Analyzing and mapping ECG signals and determining ablation points to eliminate Brugada syndrome

Patent metadata

Field	Value
Publication number	US-11844614-B2
Application number	US-202117148032-A
Country	US
Kind code	B2
Filing date	Jan 13, 2021
Priority date	Jan 25, 2017
Publication date	Dec 19, 2023
Grant date	Dec 19, 2023

Abstract

A system and method for Brugada syndrome epicardial ablation comprising preparing an endocardial duration map; preparing a baseline epicardial duration map comprising at least one or more areas of delimination; and when some of the areas of delimination are greater than 200 ms, performing epicardial ablation of the areas of delimination greater than 200 ms. The method may further comprise preparing an updated epicardial duration map after performing epicardial ablation, and determining whether or not a BrS pattern appears in the updated epicardial duration map; and when the BrS pattern appears, performing epicardial ablation. The method may further comprise preparing an updated epicardial duration map after performing epicardial ablation, and determining whether or not an abnormal EGM exists in the updated epicardial duration map; and when the abnormal EGM exists, performing epicardial ablation. The method may further comprise preparing an updated epicardial map comprising maintaining anatomical volume data and adding electroanatomical data.

First claim

What is claimed is:

1. A computer implemented method of identifying target ablation areas in a heart, comprising:
acquiring electrical signals of the heart over time via a plurality of electrodes disposed at different areas of the heart;
providing an endocardial duration map for display based on the electrical signals;
providing an epicardial duration map, comprising at least one or more areas of delimination, for display based on the electrical signals;
determining when one or more of the areas of delimination have a potential duration greater than a threshold duration amount; and
identifying the one or more areas of delimination determined as having a potential duration greater than the threshold duration amount as areas to be ablated,
wherein epicardial ablation is performed on the one or more identified areas of delimination,
wherein after epicardial ablation is performed on the one or more identified areas of delimination, providing an updated epicardial duration map and determining whether or not a Brugada syndrome (BrS) pattern appears in the updated epicardial duration map, and
wherein providing the epicardial duration map comprises:
defining a window of interest (WOI) equal to a time interval comprising at least a heart beat cycle length;
for each electrical signal:
calculating heart beats based on the cycle length and a reference annotation;

assigning each of the heart beats to a sub-WOI within the WOI;
determining a start potential duration and an end potential duration; and
selecting an ablation point based on a heart beat having a minimum standard deviation from the heart beats assigned to the sub-WOI.

2. The method according to claim 1 , further comprising:
when it is determined that the BrS pattern appears in the updated epicardial duration map:
repeating the determining of whether one or more of the areas of delimination have a potential duration greater than the threshold duration amount; and
repeating the identifying of the one or more areas of delimination determined as having a potential duration greater than the threshold duration amount as the areas to be ablated; and

when it is determined that the BrS pattern does not appear in the updated epicardial duration map:
providing a remapped epicardial duration map; and
determining when one or more areas of delimination in the remapped epicardial duration map are abnormal,
wherein epicardial ablation is performed on the one or more abnormal areas of delimination.

3. The method according to claim 1 ,
wherein the threshold duration amount is 200 ms.

4. The method according to claim 1 , further comprising providing an updated epicardial duration map, which maintains an anatomical volume data and adds an electroanatomical data after ajmaline is injected into the heart and prior to determining when the one or more of the areas of delimination have a potential duration greater than a threshold duration amount.

5. The method according to claim 4 , further comprising after epicardial ablation is performed on the one or more identified areas of delimination and an additional amount of ajmaline is injected into the heart, providing a new updated epicardial duration map which maintains a new anatomical volume data and adds a new electroanatomical data.

6. The method according to claim 1 , wherein the epicardial duration map, and an updated epicardial duration map include displayed concentric areas having cut-off intervals.

7. A system for identifying target ablation areas in a heart, the system comprising:
a catheter configured to acquire electrical signals acquired over time from different areas of the heart;
memory configured to store the electrical signals;
one or more processors configured to:
provide an endocardial duration map for display based on the electrical signals;
provide an epicardial duration map, comprising at least one or more areas of delimination, for display based on the electrical signals;
determine when one or more of the areas of delimination have a potential duration greater than a threshold duration amount;
identify the one or more areas of delimination determined as having a potential duration greater than the threshold duration amount as areas to be ablated, wherein epicardial ablation is performed on the one or more identified areas of delimination; and
after epicardial ablation is performed on the one or more identified areas of delimination, provide an updated epicardial duration map and determine whether or not a Brugada syndrome (BrS) pattern appears in the updated epicardial duration map, and

a display device for displaying the endocardial duration map and the epicardial map,
wherein the one or more processors are further configured to provide the epicardial duration map by:
defining a window of interest (WOI) equal to a time interval comprising at least a heart beat cycle length;
for each electrical signal:
calculating heart beats based on the cycle length and a reference annotation;
assigning each of the heart beats to a sub-WOI within the WOI;
determining a start potential duration and an end potential duration; and
selecting an ablation point based on a heart beat having a minimum standard deviation from the heart beats assigned to the sub-WOI.

8. The system according to claim 7 , the one or more processors are further configured to:
when it is determined that the BrS pattern appears in the updated epicardial duration map:
repeat the determining of whether one or more of the areas of delimination have a potential duration greater than the threshold duration amount; and
repeat the identifying of the one or more areas of delimination determined as having a potential duration greater than the threshold duration amount as the areas to be ablated; and

when it is determined that the BrS pattern does not appear in the updated epicardial duration map:
provide a remapped epicardial duration map; and
determine when one or more areas of delimination in the remapped epicardial duration map are abnormal,

wherein epicardial ablation is performed on the one or more abnormal areas of delimination.

9. The system according to claim 7 ,
wherein the threshold duration amount is 200 ms.

10. The system according to claim 7 , the system further comprising a tool for injecting ajmaline into the heart, and
the one or more processors are further configured to provide an updated epicardial duration map, which maintains an anatomical volume data and adds an electroanatomical data after the ajmaline is injected into the heart and prior to determining when the one or more of the areas of delimination have a potential duration greater than a threshold duration amount.

11. The system according to claim 7 , wherein the one or more processors are further configured to, after epicardial ablation is performed on the one or more identified areas of delimination and additional ajmaline is injected into the heart, providing a new updated epicardial duration map which maintains an anatomical volume data and adds an electroanatomical data.

12. The system according to claim 7 , wherein the one or more processors are further configured to display concentric areas having cut-off intervals on at least one of the epicardial duration map, and an updated epicardial map.

13. A computer software product for identifying target ablation areas in a heart, including a non-transitory computer readable storage medium in which computer program instructions are stored, which instructions, when executed by a computer, cause the computer to:
acquire electrical signals of the heart over time via a plurality of electrodes disposed at different areas of

Assignees

• Biosense Webster Israel Ltd
• Pappone Carlo

Inventors

• Pappone Carlo
• Turgeman Aharon
• Pozzi Paolo Roberto
• Natalizia Andrea

Classifications

• A61B5/343

  Potential distribution indication · CPC title

• A61B5/33

  specially adapted for cooperation with other devices · CPC title

• A61B5/346

  Analysis of electrocardiograms · CPC title

• A61B5/283 Primary

  Invasive · CPC title

• A61B5/316

  Modalities, i.e. specific diagnostic methods · CPC title