Automated Annotation of Decrement-Evoked Potentials for VT Substrate Mapping
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Solution Overview
Problem
Current methods for identifying arrhythmogenic circuits in the heart, such as those causing ventricular tachycardia, are limited by their ability to accurately detect and analyze delayed evoked potentials, especially in non-inducible or hemodynamically unstable conditions, which can lead to incomplete or unsafe diagnostic procedures.
Innovation Solution
The method involves pacing the heart with normal sinus-rate pulses followed by shorter interval stimuli to detect decrement-evoked potentials (DeEPs), which are indicative of scar isthmuses, using automated annotation and correlation techniques to calculate time delays and present a graphical EP map highlighting aberrant tissue locations, thereby improving substrate mapping and potential ablation targets.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Measurement precision
If automated annotation and correlation techniques are used to detect decrement-evoked potentials, then measurement precision is improved, but device complexity increases
Solution Approach 1:
The system creates a model response by copying and averaging characteristic features from multiple normal evoked potentials. This model serves as a template for automated correlation and annotation of subsequent potentials, enabling precise detection without requiring complex manual analysis procedures
Solution Approach 2:
Manual annotation and analysis of evoked potentials is replaced with automated computational methods. The system uses algorithmic correlation between model responses and actual signals to automatically identify and annotate decrement-evoked potentials, substituting manual mechanical processes with automated computational ones
2Reliability
If abnormal pacing stimuli at shorter intervals are applied to detect decrement-evoked potentials, then reliability of arrhythmogenic circuit identification is improved, but object-generated harmful factors increase due to potential induction of ventricular tachycardia
Solution Approach 1:
The system establishes a model response from normal evoked potentials before applying abnormal pacing stimuli. This preliminary characterization of normal response patterns enables reliable identification of decrement-evoked potentials while maintaining safety protocols to prevent induction of ventricular tachycardia
Solution Approach 2:
The system continuously monitors evoked potentials and compares them against the model response to detect decremental conduction patterns. Real-time feedback allows the system to identify arrhythmogenic circuits reliably while implementing safety mechanisms to prevent harmful arrhythmias during the mapping procedure
Data Source
AI summary
A method for evaluation of electrical propagation in the heart includes receiving a pacing signal applied to a heart of a patient, the pacing signal including a sequence of normal and shorter, abnormal, pacing stimuli. A responsive cardiac signal is received, that is sensed by electrodes at a location in the heart and on the body surface of the patient. A model response is found and annotated from evoked potentials caused by the normal pacing stimuli. A correlation is made between the model response along the different signal sections to find and calculate a normal and decremental time delays between the pacing stimuli and respectively resulting evoked potentials at a tissue location. A time difference is calculated, between the normal time delay and the decremental time delay. An EP map of at least a portion of the heart is presented to a user, with a graphical indication of the time difference presented at the tissue location.