart wall. For ablation, the physician 24 similarly brings the distal end of the ablation catheter to the target site for ablation.

[0020] The catheter 14 is an exemplary catheter comprising multiple electrodes 26 optionally distributed across multiple splines 22 at the distal tip 28 and configured to sense IEGM signals. The catheter 14 may additionally include a sensor 29 embedded in or near the distal tip 28 to track the position and orientation of the distal tip 28. Optionally and preferably, the position sensor 29 is a magnetic-based position sensor comprising three magnetic coils for sensing 3D position and orientation. According to one or more embodiments, the shape and parameters of the catheter 14 vary based on whether the catheter 14 is used for diagnostic or ablation purposes, the type of arrhythmia, the patient's anatomical structure, and other factors affecting the maneuverability of the catheter (e.g., the ability to touch the surface and tracked portion of the catheter 14 without bending). The shape and parameters of the catheter 14 also affect the accuracy of the anatomical map. Large, spherical single-shot catheters that can ablate pulmonary veins within seconds are popular but require guidance from fluoroscopy, CT / MRI, or additional mapping catheters.

[0021] A sensor 29 (e.g., a position-based or magnetic-based position sensor) may work in conjunction with a place pad 25 which includes a plurality of magnetic coils 32 configured to generate a magnetic field within a given working volume. The real-time position of the distal tip 28 of the catheter 14 may be tracked based on the magnetic field generated by the place pad 25 and sensed by the sensor 29. Details of magnetic-based position sensing technology are described in U.S. Patents 5,5391,199, 5,443,489, 5,558,091, 6,172,499, 6,239,724, 6,332,089, 6,484,118, 6,618,612, 6,690,963, 6,788,967, and 6,892,091.

[0022] System 10 includes one or more electrode patches 38 positioned on the patient 23 for skin contact to establish a location reference of the location pad 25 and impedance-based tracking of the electrodes 26. For impedance-based tracking, a current is directed to the electrodes 26 and sensed in the patch 38 (e.g., an electrode skin patch), thereby allowing the location of each electrode to be triangulated through the patch 38. Details of the impedance-based location tracking technique are described in U.S. Patents 7,536,218, 7,756,576, 7,848,787, 7,869,865, and 8,456,182, which are incorporated herein by reference.

[0023] The recorder 11 displays the electrocardiogram 21 captured by the electrode 18 (e.g., an electrocardiogram (ECG) electrode) and the intracardiac electrocardiogram (IEGM) captured by the electrode 26 of the catheter 14. The recorder 11 may include pacing capabilities for pacing the heart rhythm and / or may be electrically connected to a standalone pacer.

[0024] System 10 may include an ablation energy generator 50 adapted to deliver ablation energy to one or more electrodes 26 located at the distal tip 28 of a catheter 14 configured for ablation. The energy produced by the ablation energy generator 50 may include, but is not limited to, radio frequency (RF) energy or pulsed-field ablation (PFA) energy, or a combination thereof, including unipolar or bipolar high-voltage DC pulses that may be used to induce irreversible electroporation (IRE).

[0025] The PIU 30 is an interface configured to establish electrical communication between the catheter, the electrophysiological equipment, the power supply, and the workstation 55 that controls the operation of the system 10. The electrophysiological equipment of the system 10 may include, for example, multiple catheters 14, a location pad 25, a surface ECG electrode 18, an electrode patch 38, an ablation energy generator 50, and a recorder 11. Optionally, and preferably, the PIU 30 additionally includes processing power for implementing real-time calculation of the catheter location and performing ECG calculations.

[0026] The workstation 55 includes memory, a processor unit having memory or storage device loaded with appropriate operating software, and user interface functions. The workstation 55 may optionally provide several functions, including: modeling endocardial anatomical structures in three dimensions (3D) and rendering the model or anatomical map 20 (e.g., visualization) for display on a display device 27; displaying activation sequences (or other data) compiled from recorded electrographs 21 on the display device 27 as representative visual indicators or images superimposed on the rendered anatomical map 20; displaying the real-time location and orientation of multiple catheters within the cardiac chambers; and displaying sites of interest, e.g., where ablation energy is applied, on the display device 27. In some examples described below, the rendered electroanatomical map spatially depicts information representing a composite correlation score determined for selected spatial locations, such information indicating one or more spatial locations corresponding to suspected triggers of AF. One commercially available product embodying the elements of System 10 is the CARTO® 3 system, available from Biosense Webster, Inc. (31A Technology Drive, Irvine, CA, 92618). Note that 3D modeling of endocardial anatomical structures can include generating their surfaces as triangular meshes.

[0027] For example, system 10 may be part of a surgical system (e.g., the CARTO® system sold by Biosense Webster) configured to acquire biometric data (e.g., anatomical and electrical measurements of the patient's organs, e.g., the heart 12, and as described herein) and perform cardiac ablation procedures. More specifically, treatment for cardiac conditions, e.g., cardiac arrhythmias, often requires obtaining detailed mapping of cardiac tissue, chambers, veins, arteries, and / or electrical pathways. For example, a prerequisite for successful catheter ablation is that the cause of the cardiac arrhythmia is precisely located within the chambers of the heart 12. Such localization can be performed via an electrophysiological investigation that detects potentials and is spatially decomposed using a mapping catheter (e.g., catheter 14) introduced into the chambers of the heart 12. Thus, this electrophysiological examination, so-called electroanatomical mapping, provides 3D mapping data that can be displayed on a display device 27. Often, the mapping and therapeutic functions (e.g., ablation) are provided by a single catheter or a group of catheters, such that the mapping catheter also acts as a therapeutic catheter at the same time.

[0028] Figure 2 is a block diagram of an exemplary system 100 for remotely monitoring and communicating biometric data (e.g., patient biometrics). In the example illustrated in Figure 2, system 100 includes a patient biometric monitoring and processing unit 102 associated with a patient 104, a local computing device 106, a remote computing system 108, a first network 110, a patient biometric sensor 112, a processor 114, a user input (UI) sensor 116, a memory 118, a second network 120, and a transmitter-receiver (i.e., transceiver) 122.

[0029] According to one or more embodiments, the patient biometric monitoring and processing device 102 may be a device located inside the patient's body (e.g., implantable subcutaneously), such as the catheter 14 in Figure 1. The patient biometric monitoring and processing device 102 may be inserted into the patient via any applicable method, including oral injection, surgical insertion via vein or artery, endoscopic procedure, or laparoscopic procedure.

[0030] According to one or more embodiments, the patient biometric monitoring and processing device 102 may be an external device to the patient, such as the electrode patch 38 in Figure 1. For example, as will be described in more detail below, the patient biometric monitoring and processing device 102 may include an attachable patch (e.g., one attached to the patient's skin). The monitoring and processing device 102 may also include a catheter, probe, blood pressure cuff, scale, bracelet or smartwatch biometric tracker having one or more electrodes, a glucose monitor, a continuous positive airway pressure (CPAP) machine, or substantially any device capable of providing input regarding the patient's health or biometric indicators.

[0031] According to one or more embodiments, the patient biometric measurement monitoring and processing device 102 may include both components located inside the patient and components located outside the patient.

[0032] A single patient biometric monitoring and processing unit 102 is shown in Figure 2. However, the exemplary system may include multiple patient biometric monitoring and processing units. A patient biometric monitoring and processing unit may communicate with one or more other patient biometric monitoring and processing units. Additionally or alternatively, a patient biometric monitoring and processing unit may communicate with a network 110.

[0033] One or more patient biometric monitoring and processing devices 102 may acquire biometric data (e.g., patient biometrics, e.g., electrical signals, blood pressure, temperature, blood glucose levels, or other biometric data) and may receive at least a portion of the biometric data representing the acquired patient biometrics and additional information associated with the acquired patient biometrics from one or more other patient biometric monitoring and processing devices 102. The additional information may be, for example, diagnostic information and / or additional information acquired from additional devices, e.g., wearable devices. Each patient biometric monitoring and processing device 102 may process data including its own biometric data and data received from one or more other patient biometric monitoring and processing devices 102.

[0034] Biometric data (e.g., patient biometrics, patient data, or patient biometric data) may include one or more of the following: local activation time (LAT), electrical activity, topology, bipolar mapping, baseline activity, ventricular activity, dominant frequency, impedance, or other data. LAT may be the time of threshold activity corresponding to local activation, calculated based on a normalized initial start point. Electrical activity may be any applicable electrical signal that can be measured based on one or more thresholds and may be sensed and / or augmented based on signal-to-noise ratio and / or other filters. Topology may correspond to the physical structure of a body part or a portion of a body part, and may correspond to variations in the physical structure of different parts of a body part or different parts of a body part. Dominant frequency may be a frequency or range of frequencies commonly found in a portion of a body part, and may differ in different parts of the same body part. For example, the dominant frequency of the PV in a heart may differ from the dominant frequency of the right atrium of the same heart. Impedance may be a resistance measurement in a given region of a body part.

[0035] Examples of biometric data, though not limited to these, include patient identification data, intracardiac electrocardiogram (IC ECG) data, bipolar intracardiac reference signals, anatomical and electrical measurements, trajectory information, body surface (BS) ECG data, historical data, brain biometrics, blood pressure data, ultrasound signals, radio signals, voice signals, two-dimensional or three-dimensional image data, blood glucose data, and temperature data. Biometric data can generally be used to monitor, diagnose, and treat any number of different diseases, such as cardiovascular diseases (e.g., arrhythmias, cardiomyopathy, and coronary artery disease), and autoimmune diseases (e.g., type 1 and type 2 diabetes). Note that BS ECG data may include data and signals collected from electrodes on the patient's surface, IC ECG data may include data and signals collected from electrodes inside the patient's body, and ablation data may include data and signals collected from the tissue being ablated. Furthermore, BS ECG data, IC ECG data, and ablation data can be derived from one or more procedure records, along with catheter electrode position data.

[0036] In Figure 2, network 110 is an example of a short-range network (e.g., a local area network (LAN) or a personal area network (PAN)). Information can be transmitted between the patient vital signs monitoring and processing device 102 and the local computing device 106 via network 110 using one of various short-range wireless communication protocols, such as Bluetooth, Wi-Fi, Zigbee, Z-Wave, near-field communication (NFC), ultra-wideband wireless, or infrared (IR).

[0037] Network 120 may be a wired network, a wireless network, or may include one or more wired and wireless networks. For example, network 120 may be a long-range network (e.g., a wide area network (WAN), the Internet, or a cellular network). Information may be transmitted over network 120 using any one of various long-range wireless communication protocols (e.g., TCP / IP, HTTP, 3G, 4G / LTE, or 5G / New Radio).

[0038] The patient biometric monitoring and processing device 102 may include a patient biometric sensor 112, a processor 114, a UI sensor 116, a memory 118, and a transceiver 122. The patient biometric monitoring and processing device 102 may continuously or periodically monitor, store, process, and communicate any number of different biometric data via the network 110. Examples of biometric data include electrical signals (e.g., ECG signals and brain biometrics), blood pressure data, blood glucose data, and temperature data. The biometric data may be monitored and communicated for the treatment of any number of different diseases, such as cardiovascular diseases (e.g., arrhythmias, cardiomyopathy, and coronary artery disease), and autoimmune diseases (e.g., type 1 and type 2 diabetes).

[0039] The patient biometric sensor 112 may include, for example, one or more sensors configured to sense a certain type of biometric data. For example, the patient biometric sensor 112 may include electrodes configured to acquire electrical signals (e.g., cardiac signals, brain signals, or other bioelectrical signals), a body temperature sensor, a blood pressure sensor, a blood glucose sensor, a blood oxygen sensor, a pH sensor, an accelerometer, and a microphone.

[0040] As will be described in more detail below, the patient biometric monitoring and processing device 102 may be an ECG monitor for monitoring the ECG signal of the heart (e.g., heart 12). The patient biometric sensor 112 of the ECG monitor may include one or more electrodes for acquiring the ECG signal. The ECG signal may be used for the treatment of various cardiovascular diseases, as well as for anatomical mapping.

[0041] The transceiver 122 may include separate transmitters and receivers. Alternatively, the transceiver 122 may include transmitters and receivers integrated into a single device.

[0042] The processor 114 may be configured to store biometric data acquired by the patient biometric sensor 112 in memory 118 and to communicate the biometric data over the network 110 via the transmitter of the transceiver 122. Data from one or more other patient biometric monitoring and processing devices 102 may also be received by the receiver of the transceiver 122, as described in more detail herein. As an example, the technique for identifying one or more spatial locations corresponding to suspected triggers of AF in the heart as described herein is implemented as processor-executable code or software that can be stored on memory 118 (as shown) and executed by the processor 114. As a further example, the technique for identifying one or more spatial locations corresponding to suspected triggers of AF is implemented as code that is stored and executed on the local computing device 106 and / or the remote computing system 108. Thus, the operation of the technique for identifying one or more spatial locations corresponding to suspected triggers of AF is necessarily rooted in the process operation by system 100 and the processing hardware of system 100.

[0043] According to one or more embodiments, the system 100 operates during the ablation procedure to identify one or more spatial locations on an electroanatomical map depicted on a display device 27 that correspond to suspected triggers of AF in the human heart. Applying the technique described in relation to Figures 7 to 14 below, the electrodes collect electrical signals from spatial locations within the heart as the multi-electrode catheter moves within the heart during the procedure. A composite correlation score associated with a selected spatial location within the heart is determined based on a plurality of individual correlation values, each of which is based on the correlation between the signal associated with the selected electrode positioned at the selected spatial location (e.g., an FM signal) and the signal associated with another of the plurality of electrodes when the selected electrode is positioned at the selected spatial location (e.g., another FM signal). A composite correlation score associated with each of the plurality of other selected spatial locations within the heart is determined in the same manner for each of the other selected spatial locations. An electroanatomical map of the heart is displayed (for example, on display 27) that spatially depicts information representing the composite correlation score determined for each selected spatial location, where one or more spatial locations on the map correspond to suspected triggers of AF. In some examples, the composite correlation score corresponds to the average of several individual correlation values.

[0044] According to one or more embodiments, the patient biometric monitoring and processing device 102 includes a UI sensor 116, which may be a piezoelectric or capacitive sensor configured to receive user input, such as tapping or touching. For example, the UI sensor 116 may be controlled to implement capacitive coupling in response to a patient 104 tapping or touching the surface of the patient biometric monitoring and processing device 102. Gesture recognition may be implemented via any one of various capacitive types, such as resistive capacitance, surface capacitance, projected capacitance, surface acoustic wave, piezoelectric, and infrared touch. The capacitive sensor may be positioned over a small area or length on the surface so that a tap or touch on the surface activates the monitoring device.

[0045] As will be described in more detail below, the processor 114 may be configured to selectively respond to different tapping patterns (e.g., single tap or double tap) of a capacitive sensor, which may be a UI sensor 116, and as a result, different tasks of the patch (e.g., data acquisition, storage, or transmission) may be triggered based on the detected pattern. In some embodiments, when a gesture is detected, audible feedback may be provided to the user from the patient biometric monitoring and processing device 102.

[0046] The local computing device 106 of system 100 may be configured to communicate with the patient biometrics monitoring and processing device 102 and to function as a gateway to the remote computing system 108 via a second network 120. The local computing device 106 may be, for example, a smartphone, smartwatch, tablet, or other portable smart device configured to communicate with other devices via network 120. Alternatively, the local computing device 106 may be a fixed or standalone device such as a desktop or laptop computer, or a USB dongle, which uses an executable program to communicate information between the patient biometrics monitoring and processing device 102 and the remote computing system 108 via a fixed base station, a PC wireless module, etc., including modem and / or router capabilities. Biometric data may be communicated between the local computing device 106 and the patient biometrics monitoring and processing device 102 via a short-range wireless network 110, for example, a local area network (LAN) (e.g., a personal area network (PAN)), using short-range wireless technology standards (e.g., Bluetooth, Wi-Fi, ZigBee, Z-wave, and other short-range wireless standards). In some embodiments, the local computing device 106 may also be configured to display acquired patient electrical signals and information associated with the acquired patient electrical signals, as described in detail herein.

[0047] In some embodiments, the remote computing system 108 may be configured to receive at least one of monitored patient biometrics and information associated with the monitored patient via a long-range network 120. For example, if the local computing device 106 is a mobile phone, the network 120 may be a wireless cellular network, and information may be communicated between the local computing device 106 and the remote computing system 108 via wireless technology standards, e.g., any of the wireless technologies mentioned above. As will be described in more detail below, the remote computing system 108 may be configured to provide (e.g., visually and / or audibly) at least one of the patient biometrics and associated information to the physician 24.

[0048] Figure 3 is a system diagram of an example computing environment 200 communicating with network 120. In some examples, the computing environment 200 is integrated into a public cloud computing platform (e.g., Amazon Web Services or Microsoft Azure), a hybrid cloud computing platform (e.g., HP Enterprise OneSphere), or a private cloud computing platform.

[0049] As shown in Figure 3, the computing environment 200 includes a computer system 210, which is an example of the workstation 55 in Figure 1, the local computing device 106 in Figure 2, and / or the remote computing system 108 in Figure 2, on which embodiments described herein may be implemented. For example, the technique for identifying the spatial location corresponding to a suspected AF trigger described herein may be implemented as processor-executable code or software, which may be stored in system memory 231 (as shown) and executed by the processor 220, and which may be rooted in the process operation and hardware processing by the computing environment 200.

[0050] The computer system 210 may perform various functions via a processor 220 which may include one or more processors. Functions may include analyzing monitored biometric data and related information, and providing alerts, additional information, or instructions (e.g., via display 266) according to physician judgment or algorithm-driven thresholds and parameters. Functions may include the operation of techniques for identifying the spatial location corresponding to suspected AF triggers as described herein. As described in more detail herein, the computer system 210 may be used to provide a patient information dashboard (e.g., via display 266) to physician 24 in Figure 1, such information may enable physician 24 to identify and prioritize patients with more critical needs than others.

[0051] As shown in Figure 3, the computer system 210 may include a communication mechanism, such as a bus 221 or other communication mechanism for communicating information within the computer system 210. The computer system 210 further includes one or more processors 220 coupled to the bus 221 for processing information. The processors 220 may include one or more CPUs, GPUs, or any other processors known in the art.

[0052] The computer system 210 also includes a system memory 230 coupled to a bus 221 for storing information and instructions executed by the processor 220. The system memory 230 may include computer-readable storage media in the form of volatile and / or non-volatile memory, such as read-only system memory (ROM) 231 and / or random-access memory (RAM) 232. The system memory RAM 232 may include other dynamic storage devices (e.g., dynamic RAM, static RAM, and synchronous DRAM). The system memory ROM 231 may include other static storage devices (e.g., programmable ROM, erasable PROM, and electrically erasable PROM). In addition, the system memory 230 may be used to store temporary variables or other intermediate information during the execution of instructions by the processor 220. A basic input / output system (BIOS) 233 may include routines for transferring information between elements within the computer system 210, for example during startup, and these routines may be stored in the system memory ROM 231. RAM 232 may include data and / or program modules that are immediately accessible to the processor 220 and / or currently being manipulated by the processor 220. System memory 230 may additionally include, for example, an operating system 234, application programs 235, other program modules 236, and program data 237.

[0053] The illustrated computer system 210 also includes a disk controller 240 coupled to a bus 221 for controlling one or more storage devices for storing information and instructions, such as a magnetic hard disk 241 and a removable media drive 242 (e.g., a floppy disk drive, a compact disk drive, a tape drive, and / or a solid-state drive). The storage devices may be added to the computer system 210 using a suitable device interface (e.g., a small computer system interface (SCSI), integrated device electronics (IDE), a Universal Serial Bus (USB), or FireWire).

[0054] The computer system 210 may also include a display controller 265 coupled to a bus 221 for controlling a monitor or display 266 for displaying information to a computer user, such as a cathode ray tube (CRT) or a liquid crystal display (LCD). The illustrated computer system 210 includes a user input interface 260 for interacting with a computer user and providing information to a processor 220, and one or more input devices, such as a keyboard 262 and a pointing device 261. The pointing device 261 may be, for example, a mouse, trackball, or pointing stick for communicating instruction information and command selections to the processor 220 and controlling cursor movement on the display 266. The display 266 may provide a touchscreen interface, which may allow input that complements or replaces the communication of instruction information and command selections by the pointing device 261 and / or the keyboard 262.

[0055] The computer system 210 may perform some or each of the functions and methods described herein in response to a processor 220 executing one or more sequences of one or more instructions contained in memory, for example, system memory 230. Such instructions may be read into system memory 230 from another computer-readable medium, for example, a hard disk 241 or a removable media drive 242. The hard disk 241 may include one or more data stores and data files used by embodiments described herein. The data store contents and data files may be encrypted to improve security. The processor 220 may also be employed in a multi-processing configuration to execute one or more sequences of instructions contained in system memory 230. In alternative embodiments, hardwired circuitry may be used instead of or in combination with software instructions. Thus, embodiments are not limited to any particular combination of hardware circuitry and software.

[0056] As described above, the computer system 210 may include at least one computer-readable medium or memory for holding instructions programmed according to embodiments described herein (e.g., embodiments of tenting error detection and correction techniques) and for containing data structures, tables, records, or other data described herein. As used herein, the term computer-readable medium refers to any non-temporary tangible medium involved in providing instructions to the processor 220 for execution. Computer-readable mediums can take many forms, including but not limited to non-volatile mediums, volatile mediums, and transmission mediums. Non-limited examples of non-volatile mediums include optical disks, solid-state drives, magnetic disks, and magneto-optical disks, e.g., hard disk 241 or removable media drive 242. Non-limited examples of volatile mediums include dynamic memory, e.g., system memory 230. Non-limited examples of transmission mediums include coaxial cables, copper wires, and optical fibers, including wires that make up the bus 221. Transmission mediums can also take the form of sound waves or light waves, e.g., those generated during radio and infrared data communications.

[0057] The computing environment 200 may further include a computer system 210 operating in a networked environment using a local computing device 106 and logical connections to one or more other devices, such as a personal computer (laptop or desktop), a mobile device (e.g., a patient mobile device), a server, a router, a network PC, a peer device, or other common network node, and typically includes many or all of the elements described above for the computer system 210. When used in a networking environment, the computer system 210 may include a modem 272 for establishing communication over a network 120, such as the Internet. The modem 272 may be connected to the system bus 221 via a network interface 270 or via another suitable mechanism.

[0058] Network 120, as shown in Figures 2 and 3, may be any network or system generally known in the art, including the Internet, an intranet, a local area network (LAN), a wide area network (WAN), a metropolitan area network (MAN), a direct connection or a series of connections, a cellular telephone network, or any other network or medium that can facilitate communication between computer system 210 and other computers (e.g., local computing device 106).

[0059] Figure 4 is a block diagram of an exemplary device 400 that can implement one or more features of the present disclosure. Device 400 may be, for example, a local computing device 106. Device 400 may include, for example, a computer, a game device, a handheld device, a set-top box, a television, a mobile phone, or a tablet computer. Device 400 includes a processor 402, memory 404, a storage device 406, one or more input devices 408, and one or more output devices 410. Device 400 may also optionally include an input driver 412 and an output driver 414. It is understood that device 400 may include additional components not shown in Figure 4, including an artificial intelligence accelerator.

[0060] In various alternatives, the processor 402 includes a central processing unit (CPU), a graphics processing unit (GPU), a CPU and GPU located on the same die, or one or more processor cores, each of which may be a CPU or a GPU. In various alternatives, the memory 404 is located on the same die as the processor 402 or is located separately from the processor 402. The memory 404 includes volatile or non-volatile memory, such as random access memory (RAM), dynamic RAM, or a cache. For example, the map modification technique described herein is implemented as processor-executable code or software, which is stored on the memory 404 (as illustrated), can be executed by the processor 402, and may be rooted in the process operation and hardware processing of the exemplary device 400.

[0061] The storage device 406 includes fixed or removable storage means, such as a hard disk drive, solid-state drive, optical disc, or flash drive. The input device 408 includes, but is not limited to, a keyboard, keypad, touchscreen, touchpad, detector, microphone, accelerometer, gyroscope, biometric scanner, or network connectivity (e.g., a wireless local area network card for transmitting and / or receiving wireless IEEE 802 signals). The output device 410 includes, but is not limited to, a display device, speaker, printer, haptic feedback device, one or more lights, antenna, or network connectivity (e.g., a wireless local area network card for transmitting and / or receiving wireless IEEE 802 signals).

[0062] The input driver 412 communicates with the processor 402 and the input device 408, enabling the processor 402 to receive input from the input device 408. The output driver 414 communicates with the processor 402 and the output device 410, enabling the processor 402 to send output to the output device 410. Note that the input driver 412 and the output driver 414 are optional components, and if the input driver 412 and the output driver 414 are not present, device 400 will operate in the same manner. The output driver 414 includes an accelerated processing device ("APD") 416 that communicates with the display device represented by the output device 410. The APD 416 receives computation commands and graphics rendering commands from the processor 402, processes those computation commands and graphics rendering commands, and provides pixel output to the display device for display. As will be described in more detail below, the APD416 includes one or more parallel processing units for performing computations in accordance with the single-instruction-multiple-data (SIMD) paradigm. Thus, while various functions are described herein as being performed by or in conjunction with the APD416, in various alternative forms, the functions described as being performed by the APD416 may, additionally or alternatively, be performed by other computing devices that are not driven by a host processor (e.g., processor 402) and have similar capabilities to provide graphical output to a display device. For example, any processing system that performs processing tasks in accordance with the SIMD paradigm is intended to perform the functions described herein. Alternatively, a computing system that does not perform processing tasks in accordance with the SIMD paradigm is intended to perform the functions described herein.

[0063] Electrical activity at a specific point within the heart can typically be measured by advancing a catheter, which contains an electrical sensor at or near its distal tip, to that point in the heart, bringing the tissue into contact with the sensor, and acquiring data at that point. One drawback of mapping the ventricles using a catheter containing only a single distal electrode is the long time required to collect data point by point for the number of points required as a whole for a detailed map of the cardiac chambers. Therefore, multi-electrode catheters have been developed to simultaneously measure electrical activity at multiple points within the cardiac chambers.

[0064] Multi-electrode catheters can be implemented using any applicable shape, such as a linear catheter with multiple electrodes, a balloon catheter including electrodes arranged on multiple aggregates forming a balloon, a lasso catheter or loop catheter with multiple electrodes, a flat multi-electrode catheter, or any other applicable shape. Figure 4 shows an example of a linear catheter 402 including multiple electrodes 404, 405, and 406 that may be used to map cardiac regions. The linear catheter 402 may be fully or partially elastic so that it can twist, bend, and / or change its shape in any other way based on a received signal and / or based on the application of an external force (e.g., cardiac tissue) to the linear catheter 402.

[0065] Figure 5 shows an example of a balloon catheter 512 comprising multiple splines, including splines 514, 515, and 516 (for example, 12 splines in the specific example of Figure 5), and multiple electrodes on each spline, including electrodes 521, 522, 523, 524, 525, and 526 as shown. The balloon catheter 512 may be designed so that its electrodes can be held in close contact with the surface of the endocardium when deployed in the patient's body. As an example, the balloon catheter may be inserted into a lumen such as a pulmonary vein (PV). The balloon catheter may be inserted into the PV in a deflated state, so that the balloon catheter does not occupy the maximum volume of the PV while inserted in the PV. The balloon catheter may expand while inside the PV, thereby causing the electrodes on the balloon catheter to contact the entire circular portion of the PV. Such contact with the entire circular portion of the PV, or any other lumen, may enable efficient mapping and / or ablation.

[0066] Figure 6 shows an example of a loop catheter 630 (also referred to as a lasso catheter) containing multiple electrodes 632, 634, and 636 that may be used to map cardiac regions. The loop catheter 630 may be fully or partially elastic so that it can twist, bend, and / or change its shape in other ways based on the received signal and / or based on the action of an external force (e.g., cardiac tissue) on the loop catheter 630. Although the loop catheter 630 is shown as having only three electrodes, it will be understood that the loop catheter 630 may have more or fewer electrodes.

[0067] Figure 7 shows an example of a flat, multi-electrode catheter 700 that can be used to map cardiac regions. In one example, the catheter 700 contains 48 closely spaced electrodes 702 (intercenter distance 2.4 × 2.4 mm). In one example, each electrode 702 is small, approximately 460 microns. The type of catheter shown in Figure 7 is available under the name "Optrell® Mapping Catheter" from Biosense Webster, Inc., 31A Technology Drive, Irvine, CA 92618.

[0068] Figure 8 illustrates a method 800 for generating a composite correlation score based on electrical signals from a multi-electrode catheter, as an example. Site electrode inputs correspond to electrical measurements (or signals) collected by different electrodes of the multi-electrode catheter (e.g., electrodes 632, 634, and 636 of the loop catheter 630) in contact with different tissue locations during a period, such as when the loop catheter 630 is stationary. In the example shown in Figure 8, the collected electrical signals correspond to time-domain electrical signals derived from sample measurements collected from these different tissue locations during the period. In processing step 802, far-field filtering is performed on the collected signals along with other signal processing. In one embodiment, such other signal processing includes filtering out high frequencies from each of the collected signals (e.g., filtering out frequencies between 15 and 400 Hz) and converting amplitude values ​​to absolute values. It will be understood that other signal processing may also be used. In processing step 804, bandpass filtering is applied to limit the signals to a frequency range, for example, 3 to 10 Hz. In processing step 806, the signal output from the bandpass filter is converted into a frequency-modulated signal (FM extraction). In the example where the multi-electrode loop catheter 630 is used, FM extraction yields three FM signals, namely one FM signal for each of electrodes 632, 634, and 636. Other examples use other multi-electrode catheters, including those depicted in Figures 4, 5, and 7.

[0069] In processing step 808, a correlation operation is performed to generate a composite correlation score (referred to as the "STFM score" in the figure, where "STFM" stands for spatial-temporal frequency modulated) corresponding to the spatial position of each of the three electrodes in the heart at the time the site electrode inputs were collected. In this example, for illustrative purposes, the three FM signals obtained from the FM extraction, namely one FM signal for each of electrodes 632, 634, and 636, are referred to as signals A1, A2, and A3, respectively. Referring first to signal A1, in this example, the individual linear correlation between signals A1 and A2 (Corr(A1,A2)) is determined, and the individual linear correlation between signals A1 and A3 (Corr(A1,A3)) is determined. Then, the composite correlation score of A1 (Score(A1)) is determined from the individual correlation values ​​(Corr(A1,A2) and Corr(A1,A3)). In a specific example, the composite correlation score (Score(A1)) for A1 is the average of the individual correlation values ​​(Corr(A1,A2) and Corr(A1,A3)). The same process is then repeated to determine the composite correlation scores for signals A2 and A3. For example, the composite correlation score (Score(A2)) for signal A2 is determined from the correlation Corr(A1,A2) between A1 and A2, and the correlation Corr(A2,A3) between A2 and A3. In a specific example, the composite correlation score (Score(A2)) for A2 is the average of the individual correlation values ​​(Corr(A1,A2) and Corr(A2,A3)). Similarly, the composite correlation score (Score(A3)) for signal A3 is determined from the correlation Corr(A1,A3) between A1 and A3, and the correlation Corr(A2,A3) between A2 and A3. In a specific example, the composite correlation score for A3 (Score(A3)) is the mean of the individual correlation values ​​(Corr(A1,A3) and Corr(A2,A3)). From a spatial perspective, Score(A1), Score(A2), and Score(A3) are associated with the respective locations of electrodes 632, 634, and 636 within the heart at the time the site electrode inputs were collected.

[0070] As stated above, the multi-electrode catheters used in the techniques described herein are not limited to three-electrode catheters. The above examples can be generalized to cases where the multi-electrode catheter has m electrodes (where m is an integer greater than or equal to 2). In certain embodiments, a weighting function is applied to determine a composite correlation score for each electrode. The following is an exemplary formula for determining a composite correlation score for each electrode using a weighting function.

[0071]

number

[0072] In the example formula above, the weight (w ij ) is the distance between electrodes i and j, based on the following conditions ("distance"). ij It is determined based on the following (also indicated as "): (distance ij ) <c1ならばw ij =0, (distance ij If ) ≥ c1

[0073]

number

[0074] Here, c1 corresponds to the minimum distance required for electrodes i and j to be considered close, and σ corresponds to the effective average diameter of the electrodes. In a particular example, c1 and σ are 3 mm and 10 mm, respectively.

[0075] In some examples, the composite correlation score is the simple average of the individual correlation scores for a given electrode, but it will be understood that other functions can be used to generate the composite correlation score for the individual correlation scores. Furthermore, in the above examples, each individual correlation score corresponds to a linear correlation between two signals, but it will be understood that other correlation functions can be used to determine the individual correlation values ​​described herein.

[0076] Figure 9 illustrates, by further example, one embodiment of technique 900 for generating a composite correlation score based on electrical signals from a multi-electrode catheter. In Figure 9, operations 902, 904, 906, and 908 are substantially the same as operations 802, 804, 806, and 808 described above in relation to Figure 8, respectively. However, in Figure 9, operation 907 is used to convert the output of the FM extractor into a binary signal before performing the correlation operation in step 908. It will be understood that such a binary conversion is optional and not required. In one example, as will be described more fully below in relation to Figure 11, the binary conversion operation converts the portion of the extracted FM signal above the 90th percentile to "1" and the portion of the signal below that percentile to "0". It will be understood that other threshold levels can be used for the binary conversion.

[0077] Figure 10 illustrates one embodiment of technique 1000 for generating a composite correlation score based on electrical signals from a multi-electrode catheter, with a further example. In Figure 10, operations 1002, 1004, 1006, and 1008 are substantially the same as operations 802, 804, 806, and 808 described above in relation to Figure 8, respectively, and operation 1007 is substantially the same as operation 907 described above in relation to Figure 9. The process in Figure 10 further includes an amplitude modulation (AM) extraction operation 1010, where the signal output from the bandpass filter is converted into an amplitude-modulated signal (AM extraction). Continuing the example from Figure 8 in which a multi-electrode loop catheter 630 is used, the AM extraction yields three AM signals, namely one AM signal for each of electrodes 632, 634, and 636. Operation 1012 is used to convert the output of the AM extractor into a binary signal before performing the correlation operation in step 1014. In one example, as will be explained more fully below in relation to Figure 12, the binary conversion operation converts the portion of the extracted AM signal above the 90th percentile to "1" and the portion of the signal below that percentile to "0". It will be understood that other threshold levels may be used for the binary conversion. In some embodiments, operation 1012 is omitted, and the output of AM extraction operation 1010 is used for correlation operation 1014.

[0078] In processing step 1014, a correlation operation is performed to generate a composite correlation score (referred to as the "STAM score" in the figure, where "STAM" stands for spatial-temporal amplitude modulated) corresponding to the spatial location of each of the three electrodes in the heart at the time the site electrode input was collected. Correlation operation 1014 is performed in substantially the same manner as operation 808, except that the input to the correlation operation corresponds to an AM signal. Continuing the same example, from a spatial point of view, each of the composite correlation scores (referred to as the STAM score in the figure) is associated with the respective locations of electrodes 632, 634, and 636 in the heart at the time the site electrode input was collected. As mentioned above in relation to Figure 8, the multi-electrode catheter used in the technique described herein is not limited to a three-electrode catheter and can be generalized to cases where the multi-electrode catheter has i electrodes. Furthermore, it will be understood that in the above example, the composite correlation score (STAM score) is simply the average of the individual correlation scores for a given electrode, but other functions can be used to generate the composite correlation score for the individual correlation scores.

[0079] Figure 11 illustrates the generation of an FM binary signal 1106 based on a frequency-modulated signal 1104 associated with a catheter electrode, according to an exemplary implementation of the process shown in Figure 9. The time-domain signal 1102 corresponds to a 3-10 Hz signal output from the bandpass filter operation 904. The FM signal 1104 corresponds to the FM signal extracted by the FM extractor operation 906. In the illustrated example, the binary conversion operation 907 converts the portion of the extracted FM signal 1104 above the 90th percentile to "1" and the portion below that percentile to "0". It will be understood that other threshold levels can also be used for the binary conversion in this case.

[0080] Figure 12 illustrates the generation of an AM binary signal 1206 based on an amplitude-modulated signal derived from a catheter electrode, using exemplary implementations of operations 1010 and 1012 shown in Figure 10. The time-domain signal 1202 corresponds to a 3-10 Hz signal output from the bandpass filter operation 1004. The AM signal 1202 corresponds to the AM signal extracted by the AM extractor operation 1010. In the illustrated example, the binary conversion operation 1012 converts the portion of the extracted AM signal 1204 above the 90th percentile to "1" and the portion below that percentile to "0". In this case as well, other threshold levels can be used for the binary conversion.

[0081] Figure 13 illustrates a technique for identifying individual correlation values ​​based on FM signals derived from two different electrodes of a multicatheter electrode, using an exemplary implementation of the correlation operation 908 in Figure 9. In relation to the example used above to illustrate Figure 9, the correlation operation 908 determined a linear correlation between signals A1 and A2 (also referred to above as (Corr(A1,A2))), where A1 and A2 correspond to binary signals output by operation 907. In the example of Figure 13, signal 1302 corresponds to the extracted FM signal associated with the input signal from one electrode (e.g., electrode 632) during a given period, and signal 1304 corresponds to the extracted FM signal associated with the input signal from a different electrode (e.g., electrode 634). The binary conversion operation 907 converts the extracted FM signal 1302 to binary signal 1306 and the extracted FM signal 1304 to binary signal 1308. To determine Corr(A1,A2), correlation operation 908 determines the linear correlation between binary signals 1306 and 1308, which is equal to 0.45 in the example shown.

[0082] Figure 14 illustrates an example of an electroanatomical map depicting composite correlation scores determined for multiple spatial locations within the heart. In the illustrative map, grayscale is used to spatially depict the composite correlation scores determined using the techniques described above at various locations within the heart. For example, the composite correlation scores depicted in map 1402 correspond to STAM scores determined by operation 1014 based on AM signals, and the composite correlation scores depicted in map 1404 correspond to STFM scores determined by operation 1008 based on FM signals. Generally, a higher composite correlation score for a given spatial location is more likely to correspond to a suspected trigger for AF. In some embodiments, thresholds can be used to identify suspected AF triggers. For example, one or both of maps 1402 and 1404 may visually classify spatial locations with a composite correlation of 0.35 or 0.40 or higher as corresponding to suspected AF triggers. In some embodiments, only one of maps 1402 and 1404 is used to identify spatial locations that are suspected AF triggers (for ablation). In other embodiments, both maps are used together to identify AF trigger locations for ablation. In one such embodiment, map 1404 (based on FM signals) is used to initially identify potential AF triggers, and map 1402 (based on AM signals) is used to confirm that a given spatial location corresponds to an AF trigger before proceeding with ablation of the spatial location.

[0083] Figure 15 illustrates Method 1500 according to one or more embodiments. In step 1502, electrodes on a multi-electrode catheter provide site-specific input signals. In one example, the site electrode input corresponds to electrosample measurements (or signals) collected by different electrodes of the multi-electrode catheter (e.g., electrodes 632, 634, and 636 of the loop catheter 630) that are in contact with different tissue locations during a period such as when the loop catheter 630 is stationary. In some examples, further processing is applied to the site-specific input signals. In one example, far-field filtering is performed in conjunction with other signal processing on the site-specific input signals. In one embodiment, such other signal processing includes filtering out high frequencies from each of the input signals (e.g., filtering out frequencies between 15 and 400 Hz), converting amplitude values ​​to absolute values, and applying bandpass filtering to limit the signal to a frequency range of, for example, 3 to 10 Hz. In some examples, the signal output from the bandpass filter is converted to an FM signal or an AM signal (or both). In some cases, FM and / or AM signals are further converted to binary signals.

[0084] In step 1504, one of the electrodes that received a site-specific input signal in step 1502 is selected for correlation processing. In step 1506, individual correlation values ​​(e.g., linear correlation values) are determined between the signal associated with the selected electrode (e.g., the processed signal associated with the selected electrode) and the signals associated with each of the other electrodes among the multiple electrodes that received site-specific input signals in step 1502. In step 1508, a composite correlation value for the site of the selected electrode is determined from the individual correlation values ​​determined in step 1506. In a specific example, the composite correlation value is the average of the individual correlation values. Steps 1510 and 1512 illustrate that the same process is used to determine the composite correlation score for each of the other electrodes of the catheter that received a site-specific input signal in step 1502. Steps 1514 and 1516 mean that the process reflected in steps 1502-1512 is repeated when the catheter moves to various locations within the heart during a medical procedure (e.g., an ablation procedure).

[0085] In step 1518, an electroanatomical map of the heart is rendered for display. The map spatially depicts information representing the composite correlation scores determined for various locations within the heart using steps 1502–1516. The information representing the composite correlation scores displayed on the electroanatomical map indicates one or more spatial locations corresponding to suspected triggers for AF.

[0086] The flowcharts and block diagrams in the figures illustrate the structure, functionality, and operation of possible implementations of systems, methods, and computer program products according to various embodiments of the present invention. In this regard, each block in the flowchart or block diagram may represent a module, segment, or portion of an instruction containing one or more executable instructions for implementing the indicated logical function. In some alternative implementations, the functions shown in the blocks may be performed in an order other than that shown in the figures. For example, two consecutively shown blocks may actually be executed substantially simultaneously, or they may, depending on the relevant functionality, be executed in reverse order. It should also be noted that each block in the block diagrams and / or flowchart illustrations, and combinations of blocks in the block diagrams and / or flowchart illustrations, may be implemented by a dedicated hardware-based system that performs the specified function or operation, or they may operate or execute a combination of dedicated hardware and computer instructions.

[0087] Although the features and elements have been described above in specific combinations, those skilled in the art will understand that each feature or element can be used individually or in combination with other features and elements. In addition, the methods described herein may be implemented in computer programs, software, or firmware incorporated into a computer-readable medium for execution on a computer or processor. When used herein, the computer-readable medium should not be interpreted as being a transient signal in itself, such as radio waves or other freely propagating electromagnetic waves, electromagnetic waves propagating through waveguides or other transmission media (e.g., optical pulses passing through optical fiber cables), or electrical signals transmitted through moving wires.

[0088] Examples of computer-readable media include electrical signals (transmitted via wired or wireless connections) and computer-readable storage media. Examples of computer-readable storage media include, but are not limited to, registers, cache memory, semiconductor memory devices, magnetic media (e.g., internal hard disks and removable disks), magneto-optical media, optical media (e.g., compact disks (CDs) and digital versatile disks (DVDs)), random access memory (RAM), read-only memory (ROM), erasable programmable read-only memory (EPROM or flash memory), static random access memory (SRAM), and memory sticks. A processor can be used with software to implement a radio frequency transceiver for use in a terminal, base station, or any host computer.

[0089] The terms used herein are intended solely to describe specific embodiments and are not intended to be limiting. Where used herein, unless otherwise specified in the context, the singular forms "a," "an," and "the" also include the plural forms. It should be further understood that the terms "comprise" and / or "comprising," as used herein, indicate the presence of a described feature, integer, step, operation, element, and / or component, but do not exclude the presence or addition of another feature, integer, step, operation, element, component, and / or group thereof.

[0090] The descriptions of the various embodiments in this specification are illustrative and not intended to be exhaustive or limitful to the embodiments disclosed. Many modifications and variations will be apparent to those skilled in the art without departing from the scope and spirit of the embodiments described. The terms used herein have been selected to best describe the principles, practical applications, or technical improvements of the embodiments compared to the art available on the market, or to enable those skilled in the art to understand the embodiments disclosed herein.

[0091] [Implementation Method] (1) A method for identifying one or more spatial locations corresponding to suspected triggers of atrial fibrillation in a human heart, the method being performed using a catheter having a plurality of electrodes positioned in the heart, the electrodes collecting electrical signals from spatial locations within the heart as the catheter moves within the heart during a medical procedure, and the method Determining at least one composite correlation score associated with a selected spatial location within the heart, wherein the at least one composite correlation score is determined based on a plurality of individual correlation values, each individual correlation value being based on the correlation between at least one signal associated with a selected electrode located at the selected spatial location and at least one signal associated with another of the plurality of electrodes when the selected electrode is located at the selected spatial location. Determining at least one composite correlation score associated with each of the multiple other selected spatial locations within the heart by repeating the determination for each of the other selected spatial locations, Displaying an electroanatomical map of the heart, wherein the map spatially depicts and displays information representing the composite correlation score determined for each of the selected spatial locations. Includes, A method in which the information representing the composite correlation score displayed on the electroanatomical map for at least one of the selected spatial locations indicates that the at least one selected spatial location corresponds to a suspected trigger for atrial fibrillation. (2) The method according to Embodiment 1, wherein each individual correlation value is based on the correlation between a first frequency-modulated signal associated with the selected electrode located at the selected spatial position and a second frequency-modulated signal associated with another of the plurality of electrodes when the selected electrode is located at the selected spatial position. (3) The method according to Embodiment 1, wherein the at least one composite correlation score corresponds to the mean of the plurality of individual correlation values. (4) The method according to Embodiment 3, wherein each individual correlation value is also based on the correlation between a first amplitude-modulated signal associated with the selected electrode located at the selected spatial position and a second amplitude-modulated signal associated with another of the plurality of electrodes when the selected electrode is located at the selected spatial position. (5) Displaying a first electroanatomical map of the heart, wherein the first map spatially depicts information representing a first composite correlation score determined for each of the selected spatial locations, and the first composite correlation score for each of the selected spatial locations is based on a plurality of first individual correlation values ​​based on the correlation between frequency-modulated signals. Displaying a second electroanatomical map of the heart, wherein the second map spatially depicts information representing a second composite correlation score determined for each of the selected spatial locations, and the second composite correlation score for each of the selected spatial locations is based on a plurality of second individual correlation values ​​based on the correlation between amplitude-modulated signals. The method according to Embodiment 1, further comprising:

[0092] (6) The method according to Embodiment 1, wherein the at least one signal derived from the selected electrodes located at the selected spatial position is generated by collecting a first electrical signal from the selected electrodes and applying at least far-field reduction processing and bandpass filtering to the first electrical signal. (7) The method according to Embodiment 1, wherein the at least one signal derived from the selected electrode located at the selected spatial position is generated by collecting a first electrical signal from the selected electrode, applying signal processing to the first electrical signal to generate a second electrical signal, and converting the second electrical signal to a binary signal. (8) The method according to Embodiment 1, wherein each individual correlation value is based on a linear correlation between the at least one signal associated with the selected electrode located at the selected spatial position and the at least one signal associated with another of the plurality of electrodes when the selected electrode is located at the selected spatial position. (9) The method according to Embodiment 1, further comprising the information representing the composite correlation score displayed on the electroanatomical map for at least one of the selected spatial locations indicating that the at least one selected spatial location corresponds to a suspected trigger for atrial fibrillation if the spatial location has a corresponding composite correlation score above a threshold. (10) The method according to Embodiment 1, wherein the medical procedure is a cardiac ablation procedure.

[0093] (11) A system for identifying one or more spatial locations corresponding to suspected triggers of atrial fibrillation in a human heart, A catheter having multiple electrodes, A memory and a processor that is communicatively coupled to the electrodes, A display, which is communicatively coupled to the aforementioned processor, The processor is equipped with, As the catheter moves within the heart during a medical procedure, it receives electrical signals from its spatial position within the heart. For each of the plurality of selected spatial locations within the heart, to determine at least one composite correlation score associated with the selected spatial location, wherein the at least one composite correlation score is determined based on a plurality of individual correlation values, each individual correlation value being based on the correlation between at least one signal associated with a selected electrode located at the selected spatial location and at least one signal associated with another of the plurality of electrodes when the selected electrode is located at the selected spatial location. Displaying the electroanatomical map of the heart on the display, wherein the map spatially depicts and displays information representing the composite correlation score determined for each of the selected spatial locations. It operates to perform the following actions: The information representing the composite correlation score displayed on the electroanatomical map for at least one of the selected spatial locations indicates that the at least one selected spatial location corresponds to a suspected trigger for atrial fibrillation. (12) The system according to Embodiment 11, wherein each individual correlation value is based on the correlation between a first frequency-modulated signal associated with the selected electrode located at the selected spatial position and a second frequency-modulated signal associated with another of the plurality of electrodes when the selected electrode is located at the selected spatial position. (13) The system according to Embodiment 11, wherein the at least one composite correlation score corresponds to the mean of the plurality of individual correlation values. (14) The system according to Embodiment 13, wherein each individual correlation value is also based on a correlation between a first amplitude-modulated signal associated with the selected electrode located at the selected spatial position and a second amplitude-modulated signal associated with another of the plurality of electrodes when the selected electrode is located at the selected spatial position. (15) The processor Displaying a first electroanatomical map of the heart on the display, wherein the first map spatially depicts information representing a first composite correlation score determined for each of the selected spatial locations, and the first composite correlation score for each of the selected spatial locations is displayed, each based on a plurality of first individual correlation values ​​based on the correlation between frequency-modulated signals. Displaying a second electroanatomical map of the heart on the display, wherein the second map spatially depicts information representing a second composite correlation score determined for each of the selected spatial locations, and the second composite correlation score for each of the selected spatial locations is displayed, each based on a plurality of second individual correlation values ​​based on the correlation between amplitude-modulated signals. The system according to embodiment 11, which operates to perform the following:

[0094] (16) The system according to Embodiment 11, wherein the at least one signal associated with the selected electrode located at the selected spatial position is generated by collecting a first electrical signal from the selected electrode and applying at least far-field reduction processing and bandpass filtering to the first electrical signal. (17) The system according to Embodiment 11, wherein the at least one signal associated with the selected electrode located at the selected spatial position is generated by collecting a first electrical signal from the selected electrode, applying signal processing to the first electrical signal to generate a second electrical signal, and converting the second electrical signal to a binary signal. (18) The system according to Embodiment 11, wherein each individual correlation value is based on a linear correlation between the at least one signal associated with the selected electrode located at the selected spatial position and the at least one signal associated with another of the plurality of electrodes when the selected electrode is located at the selected spatial position. (19) The system according to Embodiment 11, wherein the information representing the composite correlation score displayed on the electroanatomical map for at least one of the selected spatial locations indicates that the at least one selected spatial location corresponds to a suspected trigger for atrial fibrillation if the spatial location has a corresponding composite correlation score above a threshold. (20) The system according to embodiment 11, wherein the medical procedure is a cardiac ablation procedure.

Claims

1. A system for identifying one or more spatial locations corresponding to suspected triggers of atrial fibrillation in a patient's heart, A catheter having multiple electrodes, configured to be positioned in the heart, A memory and a processor that is communicatively coupled to the electrodes, A display, which is communicatively coupled to the aforementioned processor, The processor is equipped with, The catheter receives electrical signals from its spatial position within the heart as it moves within the heart during a medical procedure. For each of the plurality of selected spatial locations within the heart, the determination of at least one composite correlation score associated with the selected spatial location, wherein the at least one composite correlation score is determined based on a plurality of individual correlation values, each individual correlation value being based on the correlation between at least one signal associated with a selected electrode located at the selected spatial location and at least one signal associated with another of the plurality of electrodes when the selected electrode is located at the selected spatial location. Displaying the electroanatomical map of the heart on the display, wherein the map spatially depicts and displays information representing the composite correlation score determined for each of the selected spatial locations. It operates to perform the following actions: The information representing the composite correlation score displayed on the electroanatomical map for at least one of the selected spatial locations indicates that the at least one selected spatial location corresponds to a suspected trigger for atrial fibrillation.

2. The system according to claim 1, wherein each individual correlation value is based on the correlation between a first frequency-modulated signal associated with the selected electrode located at the selected spatial position and a second frequency-modulated signal associated with another of the plurality of electrodes when the selected electrode is located at the selected spatial position.

3. The system according to claim 1, wherein the at least one composite correlation score corresponds to the mean of the plurality of individual correlation values.

4. The system according to claim 3, wherein each individual correlation value is also based on a correlation between a first amplitude-modulated signal associated with the selected electrode located at the selected spatial position and a second amplitude-modulated signal associated with another of the plurality of electrodes when the selected electrode is located at the selected spatial position.

5. The aforementioned processor, Displaying a first electroanatomical map of the heart on the display, wherein the first map spatially depicts information representing a first composite correlation score determined for each of the selected spatial locations, and the first composite correlation score for each of the selected spatial locations is displayed, each based on a plurality of first individual correlation values ​​based on the correlation between frequency-modulated signals. Displaying a second electroanatomical map of the heart on the display, wherein the second map spatially depicts information representing a second composite correlation score determined for each of the selected spatial locations, and the second composite correlation score for each of the selected spatial locations is displayed, each based on a plurality of second individual correlation values ​​based on the correlation between amplitude-modulated signals. The system according to claim 1, which operates to perform the following:

6. The system according to claim 1, wherein the at least one signal associated with the selected electrode located at the selected spatial position is generated by collecting a first electrical signal from the selected electrode and applying at least far-field reduction processing and bandpass filtering to the first electrical signal.

7. The system according to claim 1, wherein the at least one signal associated with the selected electrode located at the selected spatial position is generated by collecting a first electrical signal from the selected electrode, applying signal processing to the first electrical signal to generate a second electrical signal, and converting the second electrical signal into a binary signal.

8. The system according to claim 1, wherein each individual correlation value is based on a linear correlation between the at least one signal associated with the selected electrode located at the selected spatial position and the at least one signal associated with another of the plurality of electrodes when the selected electrode is located at the selected spatial position.

9. The system according to claim 1, wherein the information representing the composite correlation score displayed on the electroanatomical map for at least one of the selected spatial locations indicates that the at least one selected spatial location corresponds to a suspected trigger for atrial fibrillation if the spatial location has a corresponding composite correlation score above a threshold.

10. The system according to claim 1, wherein the medical procedure is a cardiac ablation procedure.

11. A method for identifying one or more spatial locations corresponding to suspected triggers of atrial fibrillation in a patient's heart, the method being performed using a catheter having a plurality of electrodes configured to be positioned in the heart, the electrodes being configured to collect electrical signals from spatial locations within the heart as the catheter moves within the heart during a medical procedure, the method is, Determining at least one composite correlation score associated with a selected spatial location within the heart, wherein the at least one composite correlation score is determined based on a plurality of individual correlation values, each individual correlation value being based on the correlation between at least one signal associated with a selected electrode located at the selected spatial location and at least one signal associated with another of the plurality of electrodes when the selected electrode is located at the selected spatial location. Determining at least one composite correlation score associated with each of the multiple other selected spatial locations within the heart by repeating the determination for each of the other selected spatial locations, Displaying an electroanatomical map of the heart, wherein the map spatially depicts and displays information representing the composite correlation score determined for each of the selected spatial locations. Includes, A method in which the information representing the composite correlation score displayed on the electroanatomical map for at least one of the selected spatial locations indicates that the at least one selected spatial location corresponds to a suspected trigger for atrial fibrillation.

12. The method according to claim 11, wherein each individual correlation value is based on the correlation between a first frequency-modulated signal associated with the selected electrode located at the selected spatial position and a second frequency-modulated signal associated with another of the plurality of electrodes when the selected electrode is located at the selected spatial position.

13. The method according to claim 11, wherein the at least one composite correlation score corresponds to the mean of the plurality of individual correlation values.

14. The method according to claim 13, wherein each individual correlation value is also based on a correlation between a first amplitude-modulated signal associated with the selected electrode located at the selected spatial position and a second amplitude-modulated signal associated with another of the plurality of electrodes when the selected electrode is located at the selected spatial position.

15. Displaying a first electroanatomical map of the heart, wherein the first map spatially depicts information representing a first composite correlation score determined for each of the selected spatial locations, and the first composite correlation score for each of the selected spatial locations is based on a plurality of first individual correlation values ​​based on the correlation between frequency-modulated signals. Displaying a second electroanatomical map of the heart, wherein the second map spatially depicts information representing a second composite correlation score determined for each of the selected spatial locations, and the second composite correlation score for each of the selected spatial locations is based on a plurality of second individual correlation values ​​based on the correlation between amplitude-modulated signals. The method according to claim 11, further comprising:

16. The method according to claim 11, wherein the at least one signal derived from the selected electrodes located at the selected spatial position is generated by collecting a first electrical signal from the selected electrodes and applying at least far-field reduction processing and bandpass filtering to the first electrical signal.

17. The method according to claim 11, wherein the at least one signal derived from the selected electrode located at the selected spatial position is generated by collecting a first electrical signal from the selected electrode, applying signal processing to the first electrical signal to generate a second electrical signal, and converting the second electrical signal into a binary signal.

18. The method according to claim 11, wherein each individual correlation value is based on a linear correlation between the at least one signal associated with the selected electrode located at the selected spatial position and the at least one signal associated with another of the plurality of electrodes when the selected electrode is located at the selected spatial position.

19. The method according to claim 11, further comprising the information representing the composite correlation score displayed on the electroanatomical map for at least one of the selected spatial locations indicating that the at least one selected spatial location corresponds to a suspected trigger for atrial fibrillation if the spatial location has a corresponding composite correlation score above a threshold.

20. The method according to claim 11, wherein the medical procedure is a cardiac ablation procedure.

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