How to solve the dual potential problem

Abstract

To analyze results of a cardiac invasive procedure.SOLUTION: A method for electrophysiological assessment comprises: acquiring electrical signals from tissue at a plurality of locations in a heart chamber; a computer processor automatically deriving, from the electrical signals, annotations indicative of times within a heart cycle at which a conduction wave traversed the plurality of locations; receiving from a processor user an input indicating, for a first location in the tissue where the electrical signals include a double-potential signal, a first annotation as a valid annotation; the processor automatically identifying second locations, within a predefined distance from the first location, where the electrical signals include double-potential signals, each having two respective annotations; the processor automatically selecting, in response to the selection of the first annotation, one of the two respective annotations as the valid annotation at each of the second locations; and displaying the valid annotations on an electroanatomical map of the heart.SELECTED DRAWING: Figure 1

Description

[Technical field]

[0001] The present invention relates generally to analyzing the results of cardiac invasive procedures, and in particular to correcting erroneous results. [Background technology]

[0002] Invasive cardiac procedures typically involve acquiring intracardiac (IC) electrocardiogram (ECG) signals and analyzing the signals. Analysis of IC ECG signals is well known in the art.

[0003] For example, a system for determining a region of interest for cardiac ablation using segmentation is described in U.S. Patent No. 10,314,542 (Bar-Tal et al.). The method can include detecting electrocardiogram (ECG) signals via sensors, each ECG signal detected via one of the sensors and indicative of electrical activity of the heart. The system also includes determining a region of interest for performing cardiac ablation according to the segmentation.

[0004] U.S. Patent Application Publication No. 2018 / 0235495 (Rubenstein) describes a cardiac mapping catheter and method for using the catheter that can detect the presence, direction, and / or origin of depolarization wavefronts associated with cardiac arrhythmias.

[0005] US Patent No. 10,335,052 (El Haddad) describes an apparatus for analysing electrophysiological data which uses processing means adapted to perform a stepwise analysis of the electrophysiological data to generate a signal indicative of the presence of a pulmonary vein potential component.

[0006] US Pat. No. 6,236,883 (U. Ciuno et al.) describes a method that includes identifying and localizing reentrant circuits from electrogram features using a feature detection and localization (FDL) algorithm.

[0007] U.S. Patent Application No. 2017 / 0079539 (U. Chauhan et al.) describes a system for locating focal sources of electrophysiological activity within an organ. The system can also be used to guide catheter ablation of the organ. Summary of the Invention [Means for solving the problem]

[0008] An exemplary embodiment of the present invention is a method for performing an electrophysiological assessment, comprising: acquiring electrical signals from myocardial tissue at a plurality of locations within a chamber of the heart; automatically deriving, by a computer processor, from the electrical signals, respective annotations indicative of times within a cardiac cycle at which a conduction wave in the myocardial tissue traversed a plurality of locations; For a first location in the tissue where the electrical signal includes a dual potential signal having a first annotation and a second annotation at different respective times within the cardiac cycle, receiving an input from a user of the computer processor indicating a selection of the first annotation as a valid annotation; automatically identifying, by the computer processor, one or more second locations within a predetermined distance from the first location, where the electrical signal includes a dual potential signal, each having two respective annotations; automatically selecting, by the computer processor, one of the two respective annotations as a valid annotation at each of the one or more second locations in response to the selection of the first annotation; and displaying the valid annotations on an electro-anatomical map of the heart.

[0009] In a disclosed exemplary embodiment, the heart chamber includes an atrium of the heart.

[0010] In a further disclosed exemplary embodiment, the heart chamber includes a ventricle of the heart.

[0011] In yet further disclosed exemplary embodiments, each annotation includes a maximum voltage of each of the cardiac P waves. Alternatively or additionally, each annotation includes a most negative voltage of each of the cardiac P waves.

[0012]

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[0013] In an alternative exemplary embodiment, each annotation includes the steepest negative slope of each of the cardiac QRS complexes.

[0014] In a further alternative exemplary embodiment, prior to selection of the first annotation by the user as the valid annotation, the computer processor provides the user with an indication that the first annotation is a valid annotation.

[0015] In a still further alternative exemplary embodiment, prior to selection by the user of the first annotation as the valid annotation, the computer processor provides the user with an indication that the second annotation is a valid annotation.

[0016] In another exemplary embodiment, for a given second position, prior to selection by the user of the first annotation as a valid annotation, the computer processor selects one of the two respective annotations as an invalid annotation.

[0017] In yet another alternative exemplary embodiment, for a given second position, prior to selection of the first annotation by the user as the valid annotation, the computer processor selects one of the two respective annotations as the valid annotation.

[0018] Displaying the valid annotations may include calculating respective local activation times (LATs) for the first location and the one or more second locations, and incorporating the LATs into an electroanatomical map of the heart.

[0019] In another exemplary embodiment of the present invention, there is provided an apparatus for performing electrophysiological assessment, comprising: a probe configured to acquire electrical signals from myocardial tissue at a plurality of locations within a chamber of the heart; 1. A computer processor comprising: automatically deriving respective annotations from the electrical signals indicative of times within a cardiac cycle at which a conduction wave in the myocardial tissue traversed a plurality of locations; For a first location in the tissue where the electrical signal includes a dual potential signal having a first annotation and a second annotation at different respective times within the cardiac cycle, receiving an input from a user of the computer processor indicating a selection of the first annotation as a valid annotation; automatically identifying one or more second locations within a predetermined distance from the first location, the electrical signal including a dual potential signal each having two respective annotations; automatically selecting one of the two respective annotations as a valid annotation at each of the one or more second locations in response to a selection of the first annotation; and displaying the valid annotations on an electroanatomical map of the heart. An apparatus is also provided, including: [Brief description of the drawings]

[0020] A more complete understanding of the present disclosure will be obtained when the detailed description of the embodiments of the present disclosure is read in conjunction with the following drawings. [Figure 1] 1 is a schematic diagram of a dual potential analysis system according to an exemplary embodiment of the present invention. [Diagram 2]1 is a schematic diagram of a distal end of a catheter used in the system, in accordance with an exemplary embodiment of the invention. [Diagram 3] FIG. 2 illustrates an example of an intracardiac electrogram signal, according to an exemplary embodiment of the present invention. [Figure 4] 1 is a schematic illustration of an electroanatomical map of a cross-section of an atrium of a heart, in accordance with an exemplary embodiment of the present invention; [Figure 5A] FIG. 4 is a flow diagram of algorithm steps according to an exemplary embodiment of the present invention. [Figure 5B] 4 is a schematic diagram of a map illustrating some of the steps according to an exemplary embodiment of the present invention. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0021] Overview Electroanatomical maps of the heart's chambers can be used by physicians to develop electrophysiological assessments of the chambers. The maps include overlays of local activation times (LAT) at locations on a three-dimensional (3D) map of the chambers. (Overlays are typically by coloring the 3D map.) LAT corresponds to the time it takes for a conduction wave in the tissue of the chamber to traverse multiple locations.

[0022] A computer processor typically calculates the LAT from annotations of an intracardiac electrocardiogram (IC ECG) signal, and the processor may automatically calculate the annotation for a given signal. For example, an annotation of an IC ECG signal from the atrium of the heart may be set as the maximum value of the P wave of the signal, and an annotation of an IC ECG signal from the ventricle may be set as the point of steepest negative slope of the QRS complex.

[0023] However, the processor may set the annotation incorrectly: for example, in the atrium, the P wave may have two maxima, i.e., a double potential signal, but the processor may select the wrong maximum as the signal annotation.

[0024] An exemplary embodiment of the present invention allows a user of a processor to correct invalid annotations of dual potential signals for a given location, and the processor then automatically propagates the effect of the correction to adjacent locations within a user-selected zone surrounding the given location by checking and automatically correcting, if necessary, annotations of dual potential signals at adjacent locations.

[0025] Thus, in one embodiment of the present invention, electrical signals are obtained from myocardial tissue at multiple locations within a chamber of the heart, and a computer processor then automatically derives respective annotations from the signals that indicate the times within the cardiac cycle at which conducted waves in the tissue traverse the multiple locations.

[0026] A user of the processor provides input to the processor for a selected dual-potential signal indicating which of the signal's two annotations is valid, and the processor then automatically locates locations having the dual-potential signal within a predetermined distance of the location of the selected signal.

[0027] For each automatically identified location, the processor automatically selects one of the two annotations as the valid annotation for that location. The automatic selection is made in response to a user selection of an annotation as described above. For example, for a given automatically identified location, the processor may select the annotation that is closest in time to the user selected annotation as the valid annotation for the identified location.

[0028] The valid annotations are then incorporated into an electroanatomical map of the heart, typically by using the annotations to compute a corresponding LAT that is superimposed onto a 3D map of the heart.

[0029] System Description In the following description, like elements in the figures are identified by like numerals, and where necessary, the like elements are distinguished by adding a letter to the identifying numeral.

[0030] Reference is now made to Fig. 1, which is a schematic diagram of a dual potential analysis system 20, and Fig. 2, which is a schematic diagram of the distal end of a catheter used in the system, in accordance with an embodiment of the present invention. For brevity and clarity, the following description assumes that a medical procedure is being performed by a user 22 of the system 20, assumed herein to be a medical professional, who inserts a catheter 24 into the left or right femoral vein of a patient 28, unless otherwise noted. The user 22 is also referred to herein as an operator 22. The procedure is assumed to include an investigation of a chamber of the patient's heart 34, and in the procedure, similarly, a catheter is first inserted into the patient, and then the distal end 32 of the catheter, referred to herein as a probe 32, reaches the chamber of the heart. The chamber of the heart generally includes the atria or ventricles of the heart.

[0031] The system 20 may be controlled by a system processor 40 comprising a processing unit (PU) 42 in communication with the electromagnetic tracking module 36 and / or the current tracking module 37. The PU 42 also communicates with an ablation module 39 and an ECG (electrocardiogram) module 43. The functionality of the modules is described in more detail below. The PU 42 also communicates with a memory 44. The processor 40 is typically mounted on a console 46 which typically comprises a control 38, including a positioning device such as a mouse or trackball, by which the operator 22 interacts with the processor. The processor operates the system 20 using software stored in the memory 44. The results of the calculations performed by the processor 40 are presented to the operator on a display 48. The results, typically in the form of an electroanatomical map 49 of the heart 34, enable the operator to create an electrophysiological assessment of the heart. The software may be downloaded to the processor 40 in electronic form, for example over a network, or alternatively or in addition, it may be provided and / or stored on non-transitory, tangible media, such as magnetic, optical or electronic memory.

[0032] To track the path of the probe 32 within a mapping region 30 that includes the heart 34, embodiments of the present invention use at least one of a current-based tracking system 21 and an electromagnetic-based tracking system 23. Both systems are described below.

[0033] The tracking system 21 includes an amperometric tracking system similar to that described in U.S. Pat. No. 8,456,182 (Bar-Tal et al.), the disclosure of which is incorporated herein by reference. The Carto™ system manufactured by Biosense-Webster (33 Technology Drive, Irvine, CA 92618 USA) also uses an amperometric tracking system. The amperometric tracking system is under the control of a current tracking module 37. The probe 32 has one or more probe electrodes 50, which are assumed herein to include electrodes 50A and 50B, and the module 37 in the tracking system 21 injects a current into the one or more electrodes 50 being tracked. The current is received by a plurality of generally similar patch electrodes 77, also referred to herein as patches, placed on the skin of the patient 28, and returned to the module.

[0034] A conductive cable for the patch electrode 77 and other skin electrodes described herein is present for each of the electrodes, but for clarity, the cables are shown in the figures for only some of the electrodes. The current between a given probe electrode 50 and the skin patch 77 varies according to the location of the electrode, due, among other things, to the different distances of the electrode from the patch, which generates different impedances between a given probe electrode and different patches. The module 37 may be configured to measure the different currents received by the different patches 77 on the respective channels connected to the patches, and to generate an indication of the location of the given probe electrode from the different currents.

[0035] The electromagnetic tracking system 23 is similar to that described in U.S. Patent No. 6,690,963 (Ben-Haim et al.), the disclosure of which is incorporated herein by reference, and that used in the Carto™ system. The electromagnetic tracking system is under the control of an electromagnetic tracking module 36. The electromagnetic tracking system includes a plurality of magnetic field generators, here assumed to include three sets of generators 66, each set with three orthogonal coils, for a total of nine coils. The generators 66 are placed at known positions beneath the patient 28, which positions define the generator's frame of reference. The module 36 controls, among other things, the amplitude and frequency of the alternating magnetic field generated by the generators.

[0036] The alternating magnetic field interacts with a coil 51 located in the probe 32, thereby generating an alternating electrode potential in the coil, which is received as a signal by the tracking module 36. The module, together with the processing unit 42, analyses the received signal and is able to determine from the analysis the position, i.e. location and orientation, of the probe coil in a defined frame of reference.

[0037] Typically, tracking by one or both of the systems may be visually represented on display 48, for example, by incorporating an icon representing the probe into a map 49 of the heart 34, and by the path that the icon follows. For clarity, the following description assumes that only electromagnetic tracking system 23 is used, but the description may be adapted mutatis mutandis if both system 23 and system 21 are used, or if only system 21 is used.

[0038] Ablation module 39 includes a radio frequency (RF) generator that delivers RF power to a region of heart 34 selected by operator 22, thereby ablating the region. Operator 22 selects the region by positioning an ablation probe comprising an ablation electrode at the region. In some embodiments, probe 32 and one of electrodes 50, such as electrode 50B, can be used as the ablation probe and ablation electrode. Alternatively, a separate ablation probe and ablation electrode may be used for the ablation provided by module 39.

[0039] The ECG module 43 receives intracardiac (IC) ECG signals acquired by the electrodes 50 when the electrodes are in contact with myocardial tissue of the chambers of the heart 34. As described below, the ECG module, in conjunction with the PU 42, analyzes the signals to, among other things, find the local activation time (LAT) of the signals. The module formulates its LAT measurements relative to a reference ECG signal, such as might typically be provided by electrodes placed in the coronary sinuses of the heart 34.

[0040] FIG. 3 shows an example of an IC ECG signal according to an embodiment of the present invention. Signals 100 and 102 are acquired by electrodes 50 in contact with respective locations of myocardial tissue of a heart chamber, assumed herein as an atrium, for example. The signals are voltage versus time signals, and for simplicity, the axis of the signals is not shown in FIG. 3. PU 42 and module 43 analyze each signal to determine one or more annotations for each of the signals. The annotation for a given location indicates the time during the beating heart cycle that the conducted wave in the heart crosses that location, i.e., LAT, and is assumed herein to include a regular pair of signals, i.e., the voltage V and time t of the signal.

[0041] As is well known in the art, the annotation of a given ECG signal can be set in different ways. For example, the annotation of the ventricles can be selected to be the point on the QRS complex with the steepest negative slope (i.e.,

[0042]

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[0043]

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[0044] In the following description, unless otherwise stated, it is assumed that the IC ECG signal is acquired from the atrium of the heart, and that the annotation of the acquired signal is at the time of the maximum of the P-wave signal.

[0045]

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[0046] Signal 100 shows a signal with a single annotation 110 at the peak of the P wave, also referred to as a single potential signal. Signals with a single annotation, such as signal 100, are typically produced by heart 34 when the heart is beating in sinus rhythm.

[0047] Signal 102 shows a signal with two annotations 114, 118 where the P wave has two peaks, such a signal is referred to as a double potential signal. A heart beating in sinus rhythm may produce a double potential signal, but the presence of double potentials may indicate, for example, arrhythmia, scar tissue, or ablated tissue.

[0048] As described below, signals such as those shown in FIG. 3 are used to generate an electroanatomical map 49 of the heart 34.

[0049] 4 is a schematic illustration of an electroanatomical map 150 of a cross-section of a ventricle of heart 34, according to one embodiment of the present invention. Map 150 shows a portion of electroanatomical map 49.

[0050] To generate map 49, a three-dimensional (3D) map of the atrium may first be generated by moving distal end 32 within the atrium and tracking and recording the position of the distal end using one of the tracking systems described above. The recorded locations include a point cloud of locations in and at the surface of the atrium, which processor 40 may then analyze by methods well known in the art to generate a 3D envelope that surrounds the point cloud, the envelope corresponding to the tissue surface of the atrium.

[0051] After the 3D map is generated, the surface of the atrium can be characterized by acquiring and recording IC ECG signals from multiple locations on the surface of the atrium. Signal acquisition can be performed using the distal end electrodes while recording the position of the distal end 32 and thus the position of the electrodes 50. Characterization can be as described above for the signals of FIG. 3, including the processor 40 computing an annotation of the signal. From the annotation, the processor can initially assign a LAT to the location where the IC ECG signal is acquired by methods well known in the art.

[0052] In a single potential signal, the LAT typically corresponds to the time of the single potential annotation, i.e., the time of P-wave maximum. Thus, in signal 100, the LAT is at the time of annotation 110. In a dual potential signal, except as described further below, the LAT is assumed to correspond to the time of the annotation having the maximum voltage. (If the annotation is

[0053]

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[0054]

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[0055] Thus, for signal 102, if annotation 114 has a greater voltage than annotation 118, then the LAT is at the time of annotation 114. In displays of annotated signals, referred to further below, typically only the annotation selected for the LAT is superimposed on the signal. In FIG. 3, annotation 114 is depicted as a black circle to indicate that it is the annotation selected for the LAT of signal 102. Similarly, annotation 110 is depicted as a black circle to indicate that it is the annotation selected for the LAT of signal 100.

[0056] After the LAT values ​​for particular locations have been determined, a processor can overlay the measurements onto a 3D map of the heart chambers, typically interpolating between the values ​​to generate an electroanatomical map. Different LAT values ​​are typically shown in maps 150 and 49 as different colors, but are shown diagrammatically in Figure 4 as different types of shading 152, 154, 156, 158. As diagrammatically shown in Figure 4, the value of LAT, typically expressed in ms, can be shown on display 48 as a map legend 148.

[0057] Operator 22 may review map 150 and decide to confirm areas of the map from this review, since the LAT of the ventricular locations corresponding to those map areas is generally believed to be inaccurate. For example, operator 22 may check whether area 160 on map 150 is correctly characterized, i.e., has the correct LAT.

[0058] To verify whether the assigned LAT for a location is correct, operator 22 examines the associated IC ECG signal acquired from that location by electrodes 50. Alternatively or additionally, if the LAT for the location is typically derived from interpolation, the operator examines an IC ECG signal acquired from a region of the atrium proximal to the location.

[0059] The algorithm, including the steps involved in reviewing and inspecting map 150, is described in detail below in conjunction with Figures 5A and 5B.

[0060] Figure 5A is a flow diagram of the steps of an algorithm executed by processor 40 and operator 22, and Figure 5B is a schematic diagram of map 151 illustrating some of the steps according to one embodiment of the present invention. Other than the differences described below, map 151 is generally similar to map 150, and elements indicated by the same reference numbers in both maps 150 and 151 are generally similar, since both maps show the same portions of map 49.

[0061] The following description of the algorithm assumes retrospective review of maps 150 (FIG. 4), but the description can be adapted with appropriate modifications to include real-time or near real-time generation and review of maps. The algorithm enables operator 22 to generate an electrophysiological assessment of heart 34.

[0062] In a first step 188, an electroanatomical map 49 of the atria of the heart 34 is generated in a manner substantially similar to that described above with reference to Figures 3 and 4. The generation includes, among other things, acquiring IC ECG signals from identified locations on the atrial surface and generating and displaying the map 49. In the following description, map 150 will be used as a portion of map 49.

[0063] In a review step 189, the operator 22 reviews the map 150 and decides to inspect one or more regions of the map. In reviewing, the operator typically defines distances, described in more detail with respect to step 198 below, that are used by the processor to perform further analysis of the signals used to generate the map. The following description of the steps of the flowchart are repeated for the regions of the map that have been inspected, with the repeated steps shown as being within a box 190.

[0064] In a selection step 191, operator 22 selects a region to review, assumed herein to include region 160. Upon selection, operator 22 is presented on display 48 with one or more IC ECG signals that processor 40 used to generate a LAT value for the region. As explained above, for any given map region, the processor may use interpolation to generate a LAT value for that region, in which case the IC ECG signals used for the interpolation are presented on display 48.

[0065] In a dual potential step 196, the operator examines the presented IC ECG signals. Typically, the processor 40 overlays on each presented signal an annotation that the processor selected as a valid annotation for the LAT of the signal, as generally shown in FIG. 3. Additionally, in the case of a dual potential signal, the processor provides the operator with an indication that the signal is a dual potential signal. This indication may be by any convenient means, such as overlaying on the signal an annotation that the processor did not select as the LAT of the signal, e.g., as a blinking circle or a circle of a different color, that is, the annotation that the processor assumed is invalid.

[0066] In a selection step 198, the operator selects which of the two annotations of the dual potential signal is correct. In making the choice, the operator verifies the annotation selected by the processor as the valid annotation, or verifies other annotations of the signal, i.e. annotations that were not selected by the processor. The operator 22 typically uses the control 38 to perform the verification, for example by clicking on the valid annotation. During the verification, the processor 40 also records the location in the map 150 where the dual potential signal was acquired.

[0067] As shown diagrammatically in Figure 5B, the processor then registers in memory 44 a zone 250 of map 150 that includes points within a predetermined distance "d" of the recorded position, assumed herein to correspond to a zone origin 254 on the map. The distance d may be defined by operator 22, for example, in review step 189. In one embodiment, the predetermined distance d is set to 5 mm.

[0068] In a decision step 200, the processor analyzes all IC ECG signals acquired for multiple locations within the zone 250 and determines from the analysis which signals contain dual potential signals.

[0069] If the determination of step 200 returns a positive result, i.e., if a dual potential signal is present within zone 250, then in a re-evaluation step 204, the processor selects a signal and re-evaluates the annotation of the selected signal according to the annotation selected by the operator in step 198. The re-evaluation involves the processor propagating the verification choice performed by the operator in selection step 198 to the dual potential signal within zone 250.

[0070] Thus, if the operator verifies the processor selected choice in step 198, then in a re-evaluation step 204 the processor does not change the processor selected annotations of dual potentials within zone 250. Additionally, for dual potential signals outside zone 250, the processor does not change the processor selected annotations of these dual potentials.

[0071] If in step 198 the operator verifies another annotation of the signal, i.e. if the operator changes the annotation selected by the processor, then in a re-evaluation step 204 the processor propagates the change to the dual potentials within the zone 250, i.e. the processor changes the annotation from the one originally selected by the processor to the other annotation. Furthermore, for dual potential signals outside the zone 250, the processor will typically annotate the signal peak closest in time to the closest single potential signal annotation.

[0072] If the determination returns negative, ie, there are no dual potential signals within the zone 250 or all dual potential signals within the zone have been analyzed in step 204 , the flow chart proceeds to final step 208 .

[0073] In step 208, the processor updates the electroanatomical map 49 using all valid annotations calculated in step 198 where the operator selects valid annotations, in step 204 where the processor selects valid annotations.

[0074] In the above explanation, it is assumed that the annotation of the P wave is at the time of the maximum of the P wave. This explanation assumes that the annotation of the P wave is at the most negative point of the P wave.

[0075]

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[0076] For simplicity, the above description assumes that the dual potential signal is acquired from an atrium of the heart and analyzed according to the algorithm of Figure 5A. The above description also applies mutatis mutandis to dual potential signals generated in the ventricles of the heart. Thus, embodiments of the present invention include the analysis of dual potential signals generated in either chamber of the heart.

[0077] It will be understood that the above-described embodiments are given by way of example, and that the present invention is not limited to what has been particularly shown and described above, but rather, the scope of the present invention includes both combinations and subcombinations of the various features as hereinabove described, as well as variations and modifications thereof not disclosed in the prior art that would occur to one skilled in the art upon reading the foregoing description.

[0078] [Embodiment] (1) A method for performing an electrophysiological assessment, comprising: acquiring electrical signals from myocardial tissue at a plurality of locations within a chamber of the heart; automatically deriving, by a computer processor, from the electrical signals, respective annotations indicative of times within the cardiac cycle at which conducted waves in the myocardial tissue traversed the multiple locations; receiving an input from a user of the computer processor indicating a selection of a first annotation as a valid annotation for a first location within the tissue where the electrical signal includes a dual potential signal having a first annotation and a second annotation at different respective times within the cycle of the heart; automatically identifying, by the computer processor, one or more second locations within a predetermined distance from the first location, where the electrical signal includes a dual potential signal, each having two respective annotations; automatically selecting, by the computer processor, one of the two respective annotations as the valid annotation at each of the one or more second locations in response to the selection of the first annotation; and displaying the valid annotations on an electroanatomical map of the heart. (2) The method of embodiment 1, wherein the heart chamber comprises an atrium of the heart. (3) The method of embodiment 1, wherein the heart chamber comprises a ventricle of the heart. (4) The method of embodiment 1, wherein each of the annotations includes a maximum voltage of each of the cardiac P waves. (5) each of said annotations being the most negative of each of said cardiac P waves;

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[0079] (6) The method of embodiment 1, wherein each of the annotations comprises the steepest negative slope of each of the cardiac QRS complexes. (7) The method of embodiment 1, wherein prior to the user's selection of the first annotation as the valid annotation, the computer processor provides the user with an indication that the first annotation is the valid annotation. (8) The method of embodiment 1, wherein prior to the selection by the user of the first annotation as the valid annotation, the computer processor provides the user with an indication that the second annotation is the valid annotation. (9) The method of embodiment 1, wherein, for a given second position, prior to the user's selection of the first annotation as the valid annotation, the computer processor selects one of the two respective annotations as an invalid annotation. (10) The method of embodiment 1, wherein, for a given second position, prior to the selection by the user of the first annotation as the valid annotation, the computer processor selects one of the two respective annotations as the valid annotation.

[0080] (11) The method of embodiment 1, wherein displaying the valid annotations includes calculating a respective local activation time (LAT) for the first location and the one or more second locations, and incorporating the LAT into the electroanatomical map of the heart. (12) An apparatus for performing electrophysiological evaluation, comprising: a probe configured to acquire electrical signals from myocardial tissue at a plurality of locations within a chamber of the heart; 1. A computer processor comprising: automatically deriving respective annotations from the electrical signals indicative of times within the cardiac cycle at which conducted waves in the myocardial tissue traversed the multiple locations; receiving an input from a user of the computer processor indicating a selection of a first annotation as a valid annotation for a first location within the tissue where the electrical signal includes a dual potential signal having a first annotation and a second annotation at different respective times within the cycle of the heart; automatically identifying one or more second locations within a predetermined distance from the first location, the electrical signal including a dual potential signal each having two respective annotations; automatically selecting one of the two respective annotations as the valid annotation at each of the one or more second locations in response to the selection of the first annotation; and displaying the valid annotations on an electroanatomical map of the heart. 13. An apparatus comprising: (13) The device of embodiment 12, wherein the heart chamber includes an atrium of the heart. (14) The device of embodiment 12, wherein the heart chamber comprises a ventricle of the heart. (15) The device of embodiment 12, wherein each of the annotations includes a maximum voltage of each of the cardiac P waves.

[0081] (16) each of said annotations comprising a most negative P wave of each of said cardiac P waves;

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[0082] (21) The apparatus of embodiment 12, wherein, for a given second position, prior to the selection by the user of the first annotation as the valid annotation, the computer processor selects one of the two respective annotations as the valid annotation. (22) The device of embodiment 12, wherein displaying the valid annotations includes calculating a respective local activation time (LAT) for the first location and the one or more second locations, and incorporating the LAT into the electroanatomical map of the heart.

Claims

1. 1. A method of operating an apparatus for performing electrophysiological assessment, comprising: a probe acquiring electrical signals from myocardial tissue at a plurality of locations within a chamber of the heart; a computer processor automatically deriving from the electrical signals respective annotations indicative of times within the cardiac cycle at which conducted waves in the myocardial tissue traversed the plurality of locations; receiving an input from a user, for a first location in the tissue where the electrical signal includes a bi-potential signal having a first annotation and a second annotation at different respective times within the cycle of the heart, indicating a selection of the first annotation as a valid annotation; receiving a predetermined distance from the first location defined by a user; the computer processor automatically identifying one or more second locations within the predetermined distance from the first location, where the electrical signal includes a dual potential signal, each having two respective annotations; automatically selecting, by the computer processor, one of the two respective annotations as the valid annotation at each of the one or more second locations in response to the selection of the first annotation; The method includes the computer processor displaying the valid annotations on an electroanatomical map of the heart on a display.

2. The method of claim 1 , wherein the heart chamber comprises an atrium of the heart.

3. The method of claim 1 , wherein the heart chamber comprises a ventricle of the heart.

4. The method of claim 1 , wherein the respective annotations include a maximum voltage of each of the cardiac P waves.

5. The respective annotations are the most negative of each of the cardiac P waves. [0010] The method of claim 1 , comprising:

6. The method of claim 1 , wherein the respective annotations include a steepest negative slope of each of the cardiac QRS complexes.

7. The method of claim 1 , wherein prior to the selection by the user of the first annotation as the valid annotation, the computer processor provides the user with an indication that the first annotation is the valid annotation.

8. The method of claim 1 , wherein prior to the selection by the user of the first annotation as the valid annotation, the computer processor provides the user with an indication that the second annotation is the valid annotation.

9. The method of claim 1 , wherein, for a given second position, prior to the selection by the user of the first annotation as the valid annotation, the computer processor selects one of the two respective annotations as an invalid annotation.

10. The method of claim 1 , wherein, for a given second position, prior to the selection by the user of the first annotation as the valid annotation, the computer processor selects one of the two respective annotations as the valid annotation.

11. 2. The method of claim 1, wherein displaying the valid annotations comprises calculating a respective local activation time (LAT) for the first location and the one or more second locations, and incorporating the LAT into the electroanatomical map of the heart.

12. 1. An apparatus for performing electrophysiological assessment, comprising: a probe configured to acquire electrical signals from myocardial tissue at a plurality of locations within a chamber of the heart; 1. A computer processor comprising: automatically deriving respective annotations from the electrical signals indicative of times within the cardiac cycle at which conducted waves in the myocardial tissue traversed the multiple locations; receiving an input from a user of the computer processor indicating a selection of a first annotation as a valid annotation for a first location within the tissue where the electrical signal includes a dual potential signal having a first annotation and a second annotation at different respective times within the cycle of the heart; receiving a predetermined distance from the first location defined by a user; automatically identifying one or more second locations within the predetermined distance from the first location, the electrical signals including dual potential signals each having two respective annotations; automatically selecting one of the two respective annotations as the valid annotation at each of the one or more second locations in response to the selection of the first annotation; and displaying the valid annotations on an electroanatomical map of the heart.

13. An apparatus comprising:

13. The apparatus of claim 12 , wherein the heart chamber comprises an atrium of the heart.

14. The apparatus of claim 12 , wherein the heart chamber comprises a ventricle of the heart.

15. The apparatus of claim 12 , wherein the respective annotations include a maximum voltage of each of the cardiac P waves.

16. The respective annotations are the most negative of each of the cardiac P waves. [0025] The apparatus of claim 12 , comprising:

17. The apparatus of claim 12 , wherein the respective annotations include a steepest negative slope of each of the cardiac QRS complexes.

18. The apparatus of claim 12 , prior to the selection by the user of the first annotation as the valid annotation, the computer processor provides the user with an indication that the first annotation is the valid annotation.

19. The apparatus of claim 12 , wherein prior to the selection by the user of the first annotation as the valid annotation, the computer processor provides the user with an indication that the second annotation is the valid annotation.

20. The apparatus of claim 12 , wherein, for a given second position, prior to the selection by the user of the first annotation as the valid annotation, the computer processor selects the one of the two respective annotations as an invalid annotation.

21. The apparatus of claim 12 , wherein, for a given second position, prior to the selection by the user of the first annotation as the valid annotation, the computer processor selects one of the two respective annotations as the valid annotation.

22. 13. The apparatus of claim 12, wherein displaying the valid annotations comprises calculating a respective local activation time (LAT) for the first location and the one or more second locations, and incorporating the LAT into the electroanatomical map of the heart.

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