Automatic Pattern Acquisition

Abstract

To provide a medical system.SOLUTION: In one embodiment, a medical system includes: corresponding electrodes for application to a body of a subject and to output a set of corresponding activation signals in response to electrical activity of the heart of the subject captured over a sequence of heartbeat intervals; and a processor. The processor is configured to: classify a first heartbeat interval of the set of activation signals as a first morphological template; compute a measure of similarity between a second heartbeat interval of the set of activation signals and the first morphological template; group the second heartbeat interval of the set of activation signals in a first morphological group with the first morphological template responsively to the measure exceeding a predefined threshold; classify the second heartbeat interval of the set of activation signals as a second morphological template responsively to the measure not exceeding the predefined threshold; and repeat the above, mutatis mutandis, for subsequent heartbeat intervals.SELECTED DRAWING: Figure 1

Description

[Technical Field]

[0001] (CROSS-REFERENCE TO RELATED APPLICATIONS) This application claims the benefit of U.S. Provisional Patent Application No. 62 / 963,710, filed January 21, 2020, the disclosure of which is incorporated herein by reference.

[0002] FIELD OF THE INVENTION The present invention relates to medical devices, particularly but not exclusively to measuring electrical activity. [Background technology]

[0003] The electrocardiograph (ECG) process records the electrical activity of the heart over a period of time using electrodes applied to a living person's skin that detect electrical charges on the skin resulting from the electrophysiological patterns of depolarization and repolarization during each heartbeat.

[0004] Electrocardiograms may be performed to detect cardiac problems, such as cardiac arrhythmias, and to monitor improvement in cardiac condition following corrective treatment (for example, but not limited to, ablation therapy).

[0005] A typical electrocardiograph may include connections to ten electrodes that are applied to the skin of a living subject, including the limbs and chest. These ten electrodes are then used to measure and record the cardiac electrical potential over a period of time, thereby capturing the overall magnitude and direction of the heart's electrical depolarization at each instant throughout the cardiac cycle. A graph of voltage versus time can be created to obtain an electrocardiogram.

[0006] During a medical procedure such as cardiac ablation, an operator (e.g., a physician) typically monitors multiple real-time data streams while simultaneously performing the procedure. For example, while using an intracardiac catheter to ablate intracardiac tissue, the operator may want to keep track of real-time electrophysiological (EP) data, such as ECG data, as well as ancillary data, such as the position of the catheter's distal tip and the ablation energy being delivered to the cardiac tissue.

[0007] U.S. Patent Publication No. 2002 / 0026220 (Groenewegen et al.) describes arrhythmia classification and localization. More specifically, a system and method are provided for developing a database of body surface ECG P-wave maps for left-sided atrial arrhythmia classification and localization. The invention includes generating and receiving P-wave data in a subject by left-atrial pacing or receiving P-wave data in a subject during spontaneous or induced left-sided atrial arrhythmia, calculating a map (e.g., potential or integral) of the P-wave data, classifying the map specific to left-sided ectopic origin, verifying the classification procedure, averaging the classified maps into a mean map, and storing and accessing the mean map in a database. The mean map of P-wave data in the database can be used to automatically classify and localize P-wave data from a patient obtained during left-sided arrhythmias such as atrial tachycardia, focal atrial fibrillation, or antegrade atrioventricular reentrant tachycardia.

[0008] U.S. Patent Publication No. 2002 / 0193695 to Koyrakh et al. describes a method for generating a template in an implantable medical device for implantation in a patient, and a processor-readable medium for implementing the method, including generating the template from collected events corresponding to the patient, delaying generation of the template for a first predetermined time period in response to a template not being generated within a predetermined number of collected events, determining whether the template is valid, and monitoring the template to determine whether it accurately represents the patient.

[0009] U.S. Patent Application Publication No. 2010 / 0280400 to Ettori et al. describes a cardiac rhythm management system that can be used to detect paroxysmal heartbeats associated with cardiac events within a subject. These events can be monitored to derive depolarization morphology information for candidates for arrhythmic heartbeats in arrhythmia episodes. An arrhythmic heartbeat morphology template can be formed by selecting at least one of the candidates for arrhythmic heartbeats based on user labeling according to the specific morphology of one or more candidates for the episode. Methods of use are also provided.

[0010] U.S. Patent Application Publication No. 2011 / 0238127 to Conley et al. describes systems, devices, structures, and methods for presenting visual displays based on data from an implantable medical device, including charts showing the frequency of types of arrhythmia detected over a predetermined period of time.

[0011] U.S. Patent Publication No. 2008 / 0234770 to Kim et al. describes a method and system for generating a snapshot representing one beat of a patient's normal cardiac rhythm. Heart rate channel signals and shock channel signals are sensed. Fiducial points are determined for a predetermined number of heart rate channel signals. The predetermined number of shock channel signals are aligned using the fiducial points. A template is generated using the aligned shock channel signals, whereby the template represents one of the patient's normal supraventricular conduction heartbeats. The template is periodically updated.

[0012] U.S. Patent Publication No. 2005 / 0137485 to Cao et al. describes an implantable medical device and associated method for automatically generating morphological templates during fast cardiac rhythms, confirming the provisional template as a confirmed template, and using the confirmed template to classify subsequently detected arrhythmias. A provisional ventricular tachycardia (SVT) template is created during a fast ventricular rate and can be activated as a confirmed SVT template once it is verified that the fast rate was due to SVT. The confirmed SVT template can be used to distinguish SVT from ventricular tachycardia or ventricular fibrillation. Summary of the Invention [Means for solving the problem]

[0013] According to an embodiment of the present disclosure, a method and apparatus for detecting cardiac activity includes: respective electrodes configured to be applied to a body of a subject and configured to output a respective set of activation signals in response to electrical activity of the subject's heart captured over a series of cardiac intervals; and a processor configured to classify a first cardiac interval of the set of activation signals as a first morphology template; and for a second cardiac interval after the first cardiac interval, calculate a similarity measure between the second cardiac interval of the set of activation signals and the first morphology template; in response to the similarity measure exceeding a predetermined threshold, group the second cardiac interval of the set of activation signals within the first morphology group with the first morphology template; and in response to the similarity measure not exceeding the predetermined threshold, group the second cardiac interval of the set of activation signals within the first morphology group. and a processor configured to: classify a subsequent cardiac interval of the set of activation signals as one of the two morphological templates; calculate, for a subsequent cardiac interval, a similarity measure between the subsequent cardiac interval of the set of activation signals and at least one of the plurality of previously assigned morphological templates of a respective morphological group; group the subsequent cardiac interval of the set of activation signals of one of the morphological groups of the previously assigned morphological templates in response to the similarity measure with one of the previously assigned morphological templates exceeding a predetermined threshold; and classify the subsequent cardiac interval of the set of activation signals as another morphological template in response to the similarity measure with the previously assigned morphological template not exceeding a predetermined threshold.

[0014] Further, according to an embodiment of the present disclosure, the processor is configured to find a new morphology template for one of the morphology groups in response to the number of cardiac intervals of the set of activation signals within one morphology group exceeding a predetermined threshold size.

[0015] Furthermore, according to an embodiment of the present disclosure, the processor is configured to select one of the cardiac intervals of the set of activation signals that is most similar to other cardiac intervals of the set of activation signals within a morphology group as the new morphology template.

[0016] Additionally, according to an embodiment of the present disclosure, the system includes a display, and the processor is configured to render on the display a user interface screen including an indication of the corresponding ones of the morphology templates and the corresponding relative numbers of cardiac intervals of the sets of activation signals of the corresponding ones of the morphology groups.

[0017] Further, according to an embodiment of the present disclosure, the indication includes a histogram indicating the corresponding relative numbers of cardiac intervals in the sets of activation signals of corresponding ones of the morphology groups.

[0018] Further, according to an embodiment of the present disclosure, the instructions include a count of cardiac intervals and / or activation rates and / or occurrence rates of the set of activation signals of the corresponding ones of the morphology groups.

[0019] Furthermore, according to an embodiment of the present disclosure, the processor is configured to order the corresponding ones of the morphology templates in the user interface screen according to any one or more of: a count of cardiac intervals of the set of activation signals of the corresponding ones of the morphology groups; an activation rate or incidence rate of cardiac intervals of the set of activation signals of the corresponding ones of the morphology groups; an earliest activation of cardiac intervals of the set of activation signals of the corresponding ones of the morphology groups; or a most recent activation of cardiac intervals of the set of activation signals of the corresponding ones of the morphology groups.

[0020] Additionally, according to an embodiment of the present disclosure, the processor is configured to select from the morphology templates corresponding ones to be included in the user interface screen according to any one or more of the following filters: minimum count of cardiac intervals of the set of activation signals of the corresponding ones of the morphology groups; minimum activation rate or incidence of cardiac intervals of the set of activation signals of the corresponding ones of the morphology groups; most recent activation of cardiac intervals of the set of activation signals of the corresponding ones of the morphology groups; minimum consecutive sequence of cardiac intervals within the same morphology group.

[0021] Further, according to an embodiment of the present disclosure, the processor is configured to receive a user selection to assign a favorite to the morphology template, and the processor is configured to render the favorite within the user interface screen even if the favorite is not selected according to one or more filters.

[0022] Further, according to an embodiment of the present disclosure, the processor is configured to separately track a first corresponding number of cardiac intervals of the set of activation signals added to the corresponding morphological group before and during the verification period and a second corresponding number of cardiac intervals of the set of activation signals added to the corresponding morphological group during the verification period, and the processor is configured to render a user interface screen on the display, the user interface screen simultaneously including an indication of the first corresponding number and an indication of the second corresponding number of cardiac intervals to be added to the corresponding morphological group.

[0023] Furthermore, according to an embodiment of the present disclosure, the processor is configured to highlight new morphological templates created during the validation period.

[0024] Additionally, according to an embodiment of the present disclosure, the processor is configured to render a user interface screen including a graph of cardiac cycle length versus time, the graph indicating when a selected one of the morphologies of the group of morphologies was active.

[0025] Further, according to an embodiment of the present disclosure, the system includes a display, and the processor is configured to calculate corresponding similarity measures between the pacing-induced cardiac intervals of the set of activation signals and corresponding ones of the previously assigned morphology templates of the corresponding morphology group, and render on the display a user interface screen including an indication of the corresponding similarity measures between the pacing-induced cardiac intervals of the set of activation signals and corresponding ones of the previously assigned morphology templates of the corresponding morphology group.

[0026] Further, according to an embodiment of the present disclosure, the processor is configured to render a user interface screen on the display, the user interface screen including an indication of a corresponding previously assigned morphology template and a corresponding similarity measure between the pacing-induced cardiac intervals of the set of activation signals and the corresponding previously assigned morphology template of the corresponding morphology group.

[0027] Also, according to another embodiment of the present disclosure, a method for detecting a cardiac electrical activity includes applying corresponding electrodes to a body of a subject, outputting a set of corresponding activation signals by the electrodes in response to electrical activity of the subject's heart captured over a series of cardiac intervals, classifying a first cardiac interval of the set of activation signals as a first morphology template, calculating a similarity measure between the second cardiac interval of the set of activation signals and the first morphology template for a second cardiac interval after the first cardiac interval, grouping the second cardiac interval of the set of activation signals in the first morphology group with the first morphology template in response to the similarity measure exceeding a predetermined threshold, and classifying the second cardiac interval of the set of activation signals in the first morphology group in response to the similarity measure not exceeding the predetermined threshold. classifying the subsequent cardiac interval of the set of activation signals as a second morphology template; calculating, for a subsequent cardiac interval, a similarity measure between the subsequent cardiac interval of the set of activation signals and at least one of a plurality of previously assigned morphology templates of a corresponding morphology group; grouping the subsequent cardiac interval of the set of activation signals of one of the morphology groups of the previously assigned morphology templates in response to the similarity measure with one of the previously assigned morphology templates exceeding a predetermined threshold; and classifying the subsequent cardiac interval of the set of activation signals as another morphology template in response to the similarity measure with the previously assigned morphology template not exceeding a predetermined threshold.

[0028] Furthermore, according to an embodiment of the present disclosure, the method includes finding a new morphology template for one of the morphology groups in response to the number of cardiac intervals of the set of activation signals within one morphology group exceeding a predetermined threshold size.

[0029] Additionally, according to an embodiment of the present disclosure, the method includes selecting one of the cardiac intervals of the set of activation signals that is most similar to other cardiac intervals of the set of activation signals within a morphology group as a new morphology template.

[0030] Further, in accordance with an embodiment of the present disclosure, the method includes rendering on the display a user interface screen including an indication of the corresponding ones of the morphology templates and the corresponding relative numbers of cardiac intervals of the sets of activation signals of the corresponding ones of the morphology groups.

[0031] Further, according to an embodiment of the present disclosure, the indication includes a histogram indicating the corresponding relative numbers of cardiac intervals in the sets of activation signals of corresponding ones of the morphology groups.

[0032] Furthermore, according to an embodiment of the present disclosure, the instructions include a count of cardiac intervals and / or activation rates and / or occurrence rates of the set of activation signals of the corresponding ones of the morphology groups.

[0033] Additionally, according to an embodiment of the present disclosure, the method includes ordering the corresponding ones of the morphology templates within the user interface screen according to any one or more of: a count of cardiac intervals of the set of activation signals of the corresponding ones of the morphology groups; an activation rate or incidence rate of cardiac intervals of the set of activation signals of the corresponding ones of the morphology groups; an earliest activation of cardiac intervals of the set of activation signals of the corresponding ones of the morphology groups; or a most recent activation of cardiac intervals of the set of activation signals of the corresponding ones of the morphology groups.

[0034] Further, according to an embodiment of the present disclosure, the method includes selecting from the morphology templates corresponding ones to be included in the user interface screen according to any one or more of the following filters: minimum count of cardiac intervals of the set of activation signals of the corresponding ones of the morphology groups; minimum activation rate or incidence of cardiac intervals of the set of activation signals of the corresponding ones of the morphology groups; most recent activation of cardiac intervals of the set of activation signals of the corresponding ones of the morphology groups; minimum consecutive sequence of cardiac intervals within the same morphology group.

[0035] Further, according to an embodiment of the present disclosure, the method includes receiving a user selection to assign a favorite to a morphology template and rendering the favorite within a user interface screen even if the favorite is not selected according to one or more filters.

[0036] Furthermore, according to an embodiment of the present disclosure, the method includes separately tracking a first corresponding number of cardiac intervals of the set of activation signals added to the corresponding morphological group before and during the verification period and a second corresponding number of cardiac intervals of the set of activation signals added to the corresponding morphological group during the verification period, and rendering includes rendering a user interface screen on the display, the user interface screen simultaneously including an indication of the first corresponding number and an indication of the second corresponding number of cardiac intervals to be added to the corresponding morphological group.

[0037] Additionally, according to an embodiment of the present disclosure, the method includes highlighting new morphological templates created during the validation period.

[0038] Further, according to an embodiment of the present disclosure, the rendering includes rendering a user interface screen including a graph of cardiac cycle length versus time, the graph indicating when a selected one of the morphologies of the group of morphologies was active.

[0039] Further, in accordance with an embodiment of the present disclosure, the method includes calculating corresponding similarity measures between pacing-induced cardiac intervals of the set of activation signals and corresponding ones of the previously assigned morphology templates of the corresponding morphology group, and rendering on a display a user interface screen including an indication of the corresponding similarity measures between the pacing-induced cardiac intervals of the set of activation signals and corresponding ones of the previously assigned morphology templates of the corresponding morphology group.

[0040] Furthermore, according to an embodiment of the present disclosure, the rendering includes rendering a user interface screen on the display that includes an indication of the corresponding previously assigned morphology template and a corresponding similarity measure between the pacing-induced cardiac intervals of the set of activation signals and the corresponding previously assigned morphology template of the corresponding morphology group. [Brief explanation of the drawings]

[0041] The present invention will be understood from the following detailed description taken in conjunction with the accompanying drawings. [Figure 1] 1 is a schematic illustration of a medical treatment system constructed and operative in accordance with an embodiment of the present invention; [Figure 2] FIG. 2 is a schematic diagram of a catheter for use in the system of FIG. 1. [Figure 3] FIG. 2 is a schematic diagram of a morphology group for use in the system of FIG. 1; [Figure 4] 2 is a flow chart including steps in a method of operating the system of FIG. 1. [Figure 5] 2 is a flow chart including steps in a method of operating the system of FIG. 1. [Figure 6] 2 is a flow chart including steps in a method of operating the system of FIG. 1. [Figure 7] 2 is a flow chart including steps in a method of operating the system of FIG. 1. [Figure 8] 2 is a schematic diagram of a user interface screen generated by the system of FIG. 1. [Figure 9] 2 is a flow chart including steps in a method of operating the system of FIG. 1. [Figure 10] FIG. 9 is a schematic diagram of the user interface screen of FIG. 8 in verification mode. [Figure 11] FIG. 2 is a schematic diagram of a pacing user interface screen generated by the system of FIG. 1. DETAILED DESCRIPTION OF THE INVENTION

[0042] Overview When analyzing electrocardiogram (ECG) signals or intracardiac (IC) electrograms for various types of arrhythmias, physicians may visually inspect the signal graphs and use the inspection to determine the type and timing of the arrhythmia that occurred. This type of visual inspection is time-consuming and potentially prone to error. Accurate identification of arrhythmias is particularly important during cardiac procedures such as ablation therapy, which can be targeted according to the various arrhythmias present.

[0043] In some systems, due to the large volume of data generated during a procedure, e.g., ablation and ECG and / or IEGM data, a physician may set different filters to obtain relevant electroanatomical data to be included in the cardiac conduction map. For example, even though the ECG and / or IEGM data may indicate many different arrhythmias, a physician may set a filter to detect one or more of the various arrhythmia types based on pattern matching. As the procedure continues, for example, the heart rate may change due to the implementation of a corrective procedure, so a physician may change the filter during the procedure. The need to assign a particular pattern representative of the mapped arrhythmia from the entire set of activations can be difficult, time-consuming, and prone to error.

[0044] Embodiments of the present invention provide automatic pattern acquisition to provide a burden analysis of activity within the mapped ventricles and to automate the pattern acquisition process for both body surface (BS) and intracardiac (IC) reference signals without requiring a physician to preselect a specific pattern. The term "pattern," as used herein and in the claims, is defined as a set of respective cardiac activation signals from respective ECG and / or IEGM channels over a single cardiac interval. The term "group," as used herein and in the claims, is defined as a set of patterns having similar morphology, each group represented by a morphology template, which may be one pattern selected from the group.

[0045] Automating acquisition reduces manual operator intervention and potentially reduces procedure time and improves efficiency. The system groups recorded beats into groups of similar morphology, and a set of filters allows the physician to select which of those groups are most important. The automated process allows for classification of all beats, providing data to easily identify significant activity for mapping and for tracking the progression of post-ablation procedures.

[0046] In some embodiments, a first incoming heartbeat set (pattern) forms a first morphology template of a first morphology group. A second incoming heartbeat set (pattern) is compared to the first morphology template. If there is a suitable match, the second heartbeat set (pattern) is added to the first morphology group. If there is no suitable match, the second heartbeat set forms a morphology template of another morphology group. Subsequent incoming heartbeat sets (patterns) are compared to one or more existing morphology templates, and if there is a match, they are added to the matching morphology group; if there is no match, a new morphology group is created, and so on. Morphology templates and groups are formed dynamically based on matches between incoming beats and existing morphology templates.

[0047] The algorithm utilizes an optimization process that selects the best representative set of heartbeats for each group as the group's morphology template. The optimized template contributes to higher correlation values ​​with similar activations during mapping, improving pattern matching capabilities.

[0048] Once the patient is stabilized and connected to the BS patch, BS-based pattern acquisition for ventricular mapping can be achieved immediately. Automatic acquisition utilizes procedure preparation time to collect patterns and classify activity to shorten mapping time, eliminate the effects of mechanically induced heartbeats, and provide the necessary statistics of stressful activity.

[0049] In some embodiments, a user interface screen may be rendered showing at least some of the created templates and statistics indicating activation counts and / or activation rates associated with each of the morphology groups of the displayed morphology templates. A histogram may also be used to show the activity counts and / or activity rates associated with the morphology groups of the morphology templates. The user interface screen may also include a cycle length graph of cycle length versus time. The displayed morphology templates may be selected by the physician, and the activation times of cardiac beats of the selected morphology may be shown on the cycle length graph. Filters may be set by the physician to determine which morphology templates and associated data should be shown on the user interface screen. Additional settings may be set to determine the order of data on the user interface screen.

[0050] In some embodiments, the processor separately tracks a first number of cardiac intervals added to each morphology group before the verification period (e.g., after ablation is performed) and a second number of cardiac intervals added to each morphology group only during the verification period. The processor renders a user interface screen that simultaneously includes a display of the first and second numbers of cardiac intervals added to each morphology group, thereby allowing for easy verification of the effectiveness of a therapy, such as ablation, during the verification period, e.g., to determine whether an arrhythmia that was present before ablation is still present after ablation.

[0051] The activity counts of cardiac intervals in one or more of the respective morphological groups may be too low to successfully generate meaningful electroanatomical maps, such as local activation time (LAT) maps, for any of the low-count morphological groups. However, a physician may wish to identify an arrhythmia source associated with any one of the low-count groups and perform ablation at the arrhythmia source associated with that low-count group. Pacing may be used to help identify the source of the arrhythmia.

[0052] In some embodiments, pacing-induced heartbeats are generally not added to any of the morphology groups, but are compared to at least some (or all) of the morphology templates to determine a similarity measure with the corresponding morphology template. The similarity measure may be displayed in real time so that a physician can determine the source of the arrhythmia based on the similarity measure. For example, a catheter may be moved around the chambers of the heart, and when the catheter is positioned at a particular location within the chamber of the heart, a similarity measure with one of the morphology templates may exceed 90% (for example), which is a good indication that the catheter is positioned in proximity to the source of the arrhythmia associated with that morphology template. The physician may then decide to ablate at that location.

[0053] System Description Reference is now made to Figure 1, which is a schematic illustration of a medical procedure system 20 constructed and operative in accordance with one embodiment of the present invention, and Figure 2, which is a schematic illustration of a catheter 40 for use in the system 20 of Figure 1.

[0054] The medical treatment system 20 is used to determine the position of a catheter 40, shown in inset 25 of Figure 1 and in more detail in Figure 2. The catheter 40 is a probe that includes a shaft 22 and a plurality of deflectable arms 54 (only some of which are labeled for simplicity) for insertion into a body part of a living organism (e.g., a chamber of the heart 26). The deflectable arms 54 have respective proximal ends connected to the distal end of the shaft 22.

[0055] The catheter 40 includes a position sensor 53 disposed on the shaft 22 in a predetermined spatial relationship with respect to the proximal end of the deflectable arm 54. The position sensor 53 may include a magnetic sensor 50 and / or at least one shaft electrode 52. The magnetic sensor 50 may include at least one coil, such as, but not limited to, a two-axis or three-axis coil arrangement, to provide position and orientation position data, including rotation. The catheter 40 includes multiple electrodes 55 (only some of which are labeled in FIG. 2 for simplicity) disposed at different respective positions along each of the deflectable arms 54. Typically, the catheter 40 may be used to map electrical activity within a living subject's heart using the electrodes 55, or to perform any other suitable function within a body part of a living subject, such as, but not limited to, reversible and / or irreversible electroporation and / or RF ablation.

[0056] The medical treatment system 20 may determine the position and orientation of the shaft 22 of the catheter 40 based on signals provided by the magnetic sensor 50 and / or shaft electrodes 52 (proximal electrode 52 a and distal electrode 52 b) on either side of the magnetic sensor 50 attached to the shaft 22. The proximal electrode 52 a, the distal electrode 52 b, the magnetic sensor 50, and at least some of the electrodes 55 are connected to various driver circuits within the console 24 via the catheter connector 35 by wires extending through the shaft 22. In some embodiments, at least two electrodes 55 on each of the deflectable arms 54, the shaft electrodes 52, and the magnetic sensor 50 are connected to driver circuits within the console 24 via the catheter connector 35. In some embodiments, the distal electrode 52 b and / or the proximal electrode 52 a may be omitted.

[0057] The diagram shown in Figure 2 has been chosen purely for purposes of conceptual clarity. Other configurations of shaft electrode 52 and electrode 55 are possible. Additional functionality may also be included in position sensor 53. For clarity, elements not relevant to the disclosed embodiment of the invention, such as irrigation ports, have been omitted.

[0058] A physician 30 navigates the catheter 40 to a target location within a body part (e.g., the heart 26) of a patient 28 by using a manipulator 32 near the proximal end of the catheter 40 to manipulate the shaft 22 and / or by deflecting it from the sheath 23. The catheter 40 is inserted through the sheath 23 with the deflectable arms 54 gathered together, and only after the catheter 40 is retracted from the sheath 23 can the deflectable arms 54 unfold and resume their intended functional shape. By containing the deflectable arms 54 together, the sheath 23 also serves to minimize vascular trauma during navigation to the target location.

[0059] Console 24 includes processing circuitry 41, typically a general-purpose computer, and suitable front-end and interface circuitry 44 for generating signals at and / or receiving signals from body surface electrodes 49 attached by wires that extend through cable 39 to the chest and back of patient 28 or any other suitable skin surface.

[0060] Console 24 further includes a magnetic sensing subsystem. Patient 28 is placed within a magnetic field generated by a pad including at least one magnetic field emitter 42, which is driven by a unit 43 disposed on console 24. Magnetic field emitter(s) 42 are configured to transmit an alternating magnetic field into a region where a body part (e.g., heart 26) is located. The magnetic field generated by magnetic field emitter(s) 42 generates a directional signal in magnetic sensor 50. Magnetic sensor 50 is configured to detect at least a portion of the transmitted alternating magnetic field and provide the directional signal as a corresponding electrical input to processing circuitry 41.

[0061] In some embodiments, processing circuitry 41 uses position signals received from shaft electrode 52, magnetic sensor 50, and electrode 55 to estimate the position of catheter 40 within an organ, such as within a ventricle. In some embodiments, processing circuitry 41 correlates the position signals received from electrodes 52 and 55 with previously acquired magnetic position calibration position signals to estimate the position of catheter 40 within the organ. Position coordinates of shaft electrode 52 and electrode 55 may be determined by processing circuitry 41 based on impedance or current distribution ratios measured between electrodes 52, 55, and body surface electrodes 49, among other inputs. Console 24 drives display 27, which shows the distal end of catheter 40 within heart 26.

[0062] Position sensing methods using current distribution measurements and / or external magnetic fields have been used in various medical applications, e.g., by Biosense Webster This technology has been implemented in the Carto® system manufactured by Samsung Electronics Co., Ltd. (Irvine, California) and is described in detail in U.S. Pat. Nos. 5,391,199, 6,690,963, 6,484,118, 6,239,724, 6,618,612, 6,332,089, 7,756,576, 7,869,865, and 7,848,787, WO 96 / 05768, and U.S. Patent Application Publication Nos. 2002 / 0065455(A1), 2003 / 0120150(A1), and 2004 / 0068178(A1).

[0063] The Carto® 3 system applies an impedance-based position tracking method of active current position (ACL). In some embodiments, processing circuitry 41 is configured to use the ACL method to create a mapping (e.g., a current position matrix (CPM)) between a representation of electrical impedance and the position in the magnetic coordinate frame of the magnetic field emitter(s) 42. Processing circuitry 41 estimates the positions of shaft electrode 52 and electrode 55 by performing a lookup in the CPM.

[0064] Other methods of determining the position of the distal end of the catheter can be used, for example, using imaging techniques such as ultrasound or MRI or CT scans based on an ultrasound transducer and receiver, which may include placing a radiopaque tag on the catheter 40.

[0065] Processing circuitry 41 is typically programmed in software to perform the functions described herein, which software may be downloaded to a computer in electronic form, for example over a network, or alternatively or additionally may be provided and / or stored on non-transitory, tangible media, such as magnetic, optical, or electronic memory.

[0066] 1 shows only elements relevant to the disclosed technology for the sake of brevity and clarity. System 20 typically includes additional modules and elements that are not directly related to the disclosed technology and therefore have been intentionally omitted from FIG. 1 and the corresponding description.

[0067] The catheter 40 described above includes eight deflectable arms 54 with six electrodes 55 per arm 54. Any suitable catheter may be used in place of catheter 40, such as, for example, a catheter with a different number of flexible arms and / or electrodes per arm, or a variety of probe geometries, such as, by way of example only, a balloon catheter, a basket catheter, or a lasso catheter.

[0068] Medical treatment system 20 may also perform electroporation or RF ablation (or other ablation techniques) of cardiac tissue using any suitable catheter, such as catheter 40 or a different catheter, and any suitable ablation method. Console 24 may include a signal generator 34 configured to generate an electrical signal applied by electrode(s) of a catheter connected to console 24 (and, optionally, one or more of body surface electrodes 49) to perform electroporation or RF ablation of the myocardium of heart 26. Console 24 may include a pump (not shown) that pumps irrigation fluid through an irrigation channel to the distal end of the catheter performing RF ablation. The catheter performing RF ablation may further include a temperature sensor (not shown) that is used to measure the temperature of the myocardium during RF ablation and adjust the ablation power and / or the irrigation rate of pumped irrigation fluid according to the measured temperature.

[0069] Reference is now made to Figure 3, which is a schematic diagram of morphology groups 60 for use in the system 20 of Figure 1. The morphology groups 60 are dynamically created during a pattern matching process described below with reference to Figure 4. Each morphology group 60 includes a set of patterns 62 having similar morphologies, and each group is represented by a morphology template 64, which may be one pattern 62 selected from that group 60. Each pattern 62 includes a set of respective cardiac activity signals 66 (only some of which are labeled for simplicity) from respective ECG and / or IEGM channels for a single cardiac interval. The exemplary activity signals 66 shown in Figure 3 are ECG signals.

[0070] Reference is now made to FIG. 4, which is a flowchart 100 including steps in a pattern matching method for use in the system 20 of FIG. 1. The automatic pattern matching method is typically initiated by the physician 30 (FIG. 1) and can be initiated as soon as relevant data streams become available, for example, from the body surface electrodes 49 (FIG. 1) and / or the electrodes 55 (FIG. 2) of the catheter 40 (FIG. 2), and the reference signal becomes stable. The catheter 40 described with reference to FIG. 2 is an 8-spline catheter. Any suitable catheter can be used in the automatic pattern matching method, so as to be positioned in a stable and fixed position relative to the mapped chamber. Catheter stability is important for capturing comparable representative patterns of different arrhythmias as they appear in the intracardiac signal at the same location(s) over the duration of the medical procedure. In some embodiments, a linear catheter including one or more electrodes can be used and positioned within the coronary sinus (CS).

[0071] Each electrode (e.g., body surface electrode 49 and / or catheter electrode) is configured to be applied to the body of a subject (e.g., patient 28) and is configured to output (block 102) a corresponding set of activation signals 66 (FIG. 3) in response to electrical activity of the subject's heart 26 (FIG. 1) captured over a series of cardiac intervals.

[0072] The processing circuitry 41 is configured to receive and pre-process (block 104) the activation signal 66. Pre-processing may include annotating the activation signal 66 to generate timestamps that identify the location of relevant electrical activations within the activation signal 66. Thus, the activation signal 66 is divided by the timestamps into intervals, each interval representing electrical activity associated with a heartbeat. Pre-processing of the activation signal 66 is described in more detail with reference to FIG. 5.

[0073] Processing circuitry 41 is configured to receive (a next) cardiac interval of a set of activation signals 66 from electrodes (e.g., body surface electrodes 49 and / or catheter electrodes) (block 106). In decision block 108, processing circuitry 41 checks whether the received cardiac interval is a first cardiac interval. If the received cardiac interval is a first one (branch 110), processing circuitry 41 is configured to classify (block 112) the first cardiac interval of the set of activation signals 66 as a first morphology template 64 within a new morphology group 60 (even if the morphology group 60 currently has only one member). If the received cardiac interval is not a first one (e.g., a second or subsequent interval) (branch 114), processing circuitry 41 is configured to calculate (block 116) a similarity measure between the currently received cardiac interval of the set of activation signals 66 and the previously assigned morphology template 64. At decision block 118, processing circuitry 41 is configured to determine whether the similarity measure exceeds a predetermined threshold. If the similarity measure does not exceed the predetermined threshold (branch 120), processing circuitry 41 is configured to classify the currently received cardiac interval of the set of activation signals 66 as a new (second or subsequent) morphology template 64 (block 112). If the similarity measure exceeds the predetermined threshold (branch 122), processing circuitry 41 is configured to group the currently received cardiac interval of the set of activation signals 66 in the morphology group 60 with the morphology template 64 to which the currently received cardiac interval of the set of activation signals 66 is matched (block 124). For example, the second cardiac interval of the set of activation signals 66 may be grouped with the first morphology template 64 in the first morphology group 60. The steps of blocks 116-118 are described in more detail below with reference to FIG. 6.

[0074] In decision block 126, processing circuitry 41 is configured to determine whether the number of cardiac intervals in the set of activation signals 66 in a morphology group 60 (e.g., plus the currently received cardiac interval) currently exceeds a given threshold size. The given threshold size may be any suitable threshold size, for example, between 10 and 50 patterns, e.g., 20 patterns. If the number of cardiac intervals in the set of activation signals 66 in a morphology group 60 previously exceeded the predetermined threshold size but does not now (branch 128), processing continues with the step of block 102, where the next pattern is processed. If the number of cardiac intervals in the set of activation signals 66 in a morphology group 60 currently exceeds the given threshold size (branch 130), processing circuitry 41 is configured to find a new morphology template for that morphology group 60 from all patterns 62 in that morphology group 60 (block 132). The term "currently exceeding" is defined to include where the threshold size was initially exceeded but has not subsequently been exceeded. Thus, the step of block 132 is performed only once for each morphological group 60 when the threshold size is first exceeded for the respective morphological group 60. In other embodiments, the step of block 132 may be performed whenever the size of each morphological group 60 exceeds various threshold levels. The step of block 132 may include configuring processing circuitry 41 to select one of the cardiac intervals of the set of activation signals 66 (e.g., pattern 62) that is most similar to the other cardiac intervals of the set of activation signals 66 in that morphological group 60 as the new morphological template 64. The step of block 132 may include calculating correlations between all pairs of patterns 62 in that morphological group 60, for example, using a suitable pattern matching correlation function, such as that described with reference to FIG. 6, for all combinations of patterns 62 in that morphological group 60. Each pattern 62, along with its calculated counterpart (the pattern of interest), may be defined and compared to all other patterns 62 in that group 60.The variance is calculated for the correlation of each pattern 62 with the rest of the patterns 62 in its morphology group 60, and then the pattern 62 with the smallest variance is selected as the new morphology template 64 in its morphology group 60. The process continues with the step in block 102 where the next pattern is processed.

[0075] The pattern matching process described above is described as a live process that is performed when activation signals 66 are received from patient 28. In some embodiments, the pattern matching process may be performed offline as a batch process. It should be noted that the pattern matching process may be performed using any suitable pattern matching process, for example, by clustering or any grouping methodology.

[0076] The patterns 62 may be logically grouped using any suitable identification. For example, a database table may store each annotation timestamp for each pattern 62 with the identification of the respective group 60 into which the patterns 62 are grouped. The database table may then be queried to provide the number of patterns 62 in each group 60, the most recent activation time of one of the patterns 62 in the group 60, the sequence of patterns 62 in the same group, and the cycle length associated with the patterns 62. The database table may also include fields for identifying the morphological templates 64 for each morphological group 60, storing the corresponding patterns of interest (POIs) (described in further detail with reference to FIG. 5 ) of the corresponding patterns 62, and marking the morphological templates 64 as favorites (described in further detail with reference to FIG. 7 ).

[0077] Reference is now made to FIG. 5, which is a flow chart describing the substeps of the process of block 104 of FIG.

[0078] Processing circuitry 41 is configured to annotate activation signal 66 (block 140) generating timestamps that identify the location of associated electrical activations within activation signal 66. Thus, activation signal 66 is divided by timestamps into intervals, each interval representing electrical activity associated with a heartbeat.

[0079] Any suitable method of annotation can be used to provide an annotation time stamp for an ECG or IEGM signal. The annotation of a signal is the assumed time of occurrence of the signal. In one embodiment, this annotation corresponds to the time of occurrence of the maximum positive value for a selected ECG signal. Several options exist for the reference annotation (positive value, negative value, maximum negative slope, maximum positive slope) and the IEGM signal (the time of occurrence typically corresponds to the activation time of the portion of the myocardium that generates this signal). Criteria for selecting ECG signals for annotation corresponding to the above or other criteria can be defined by the physician.

[0080] Any suitable method of annotation may be used, such as that described in U.S. Patent No. 8,700,136 (Rubinstein), which provides a method for processing "raw" or filtered intracardiac signals, which may be unipolar or bipolar. Typically, the processing involves fitting the intracardiac signal to a predetermined waveform and deriving the annotation time of the signal from the fitted signal rather than the raw signal. Typically, a unipolar signal is fitted, for example, to the following equation, which represents a single complete oscillation:

[0081]

number

[0082] A bipolar signal can be fitted to an equation that represents the difference between two single complete oscillations, typically separated by a time difference. In some embodiments, the single complete oscillation corresponds to the derivative of a Gaussian function. An asymmetry factor may be applied to the derivative, and in some embodiments, the asymmetry factor corresponds to a Gaussian function. If the ECG signal is a bipolar signal, then a unipolar signal V on one electrode unipolar (t)1 and a unipolar signal V on another electrode unipolar (t)2. For bipolar signals such as these, the processor fits equation (2), derived from equation (1), to the signal.

[0083]

number

[0084] Other U.S. patents, including U.S. Patent Nos. 9,259,165 and 10,376,221, and U.S. Patent Publication Nos. 2017 / 0042443 and 2019 / 0223808, describe alternative annotation techniques.

[0085] In some embodiments, processing circuitry 41 is configured to filter activation signal 66 to remove noise and other artifacts (block 142). Noise is generally more of a problem with IEGM signals compared to ECG signals.

[0086] For example, each unipolar signal of the IEGM signal may be sampled at 1 kHz after passing through a 250 Hz finite impulse response (FIR) low-pass filter (LPF). Additional filtering may be applied to remove baseline wander caused by patient movement and breathing.

[0087] A median filter may be applied to the signal with a size of ±20 milliseconds (ms). Rapid changes in the signal may be removed using an additional FIR filter, padded with 20 zero samples (for example), applied to the median filtered signal. The filter coefficients may be calculated as follows:

[0088]

number

[0089] The median filtered signal is subtracted from the original signal to remove baseline wander while preserving the signal morphology resulting in the filtered signal as follows: Filtered Signal = Signal - FIR(Median Filtered Signal)

[0090] Any suitable filtering technique may be performed in addition to or instead of the filtering described above.

[0091] Pacing-induced activations may be irrelevant to the pattern matching process, and therefore processing circuitry 41 is configured to identify pacing-induced beats (block 144), assign them appropriate identification, and exclude them from the pattern matching process. Each incoming annotated beat with an annotation timestamp (TS) may be tested for pacing induction by the following steps.

[0092] The pacing segments may be defined as follows: [Note TS-250ms, Note TS+100ms]

[0093] A pacing activation signal may be calculated for the signal 66 defined by the pacing segment by applying the following:

[0094]

number

[0095] If the maximum value of the pacing activation signal is above the pacing threshold, the beat is classified as paced (e.g., "-1") and the algorithm continues to the next beat. Otherwise, the algorithm continues to the next substep in step 104. Exemplary pacing thresholds are as follows:

[0096]

number

[0097] The IC signal may reveal activations from the atria and ventricles that sometimes overlap. These fused activations have different morphologies caused by waveform interference and therefore generally are not used in the pattern matching and grouping described above with reference to FIG. 4 . Therefore, processing circuitry 41 may be configured to identify these fused activations (block 146) and assign them suitable identification to exclude them from the pattern matching process. Each incoming IC-annotated beat may be tested for fused activation by locating the annotation to a BS activation annotation (on the precordial leads). If the IC annotation is found to be within 100 ms of a ventricular activation identified from the BS activation signal 66, the IC annotation may be classified as fused, and the algorithm continues to process the next incoming beat.

[0098] Input patterns 62 may be compared to morphological templates 64 based on a specific window around the annotation timestamp assigned to each pattern 62. In some embodiments, patterns of interest (POIs) may be defined to limit the range of patterns 62 for calculating correlations between the patterns 62 and the morphological templates 64. In some embodiments, POIs are calculated for patterns 62 that become morphological templates 64, but may not be calculated for all patterns 62.

[0099] Processing circuitry 41 is configured to select a POI (block 148). An active segment may be defined around the reference annotation as follows. [Note TS-150ms, Note TS+150ms]

[0100] An activity signal may be calculated for the signal 66 defined by the activity segment by applying a median filter over a window (eg, 15 ms or any suitable value) as follows:

[0101]

number

[0102] The activity threshold may be calculated using the activity signal as follows: Activation threshold = (max(activation signal [i 101 ~i_ 101 ])-Min(active signal))+Min(active signal)

[0103] A local maximum can be calculated to assign a peak in activity of the activity signal to (for example) 100 ms around the reference annotation. Maximum = Max(active signal [i 101 ~i_ 101 ])

[0104] In the above two equations, i is the sample point index, and the signal is digitized and contains 1000 samples in a 1 KS / s signal.

[0105] A buffer of 10 ms (for example) is calculated around the intersection of the activity signal with the activity threshold, surrounding the local maximum, and the POI can be set as follows: POI = [maximum value -10ms from the left of the first intersection, maximum value +10ms from the right of the first intersection]

[0106] Reference is now made to FIG. 6, which is a flow chart including substeps of the steps of blocks 116 and 118 of FIG.

[0107] The processing circuitry 41 is configured to calculate (block 150) a similarity measure between a recently received cardiac interval of the activation signal 66 (e.g., a recently received pattern 62) and one of the morphological templates 64. The comparison of the recently received cardiac interval may be performed for the various morphological templates 64 according to the group size into which each template 64 is grouped, with the morphological template 64 from the largest group being selected first for comparison, and so on according to decreasing grouping size. Thus, the first morphological template 64 selected may be the morphological template 64 from the morphological group 60 containing the greatest number of patterns 62.

[0108] The similarity measure is calculated between the most recently received pattern 62 and the morphological template 64 using a moving window. In one embodiment, the moving window has a size of plus or minus 10 ms around the reference annotation, and the window is moved in 1 ms increments. Any other suitable window size and increment size may be used.

[0109] The similarity measure may be calculated using any suitable correlation method, such as Pearson correlation or weighted Pearson correlation, where an example of a weighted Pearson correlation that may be used in embodiments of the present invention is as follows:

[0110] The following description describes the correlation function for the IC signal. The correlation function may utilize a weighting mechanism to compare each annotated incoming heartbeat (e.g., pattern) to the (predefined POIs) of the template 64. The correlation function may be defined as follows:

[0111]

number

[0112]

number

[0113] Weights may be applied to each channel corresponding to each unipolar IEGM signal 66 received from each electrode of the catheter. The channel weights are calculated based on the maximum gradient of the template signal, which indicates the dominant channel that should have a greater influence on the final correlation result. Notably, the maximum gradient of the template signal is the derivative of the template signal, and therefore, the channel weights are the derivatives of the template gradient. Using a derivative-based function can distinguish sharp activations from shallow activations, which may result in a better template match compared to an amplitude-based function, which may yield more uncertain results for a particular activation. For example, the channel weights for each channel may be calculated based on the following:

[0114]

number

[0115] The maximum threshold may be defined as a default value (eg, 2).

[0116] A single correlation value for all channels may be determined. The overall correlation value may be calculated as follows: Correlation = ΣW i *Signal correlation i

[0117] Correlation of body surface ECG signals may be performed according to the method described in U.S. Patent No. 10,433,749 to Nakar et al., which describes performing cross-correlations between an initial set and subsequent sets to generate a correlation coefficient, which is a measure of fit between the geometries of the initial and subsequent sets. Specifically, processing circuitry 41 calculates a correlation coefficient for each ECG channel (ECG i,j) over the current heartbeat interval associated with annotation j according to the following formula, where i is a numerical index defining a channel of pattern 62 (typically, i=1, 2,..., 12 for BS ECG) and j is a numerical index defining the location of the annotation on the ECG signal:

[0118]

number

[0119]

number

[0120]

number

[0121] It will be appreciated that the correlation analysis performed by equation (3) compares the geometry or shape of the template 64 ECG data with the current beat-to-beat ECG data. A high correlation (x,y), i.e., a close match, indicates that the two geometries of the template 64 and the current beat are similar.

[0122] In another step of the algorithm, processing circuitry 41 calculates the overall correlation for a particular heartbeat interval using the correlation coefficient value calculated using Equation 3. Processing circuitry 41 calculates the absolute maximum amplitude A of the ECG signal being tested for the current heartbeat interval. i,j , and the absolute maximum amplitude Bi of the corresponding ECG signal in the morphological template 64. i,j and B i The sum of and is used as weights to calculate the overall correlation according to equation (4):

[0123]

number

[0124] The overall correlation coefficient calculated by equation (4) depends on the phase of the ECG signal being tested relative to the phase of the morphology template 64. In a further step, processing circuitry 41 iteratively varies the phase of the ECG signal being tested relative to the phase of the morphology pattern, and the calculations described above with reference to equations (3) and (4) are repeated according to each new relative phase to calculate an overall correlation for each of the relative phases.

[0125] At decision block 152, processing circuitry 41 is configured to determine whether the similarity measure (e.g., correlation) is greater than 0.85. The value 0.85 is given by way of example only, and any other suitable threshold value may be used. If the similarity measure is greater than 0.85 (branch 154), processing continues to the steps of block 124 of FIG. 4, where the currently received pattern 62 is added to the matching morphology group 60. If the similarity measure is not greater than 0.85 (branch 156), processing continues at decision block 158, where circuitry 41 is configured to check whether the similarity measure is greater than 0.65. The value 0.65 is given by way of example only, and any other suitable threshold value may be used. If the similarity measure exceeds 0.65 (branch 160), processing circuitry 41 is configured to repeat the calculation of the similarity measure (block 162) using a larger sliding window, e.g., ±40 ms, around the reference annotation, with the window moved in 1 ms increments. Using a larger sliding window (e.g., ±40 ms) can be computationally intensive and is therefore typically used for correlations in an uncertain range, e.g., 0.65 to 0.85. The steps of blocks 158 and 162 provide an optimization mechanism that accounts for the computational challenges of such large data sets. Any suitable window size and increment size may be used. In decision block 164, processing circuitry 41 is configured to check whether the calculated similarity measure exceeds 0.85. If the similarity measure exceeds 0.85 (branch 166), processing continues to the steps of block 124 of FIG. 4, where the currently received pattern 62 is added to the matching morphology group 60. If the similarity measure does not exceed 0.85 (branch 168), processing continues at decision block 170. Similarly, if decision block 158 finds that the similarity measure does not exceed 0.65 (branch 172), processing continues at decision block 170. At decision block 170, processing circuitry 41 is configured to check whether the currently received pattern 62 has been compared to all templates 64.If the currently received pattern 62 has not been compared to all of the morphological templates 64 (branch 174), the steps of block 150 are repeated for the currently received pattern 62 and another one of the morphological templates 64. The template 64 used is typically selected from the remaining morphological templates 64 (i.e., those not yet used for comparison with the currently received pattern 62) of the largest group 60 (i.e., the largest number of patterns 62 in the group). If the currently received pattern 62 has already been compared to all of the morphological templates 64 (branch 176), the steps of block 112 of FIG. 4 are performed, except that the currently received pattern 62 becomes the new morphological template 64 for the new morphological group 60.

[0126] Reference is now made to Figure 7, which is a flowchart 200 including steps in rendering a user interface screen 250 in system 20. Reference is also made to Figure 8, which is a schematic diagram of a user interface screen 250 generated by system 20 of Figure 1.

[0127] The processing circuitry 41 is configured to render (block 202) on the display 27 (FIG. 1) a user interface screen 250 including a corresponding morphological template 64 and an indication of the corresponding relative number of cardiac intervals of the set of activation signals 66 (e.g., patterns 62) in the corresponding morphological group 60 (FIG. 3). The indication may include a count 252 and / or an activation rate 254 (or rate of occurrence) of the cardiac intervals of the set of activation signals 66 in the corresponding morphological group 60. In other words, the indication may include a count 252 and / or an activation rate 254 (or rate of occurrence) of the patterns 62 in the morphological group 60 for each displayed morphological template 64. The activation rate 254 (or rate of occurrence) may be expressed as a percentage (or other proportion) of the patterns 62 in one of the morphological groups 60 (across all morphological groups 60) relative to the total count of the patterns 62. The morphological templates 64 of all morphological groups 60, or only some of the groups 60, may be selected to be displayed in the user interface screen 250. The criteria for selecting which configuration templates 64 are shown and in what order are described in more detail below. If there is not enough room on the user interface screen 250 to simultaneously show all selected configuration templates 64, the configuration templates 64 may be shown on different scrollable pages indicated by the page selector 256.

[0128] The user interface screen 250 may also include a most recent activation time 258 for each of the displayed morphological templates 64 (i.e., the last time the morphology represented by each morphological template 64 was active), a cycle length 260 associated with the displayed morphological template 64, and a POI 262 associated with the displayed morphological template 64. The user interface screen 250 may also indicate a total time 264 that the pattern matching process has been running.

[0129] The indication of the relative number of cardiac intervals in each of the sets of activation signals 66 (e.g., patterns 62) may include a histogram 266 indicating the relative number of cardiac intervals in each of the sets of activation signals 66 (e.g., counts 252 and activation rates 254 or occurrence rates) within each displayed morphology group 60.

[0130] Processing circuitry 41 may also be configured to render user interface screen 250 including a graph 268 of cardiac cycle length versus time. The graph may indicate when a morphology of a selected morphology group 60 (or for multiple selected groups 60) was active by using different colors on cycle length line 270 (shown in FIG. 8 using different grayscales). A vertical line 272 may be used to indicate when a selected morphology was active.

[0131] One of the morphological templates 64 (e.g., pattern / template 10) may be selected and shown in a larger pane 274 (on the right side of the user interface screen 250), allowing the physician 30 to examine the selected morphological template 64 in more detail and compare its correlation with the real-time ECG or currently captured IEGM.

[0132] As described above, a filter 276 may be used to determine which morphology templates 64 are displayed based on filtering criteria. The filter bar may be always displayed or may only be displayed when opened by the user. Thus, processing circuitry 41 is configured to select (block 204) corresponding morphology templates 64 to be included in user interface screen 250 from the available morphology templates 64 according to any one or more of the following filters: a minimum count of cardiac intervals of the set of activation signals 66 (e.g., patterns 62) within each morphology group 64 (groups 60 having counts below this value are excluded); a minimum activation rate (or rate of occurrence) of cardiac intervals of the set of activation signals 66 within each morphology group 64 (groups 60 having activation rates below this value are excluded); or a last activation of the cardiac interval of the set of activation signals 66 in each of the morphology groups 60 (only morphologies earlier than this time are excluded).

[0133] Additionally or alternatively, a classification filter may be used that may provide physician 30 with details regarding the type of activation mechanism by distinguishing between multiple consecutive activations with the same morphology (e.g., VT, flutter, etc.) and a single abnormal activation with a normal rhythmic sequence (e.g., PVC, PAC, etc.). The classification filter may define a minimum consecutive sequence of cardiac intervals in the same one of the morphology groups (which may be set to a sequence of any size or may even be set to include a single pattern).

[0134] A heart symbol 278 associated with each displayed morphological template 64 may be selected to make that morphological template 64 a favorite, causing that morphological template 64 to be displayed in the user interface screen 250 regardless of the selected filter. Accordingly, processing circuitry 41 is configured to receive a user selection (block 206) assigning a favorite to a morphological template 64 (e.g., pattern 10 in FIG. 8 ) and render that favorite on the user interface screen 250 even if the favorite is not selected according to one or more filters 276. The heart symbol 278 associated with pattern 10 in FIG. 8 is shown with a padlock symbol, indicating that pattern 10 has been selected as a favorite and assigned to a particular map as a pattern matching filter.

[0135] The selected morphology templates 64 may be ordered within the user interface screen 250 according to any suitable display order criteria 280. The processing circuitry 41 is configured to order (block 208) each morphology template 64 within the user interface screen 250 according to any one or more of the count of cardiac intervals of the set of activation signals 66 within the respective morphology group 60, the activation rate (or incidence) of cardiac intervals of the set of activation signals 66 within the respective morphology group 60, the earliest activation of cardiac intervals of the set of activation signals 66 within the respective morphology group 60, or the most recent activation of cardiac intervals of the set of activation signals 66 within the respective morphology group 60. The physician 30 can start, stop, or pause the automatic pattern matching process at will.

[0136] Reference is now made to Figures 9 and 10. Figure 9 is a flow chart 300 including steps in a method of operation of the system 20 of Figure 1. Figure 10 is a schematic illustration of the user interface screen 250 of Figure 8 in verification mode.

[0137] A physician 30 may wish to ascertain the effect a particular procedure or therapy has on the patterns 62 generated by the heart 26 (FIG. 1) of a patient 28. For example, after an ablation procedure, the physician 30 may wish to ascertain whether a problematic arrhythmia associated with a particular morphology template 64 or multiple morphology templates 64 has terminated or subsided. To track the effectiveness of the procedure, a secondary bar 282 (only partially labeled for simplicity) may be added to the histogram 266 in addition to a primary bar 284 (only partially labeled for simplicity). The primary bar 284 indicates the count 252 (only partially labeled for simplicity) and / or activation rate 254 (or incidence) (only partially labeled for simplicity) of each morphology group 60 represented by the primary bar 284 since the pattern matching process began (prior to the procedure or therapy, e.g., ablation). The secondary bars 282, each disposed adjacent to a primary bar 284, show counts 286 (only some of which are labeled for simplicity) and / or activation rates 288 (or incidence rates) (only some of which are labeled for simplicity) of the respective morphological groups 60 only during the verification period (e.g., after a procedure or treatment, e.g., ablation).

[0138] Template 20 is shown in primary bar 284 with a number equal to the secondary bar 282 when template 20 first appears during the validation period, and may represent morphology altered by treatment (e.g., ablation). Templates 9, 10, 18, and 20 do not include secondary bars to indicate that the morphology associated with these templates has not been shown during the validation period.

[0139] Processing circuitry 41 (FIG. 1) is configured to track a first corresponding number of cardiac intervals for the set of activation signals 66 applied to each morphology group 60 prior to a verification period (block 302). System 20 is configured to perform an ablation procedure (block 304). Processing circuitry 41 is configured to initiate a verification period in response to receiving user input (block 306). Processing circuitry 41 is configured to continue tracking the first corresponding number of cardiac intervals for the set of activation signals 66 applied to each morphology group 60 during the verification period (block 308). Processing circuitry 41 is configured to track a second corresponding number of cardiac intervals for the set of activation signals applied to each morphology only during the verification period (block 310). Processing circuitry 41 is configured to render on display 27 (block 312) user interface screen 250 simultaneously including an indication of the first corresponding number (e.g., count 252 and activation rate 254 or occurrence rate) and the second corresponding number (e.g., count 286 and activation rate 288 or occurrence rate) of cardiac intervals added to each morphology group 60.

[0140] The processing circuitry 41 is configured to highlight (e.g., using highlighting and / or bolding and / or any other suitable formatting changes) the first new morphology template 64 (e.g., template / pattern 20) created during the validation period. The new morphology template 64 is typically treated similarly to a favorite morphology template 64 in that the new morphology template 64 remains on the user interface screen 250 regardless of the selected filter and, optionally, regardless of the preferred display order, so that the new morphology template 64 receives appropriate attention from the physician 30.

[0141] Referring again to FIG. 8 , FIG. 8 shows that the activation count 252 of cardiac intervals in each of the morphology groups 60 ( FIG. 3 ) for each of patterns 10, 17, and 6 is less than 60. Therefore, it may be difficult to successfully generate meaningful electroanatomical maps, such as local activation time (LAT) maps, for any of the morphology groups 60 for patterns 10, 17, and 6. However, a physician 30 may wish to identify the source of an arrhythmia associated with any of patterns 10, 17, and 6 and perform ablation at the source of the arrhythmia. As described in more detail below with reference to FIG. 11 , pacing may be used to help the physician 30 identify the source of arrhythmias in such patterns in order to ablate the source of the arrhythmia.

[0142] It should be noted that the count limit of 60 is used merely as an example. The count limit may be set above or below 60 with respect to the usefulness of using the captured cardiac intervals to generate meaningful electroanatomical maps. This limit may depend on the method used to generate the electroanatomical map and / or the skill of the physician 30 (FIG. 1).

[0143] Reference is now made to Figure 11, which is a schematic diagram of a user interface screen 400 generated by system 20 of Figure 1. As described above with reference to Figure 5, pacing-induced activations may be irrelevant to the pattern matching process, and therefore processing circuitry 41 (Figure 1) is configured to identify pacing-induced beats (at block 144 of Figure 5), assign appropriate identification to the pacing-induced beats, and exclude them from the pattern matching process.

[0144] In some embodiments, pacing-induced heartbeats are generally not added as patterns 62 (FIG. 3) to any of the morphology groups 60 (FIG. 3), but the pacing-induced heartbeats are compared to the morphology templates 64 (FIG. 3) to determine a similarity measure 402 (e.g., correlation) with each morphology template 64. The similarity measure 402 for each morphology template 64 may be displayed in real time so that the physician 30 (FIG. 1) can determine the source of the arrhythmia based on the displayed similarity measure 402. For example, the catheter 40 is moved around the ventricle, and when the catheter 40 (FIG. 1) is positioned at a particular location within a chamber of the heart 26 (FIG. 1), the similarity measure 402 with one of the morphology templates 64 exceeds 90% (for example), which is a good indication that the catheter 40 is positioned in proximity to the source of the arrhythmia associated with that morphology template 64. The percentage threshold defining a good indication is determined by the physician 30 and may be any suitable value or percentage. For example, the percentage threshold defining a good indication may be less than 90% or greater than 90%. The catheter 40 may be moved around the chambers of the heart until the physician 30 is satisfied that the source of the arrhythmia (in which the physician 30 is concerned) associated with one of the morphology templates 64 has been found based on a similarity measure 402 with the morphology template 64 that exceeds a certain similarity measure.

[0145] 11 illustrates three morphological templates 64: a normal sinus rhythm (NSR) morphological template 64-1, a premature ventricular complex (PVC) 1 morphological template 64-2, and a PVC2 morphological template 64-3. A similarity measure 402 is displayed adjacent to each morphological template 64. For example, a similarity measure 402-1 equal to 23% is displayed adjacent to the NSR morphological template 64-1, a similarity measure 402-2 equal to 92% is displayed adjacent to the PVC1 morphological template 64-2, and a similarity measure 402-3 equal to 70% is displayed adjacent to the PVC2 morphological template 64-3. Thus, the catheter 40 is believed to be positioned within the chamber of the heart 26 proximate to the source of the arrhythmia associated with PVC1. Therefore, based on the above analysis, physician 30 may decide to ablate at the current location of catheter 40 associated with the source of the arrhythmia associated with PVC1.

[0146] Thus, in some embodiments, processing circuitry 41 ( FIG. 1 ) is configured to calculate a respective similarity measure 402 between the pacing-induced cardiac intervals of set 66 of activation signals (only some of which are labeled for simplicity) and each one of the previously assigned morphology templates 64 of each morphology group 60. The pacing-induced cardiac intervals of set 66 of activation signals may be compared to some or all of the previously assigned morphology templates 64. For example, the pacing-induced cardiac intervals of set 66 of activation signals may be compared (e.g., using cardiac symbols 278) to morphology templates 64 marked as favorites.

[0147] Processing circuitry 41 is configured to render a pacing user interface screen 400 on display 27 ( FIG. 1 ), the pacing user interface screen including an indication of each similarity measure 402 between the pacing-induced cardiac intervals of set 66 of activation signals and each previously assigned morphology template 64 of each morphology group 60. A portion of the calculated similarity measures 402 may be displayed on pacing user interface screen 400, a portion of the calculated similarity measures 402 may be displayed on a different user interface screen, or not displayed at all. In some embodiments, all of the calculated similarity measures 402 are displayed on pacing user interface screen 400. In some embodiments, processing circuitry 41 is configured to render a user interface screen 400 on display 27, the user interface screen including each previously assigned morphology template 64 and an indication of each similarity measure 402 between the pacing-induced cardiac intervals of set 66 of activation signals and each previously assigned morphology template 64 of each morphology group 60. Subsequent pacing-induced heart beats are captured, detected, and processed by processing circuitry 41 to calculate a similarity measure 402 that can be rendered on pacing user interface screen 400.

[0148] The term "about" or "approximately" used herein in connection with any numerical value or range of values ​​indicates a suitable dimensional tolerance that enables a portion of a component or a collection of components to function according to its intended purpose as described herein. More specifically, "about" or "approximately" may refer to a range of values ​​of ±20% of the recited value, for example, "about 90%" may refer to a range of values ​​of 72% to 108%.

[0149] Various features of the invention, which are, for clarity, described in the context of separate embodiments, may also be provided in combination in a single embodiment. Conversely, various features of the invention, which are, for brevity, described in the context of a single embodiment, may also be provided separately or in any suitable subcombination.

[0150] The above-described embodiments are cited by way of example, and the present invention is not limited to what has been particularly shown and described in the foregoing specification. Rather, the scope of the present invention includes both combinations and subcombinations of the various features described above, as well as variations and modifications thereof not disclosed in the prior art that will occur to those skilled in the art upon reading the foregoing description.

[0151] [Embodiment] (1) A medical system utilizing automatic pattern acquisition, comprising: respective electrodes configured to be applied to a body of a subject and configured to output a respective set of activation signals in response to electrical activity of the subject's heart captured over a series of cardiac intervals; 1. A processor, comprising: classifying a first cardiac interval of the set of activation signals as a first morphology template; calculating a similarity measure between the second cardiac interval of the set of activation signals and the first morphology template for a second cardiac interval after the first cardiac interval, grouping the second cardiac interval of the set of activation signals in a first morphology group with the first morphology template in response to the similarity measure exceeding a predetermined threshold, and classifying the second cardiac interval of the set of activation signals as a second morphology template in response to the similarity measure not exceeding the predetermined threshold; and a processor configured to: for a subsequent cardiac interval, calculate a similarity measure between the subsequent cardiac interval of the set of activation signals and at least one of a plurality of previously assigned morphological templates of a respective morphological group; group the subsequent cardiac interval of the set of activation signals of one of the morphological groups with one of the previously assigned morphological templates in response to the similarity measure with the one previously assigned morphological template exceeding a predetermined threshold; and classify the subsequent cardiac interval of the set of activation signals as another morphological template in response to the similarity measure with the previously assigned morphological template not exceeding the predetermined threshold. (2) The system of embodiment 1, wherein the processor is configured to find a new morphology template for one of the morphology groups in response to the number of cardiac intervals of the set of activation signals within one of the morphology groups exceeding a predetermined threshold size. (3) The system of embodiment 2, wherein the processor is configured to select one of the cardiac intervals of the set of activation signals that is most similar to other cardiac intervals of the set of activation signals within the one morphology group as the new morphology template. (4) The system of embodiment 1, further comprising a display, wherein the processor is configured to render a user interface screen on the display including an indication of corresponding ones of the morphological templates and corresponding relative numbers of cardiac intervals of the sets of activation signals of corresponding ones of the morphological groups. (5) The system of embodiment 4, wherein the indication includes a histogram indicating the corresponding relative numbers of the cardiac intervals of the sets of activation signals of the corresponding ones of the morphological groups.

[0152] (6) The system of embodiment 4, wherein the instructions include the count of the cardiac intervals and / or the activation rate and / or the occurrence rate of the set of activation signals of the corresponding ones of the morphological groups. (7) The system of embodiment 4, wherein the processor is configured to order the corresponding ones of the morphological templates within the user interface screen according to any one or more of: a count of the cardiac intervals of the set of activation signals of the corresponding ones of the morphological groups; an activation rate or incidence rate of the cardiac intervals of the set of activation signals of the corresponding ones of the morphological groups; an earliest activation of the cardiac intervals of the set of activation signals of the corresponding ones of the morphological groups; or a latest activation of the cardiac intervals of the set of activation signals of the corresponding ones of the morphological groups. (8) The system of embodiment 4, wherein the processor is configured to select the corresponding one of the morphological templates to be included in the user interface screen from the morphological templates according to any one or more of the following filters: minimum count of the cardiac intervals of the set of activation signals of the corresponding one of the morphological groups; minimum activation rate or incidence of the cardiac intervals of the set of activation signals of the corresponding one of the morphological groups; most recent activation of the cardiac intervals of the set of activation signals of the corresponding one of the morphological groups; and minimum consecutive sequence of cardiac intervals within the same morphological group of the morphological groups. (9) The system of embodiment 8, wherein the processor is configured to receive a user selection to assign a favorite to the morphological template, and the processor is configured to render the favorite within the user interface screen even if the favorite is not selected according to the one or more filters. (10) The processor: a first corresponding number of cardiac intervals of the set of activation signals applied to the corresponding morphological group before and during a verification period; and a second corresponding number of cardiac intervals of the set of activation signals applied to the corresponding morphological group during the verification period; The system of embodiment 4, wherein the processor is configured to render the user interface screen on the display, and the user interface screen simultaneously includes an indication of the first corresponding number and an indication of the second corresponding number of cardiac intervals to be added to the corresponding morphology group.

[0153] (11) The system of embodiment 10, wherein the processor is configured to highlight new morphological templates created during the validation period. (12) The system of embodiment 4, wherein the processor is configured to render the user interface screen including a graph of cardiac cycle length versus time, the graph indicating when a selected one of the morphologies of the group of morphologies was active. (13) The method further includes a display, and the processor: calculating corresponding similarity measures between pacing-induced cardiac intervals of the set of activation signals and corresponding ones of the previously assigned morphology templates of the corresponding morphology group; and rendering on the display a user interface screen including an indication of the corresponding similarity measure between the pacing-induced cardiac intervals of the set of activation signals and the corresponding previously assigned morphology template of the corresponding morphology group. (14) The system of embodiment 13, wherein the processor is configured to render the user interface screen on the display, the user interface screen including the corresponding previously assigned morphology template and the indication of the corresponding similarity measure between the pacing-induced cardiac intervals of the set of activation signals and the corresponding previously assigned morphology template of the corresponding morphology group. (15) A medical method utilizing automatic pattern acquisition, comprising: applying corresponding electrodes to the subject's body; outputting, by the electrodes, a set of corresponding activation signals in response to electrical activity of the subject's heart captured over a series of cardiac intervals; classifying a first cardiac interval of the set of activation signals as a first morphology template; for a second cardiac interval after the first cardiac interval, calculating a similarity measure between the second cardiac interval of the set of activation signals and the first morphological template; grouping the second cardiac interval of the set of activation signals in a first morphology group with the first morphology template in response to the similarity measure exceeding a predetermined threshold; classifying the second cardiac interval of the set of activation signals as a second morphology template in response to the similarity measure not exceeding the predetermined threshold; For subsequent heartbeat intervals, calculating a similarity measure between the subsequent cardiac interval of the set of activation signals and at least one of a plurality of previously assigned morphology templates of a corresponding morphology group; grouping the subsequent cardiac intervals of the set of activation signals of one of the morphology groups of one of the previously assigned morphology templates in response to the similarity measure with the one previously assigned morphology template exceeding a predetermined threshold; and classifying the subsequent cardiac interval of the set of activation signals as a different morphological template in response to the similarity measure with the previously assigned morphological template not exceeding the predetermined threshold.

[0154] (16) The method of embodiment 15, further comprising finding a new morphology template for one of the morphology groups in response to the number of cardiac intervals of the set of activation signals within the one morphology group exceeding a predetermined threshold size. (17) The method of embodiment 16, further comprising selecting as the new morphology template one of the cardiac intervals of the set of activation signals that is most similar to other of the cardiac intervals of the set of activation signals within the one morphology group. (18) The method of claim 15, further comprising rendering on a display a user interface screen including an indication of corresponding ones of the morphology templates and corresponding relative numbers of cardiac intervals of the sets of activation signals of corresponding ones of the morphology groups. 19. The method of claim 18, wherein the indication includes a histogram indicating the corresponding relative numbers of the cardiac intervals of the sets of activation signals of the corresponding ones of the morphological groups. (20) The method of embodiment 18, wherein the instructions include the count of the cardiac intervals and / or activation rates and / or occurrence rates of the set of activation signals of the corresponding ones of the morphological groups.

[0155] (21) The method of claim 18, further comprising ordering the corresponding ones of the morphology templates in the user interface screen according to any one or more of: a count of the cardiac intervals of the set of activation signals of the corresponding ones of the morphology groups; an activation rate or incidence rate of the cardiac intervals of the set of activation signals of the corresponding ones of the morphology groups; an earliest activation of the cardiac intervals of the set of activation signals of the corresponding ones of the morphology groups; or a latest activation of the cardiac intervals of the set of activation signals of the corresponding ones of the morphology groups. (22) The method of claim 18, further comprising selecting the corresponding one of the morphology templates to be included in the user interface screen from the morphology templates according to any one or more of the following filters: minimum count of the cardiac intervals of the set of activation signals of the corresponding one of the morphology groups; minimum activation rate or incidence of the cardiac intervals of the set of activation signals of the corresponding one of the morphology groups; most recent activation of the cardiac intervals of the set of activation signals of the corresponding one of the morphology groups; minimum consecutive sequence of cardiac intervals within the same morphology group of the morphology groups. (23) receiving a user selection to assign a favorite to the configuration template; 23. The method of claim 22, further comprising: rendering the favorites within the user interface screen even if the favorites are not selected according to the one or more filters. (24) a first corresponding number of cardiac intervals of the set of activation signals added to the corresponding morphological group before and during a verification period; and a second corresponding number of cardiac intervals of the set of activation signals applied to the corresponding morphological group during the verification period; The method of embodiment 18, wherein the rendering includes rendering the user interface screen on the display, the user interface screen simultaneously including an indication of the first corresponding number and an indication of the second corresponding number of cardiac intervals to be added to the corresponding morphology group. (25) The method of embodiment 24, further comprising highlighting new morphological templates created during the validation period.

[0156] (26) The method of embodiment 18, wherein the rendering includes rendering the user interface screen including a graph of cardiac cycle length versus time, the graph indicating when a selected one of the morphologies of the group of morphologies was active. (27) calculating corresponding similarity measures between pacing-induced cardiac intervals of the set of activation signals and corresponding ones of the previously assigned morphology templates of the corresponding morphology group; 16. The method of claim 15, further comprising: rendering on a display a user interface screen including an indication of the corresponding similarity measure between the pacing-induced cardiac intervals of the set of activation signals and the corresponding previously assigned morphology template of the corresponding morphology group. (28) The method of embodiment 27, wherein the rendering includes rendering the user interface screen on the display including the corresponding previously assigned morphology template and the indication of the corresponding similarity measure between the pacing-induced cardiac intervals of the set of activation signals and the corresponding previously assigned morphology template of the corresponding morphology group.

Claims

1. 1. A medical system utilizing automatic pattern acquisition, comprising: each electrode configured to be applied to a body of a subject and configured to output a cardiac pattern, the cardiac pattern being a set of activation signals in a single cardiac beat, in response to electrical activity of the subject's heart captured over a series of cardiac beats; 1. A processor, comprising: classifying the first heartbeat pattern as a morphology template of a first morphology group; for a second heartbeat pattern subsequent to the first heartbeat pattern, based on a similarity measure between the second heartbeat pattern and a morphology template of the first morphology group; responsive to the determination of similarity, grouping the second heartbeat pattern with the first morphology group; classifying the second cardiac pattern as a morphology template of a second morphology group in response to determining that the second cardiac pattern is not similar; for a subsequent heartbeat pattern, based on a similarity measure between the subsequent heartbeat pattern and a morphology template of each morphology group; If there is a morphology template determined to be similar, grouping the subsequent heartbeat pattern into a corresponding morphology group; if no morphology template is determined to be similar, classifying the subsequent cardiac pattern as a morphology template of a new morphology group; The processor is configured to, when the number of heartbeat patterns in each morphology group exceeds a predetermined threshold size, calculate correlations between pairs of all heartbeat patterns in the morphology group whose number of heartbeat patterns exceeds the threshold size, and select a heartbeat pattern with a minimum variance for the correlation as a new morphology template for the morphology group whose number of heartbeat patterns exceeds the threshold size.

2. 2. The system of claim 1, further comprising a display, wherein the processor is configured to render a user interface screen on the display including morphology templates for the corresponding morphology groups and an indication of the corresponding relative numbers of cardiac patterns within the corresponding morphology groups.

3. The system of claim 2 , wherein the indication includes a histogram indicating the corresponding relative numbers of heartbeat patterns within the corresponding morphological group.

4. The system of claim 2 , wherein the instructions include counts and / or activation rates and / or occurrence rates of heartbeat patterns within the corresponding morphological group.

5. 3. The system of claim 2, wherein the processor is configured to order the cardiac patterns of the morphological groups within the user interface screen according to any one or more of: a count of cardiac patterns of the corresponding morphological groups; an activation rate or incidence rate of cardiac patterns of the corresponding morphological groups; an earliest activation of cardiac patterns of the corresponding morphological groups; or a most recent activation of cardiac patterns of the corresponding morphological groups.

6. 3. The system of claim 2, wherein the processor is configured to select from the morphology templates of the corresponding morphology group to be included in the user interface screen according to any one or more of the following filters: minimum count of cardiac patterns within the corresponding morphology group; minimum activation rate or incidence rate of cardiac patterns within the corresponding morphology group; most recent activation of cardiac patterns within the corresponding morphology group; minimum consecutive sequence of cardiac patterns within the same morphology group within the corresponding morphology group.

7. 7. The system of claim 6, wherein the processor is configured to receive a user selection to assign a favorite to the morphology template, and the processor is configured to render the favorite within the user interface screen even if the favorite is not selected according to the one or more filters.

8. The processor: a first corresponding number of heartbeat patterns added to the corresponding morphology group before and during a validation period; and a second corresponding number of cardiac patterns added to the corresponding morphological group during the verification period; 3. The system of claim 2, wherein the processor is configured to render the user interface screen on the display, the user interface screen simultaneously including an indication of the first corresponding number and an indication of the second corresponding number of cardiac patterns to be added to the corresponding morphological group.

9. The system of claim 8 , wherein the processor is configured to highlight new morphological templates created during the validation period.

10. 3. The system of claim 2, wherein the processor is configured to render the user interface screen including a graph of cardiac cycle length versus time, the graph indicating when a selected one of the morphologies of the group was active.

11. a display, the processor calculating a similarity measure between the pacing-induced heartbeat pattern and a corresponding one of the morphology templates of the corresponding morphology group; and rendering on the display a user interface screen including an indication of a similarity measure between the pacing-induced cardiac pattern and a morphology template of the corresponding morphology group.

12. 12. The system of claim 11, wherein the processor is configured to render the user interface screen on the display, the user interface screen including a morphological template of the corresponding morphological group and the indication of a similarity measure between the pacing-induced cardiac beat pattern and the morphological template of the corresponding morphological group.

13. 1. A method of operating a medical system utilizing automatic pattern acquisition, comprising: The medical system comprises: a processor; each electrode configured to be applied to a body of a subject and configured to output a cardiac pattern, the cardiac pattern being a set of activation signals in a single cardiac beat, in response to electrical activity of the subject's heart captured over a series of cardiac beats; Equipped with The processor performing the steps of: classifying the first heartbeat pattern as a morphology template of a first morphology group; For a second heartbeat pattern following the first heartbeat pattern: based on a similarity measure between the second cardiac pattern and a morphology template of the first morphology group; responsive to the determination of similarity, grouping the second heartbeat pattern with the first morphology group; classifying the second cardiac pattern as a morphology template of a second morphology group in response to determining that the second cardiac pattern is not similar; For subsequent heart rate patterns, based on a similarity measure between the subsequent heartbeat pattern and a morphological template of each group; If there is a morphology template determined to be similar, grouping the subsequent heartbeat patterns into a corresponding morphology group; If no morphology template is determined to be similar, classifying the subsequent heartbeat pattern as a morphology template of a new morphology group; If the number of heartbeat patterns in each morphology group exceeds a predetermined threshold size, calculating correlations between pairs of all heartbeat patterns in the morphology group whose number of heartbeat patterns exceeds the threshold size, and selecting a heartbeat pattern with a minimum variance for the correlation as a new morphology template for the morphology group whose number of heartbeat patterns exceeds the threshold size; A method for carrying out the above.

14. The method of claim 13, further comprising the processor rendering on a display a user interface screen including morphological templates of the corresponding morphological groups and an indication of the corresponding relative numbers of heart rate patterns within the corresponding morphological groups.

15. The method of claim 14 , wherein the indication includes a histogram indicating the corresponding relative numbers of heartbeat patterns within the corresponding morphological group.

16. The method of claim 14 , wherein the instructions include counts and / or activation rates and / or occurrence rates of heartbeat patterns within the corresponding morphological group.

17. The method of claim 14, further comprising the processor ordering the heartbeat patterns of the corresponding morphological groups within the user interface screen according to any one or more of: a count of heartbeat patterns of the corresponding morphological groups; an activation rate or incidence rate of heartbeat patterns of the corresponding morphological groups; an earliest activation of a heartbeat pattern of the corresponding morphological groups; or a most recent activation of a heartbeat pattern of the corresponding morphological groups.

18. The method of claim 14, further comprising the processor selecting heartbeat patterns from the corresponding morphological templates to be included on the user interface screen according to any one or more of the following filters: minimum count of heartbeat patterns in the corresponding morphological groups; minimum activation rate or incidence rate of heartbeat patterns in the corresponding morphological groups; most recent activation of heartbeat patterns in the corresponding morphological groups; minimum consecutive sequence of heartbeat patterns within the same morphological group in the corresponding morphological groups.

19. The method of claim 18, further comprising: receiving a user selection for assigning a favorite to the corresponding morphological template; 20. The method of claim 18, further comprising the processor rendering the favorites in the user interface screen even if the favorites are not selected according to the one or more filters.

20. The method further includes the processor separately tracking a first number of corresponding heartbeat patterns added to the corresponding morphology groups before and during a verification period and a second number of corresponding heartbeat patterns added to the corresponding morphology groups during the verification period; 15. The method of claim 14, wherein the rendering includes the processor rendering the user interface screen on the display, the user interface screen simultaneously including an indication of the first corresponding number and an indication of the second corresponding number of cardiac patterns to be added to the corresponding morphology group.

21. The method of claim 20, further comprising the processor highlighting new morphological templates created during the verification period.

22. 15. The method of claim 14, wherein the rendering includes the processor rendering the user interface screen including a graph of cardiac cycle length versus time, the graph indicating when a selected one of the morphologies of the group of morphologies was active.

23. The method of claim 22, wherein the processor calculates a similarity measure between the pacing-induced heartbeat pattern and a corresponding one of the morphology templates of the corresponding morphology group; 14. The method of claim 13, further comprising the processor rendering on a display a user interface screen including an indication of a similarity measure between the pacing-induced cardiac pattern and a morphology template of the corresponding morphology group.

24. 24. The method of claim 23, wherein the rendering includes the processor rendering the user interface screen on the display including the morphological templates of the corresponding morphological group and the indication of a similarity measure between the pacing-induced cardiac beat pattern and the morphological templates of the corresponding morphological group.

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