阅读说明：本技术 一个或多个高计数电极导管的多路复用技术
(Multiplexing of one or more high count electrode catheters
) 是由 M.基弗-阿里
Y.本纳洛亚
R.厄曼
O.巴隆 于 2019-07-09 设计创作，主要内容包括：公开了一种方法,该方法包括：使用导管中当前有效的一组电极来执行对器官的第一扫描；基于作为第一扫描的结果所收集的数据来去激活该组中的电极中的一个或多个；通过以下中的至少一者来调谐该组：(i)去激活该组中的在去激活之后保持有效的一个或多个电极；以及(ii)激活导管中无效的一个或多个电极；使用该组中的在执行调谐之后当前有效的电极来执行对器官的第二扫描,并且基于作为第二扫描的结果所收集的数据来生成器官的标测图；以及输出该器官的标测图来呈现给用户。(A method is disclosed, the method comprising: performing a first scan of the organ using a currently active set of electrodes in the catheter; deactivating one or more of the electrodes in the set based on data collected as a result of the first scan; tuning the set by at least one of: (i) deactivating one or more electrodes in the set that remain active after deactivation; and (ii) activating one or more electrodes in the catheter that are not active; performing a second scan of the organ using electrodes in the set that are currently active after performing the tuning, and generating a map of the organ based on data collected as a result of the second scan; and outputting the map of the organ for presentation to the user.)
1. A method, the method comprising:
performing a first scan of the organ using a currently active set of electrodes in the catheter;
deactivating one or more of the electrodes in the set based on data collected as a result of the first scan;
tuning the group by at least one of: (i) deactivating one or more electrodes of the group that remain active after deactivation; and (ii) activating one or more electrodes in the catheter that are inactive;
performing a second scan of the organ using electrodes in the group that are currently active after performing tuning and generating a map of the organ based on data collected as a result of the second scan; and
outputting the map of the organ for presentation to a user.
2. The method of claim 1, wherein the organ is a heart.
3. The method of claim 1, wherein deactivating one or more of the electrodes in the set based on data collected as a result of the first scan comprises deactivating one or more electrodes that are not in physical contact with tissue of the organ, the tissue being part of one or more regions of interest in the organ.
4. The method of claim 1, wherein deactivating one or more of the electrodes in the set based on data collected as a result of the first scan comprises deactivating one or more electrodes associated with one or more non-conductive regions of the organ.
5. The method of claim 1, wherein tuning the group comprises:
identifying a region of interest in the organ having an activation index falling within a predetermined range; and
activating a first electrode in the catheter when activating the first electrode causes the activation index of the region of interest to increase.
6. The method of claim 5, further comprising:
detecting an increase in the activation index of the region of interest caused by the activated first electrode in the catheter; and
activating a second electrode in the catheter based on whether the increase in the activation index is less than a threshold.
7. The method of claim 1, wherein tuning the group comprises: reducing the set by deactivating one or more electrodes currently active in the catheter based on wave characteristics of a region of interest in the organ, the wave characteristics including a propagation speed of an action potential pulse across the region of interest.
8. The method of claim 1, wherein tuning the group comprises: reducing the set by deactivating one or more electrodes currently active in the catheter based on wave characteristics of a region of interest in the organ, the wave characteristics including a direction of propagation of an action potential pulse across the region of interest.
9. The method of claim 1, wherein tuning the group comprises: deactivating a selected first electrode of the catheter associated with a region of interest, the first electrode selected based on an effect of the first electrode on a performance of the catheter relative to the region of interest.
10. The method of claim 9, wherein the first electrode is an electrode in direct contact with tissue corresponding to the region of interest or an electrode within a predetermined distance from the tissue corresponding to the region of interest.
11. A diagnostic device, comprising:
an output device; and
at least one processor operatively coupled to the output device, the at least one processor configured to:
performing a first scan of the organ using a currently active set of electrodes in the catheter;
deactivating one or more of the electrodes in the set based on data collected as a result of the first scan;
tuning the group by at least one of: (i) deactivating one or more electrodes of the group that remain active after deactivation; and (ii) activating one or more electrodes in the catheter that are inactive;
performing a second scan of the organ using electrodes in the group that are currently active after performing tuning and generating a map of the organ based on data collected as a result of the second scan; and
outputting the map of the organ using the output device.
12. The diagnostic device of claim 11, wherein the organ is a heart.
13. The diagnostic apparatus of claim 11, wherein deactivating one or more of the electrodes in the set based on data collected as a result of the first scan comprises deactivating one or more electrodes that are not in physical contact with tissue of the organ, the tissue being part of one or more regions of interest in the organ.
14. The diagnostic apparatus of claim 11, wherein deactivating one or more of the electrodes in the set based on data collected as a result of the first scan comprises deactivating one or more electrodes associated with one or more non-conductive regions of the organ.
15. The diagnostic device of claim 11, wherein tuning the group comprises:
identifying a region of interest in the organ having an activation index falling within a predetermined range; and
activating a first electrode in the catheter when activating the first electrode causes the activation index of the region of interest to increase.
16. The diagnostic device of claim 15, further comprising:
detecting an increase in the activation index of the region of interest caused by the activated first electrode in the catheter; and
activating a second electrode in the catheter based on whether the increase in the activation index is less than a threshold.
17. The diagnostic device of claim 11, wherein tuning the group comprises: reducing the set by deactivating one or more electrodes currently active in the catheter based on wave characteristics of a region of interest in the organ, the wave characteristics including a propagation speed of an action potential pulse across the region of interest.
18. The diagnostic device of claim 11, wherein tuning the group comprises: reducing the set by deactivating one or more electrodes currently active in the catheter based on wave characteristics of a region of interest in the organ, the wave characteristics including a direction of propagation of an action potential pulse across the region of interest.
19. The diagnostic device of claim 11, wherein tuning the group comprises: deactivating a selected first electrode of the catheter associated with a region of interest, the first electrode selected based on an effect of the first electrode on a performance of the catheter relative to the region of interest.
20. The diagnostic device of claim 19, wherein the first electrode is an electrode in direct contact with tissue corresponding to the region of interest or an electrode within a predetermined distance from the tissue corresponding to the region of interest.
Disclosure of Invention
Catheterization is a medical procedure used to diagnose and treat various conditions. During catheterization, a catheter is inserted into a patient's organ through a vein or artery of the patient. The catheter may be a thin tube with an electrode on one end and a handle and connector on the other end. The connector may be inserted into a diagnostic device that processes signals received from the electrodes to provide useful diagnostic information to physicians and other medical professionals.
According to an aspect of the present disclosure, there is provided a method comprising: performing a first scan of the organ using a currently active set of electrodes in the catheter; deactivating one or more of the electrodes in the set based on data collected as a result of the first scan; tuning the set by at least one of: (i) deactivating one or more electrodes in the set that remain active after deactivation; and (ii) activating one or more electrodes in the catheter that are not active; performing a second scan of the organ using electrodes in the set that are currently active after performing the tuning, and generating a map of the organ based on data collected as a result of the second scan; and outputting the map of the organ for presentation to the user.
According to another aspect of the present disclosure, there is provided a diagnostic apparatus including: an output device; and at least one processor operatively coupled to the output device, the at least one processor configured to: performing a first scan of the organ using a currently active set of electrodes in the catheter; deactivating one or more of the electrodes in the set based on data collected as a result of the first scan; tuning the set by at least one of: (i) deactivating one or more electrodes in the set that remain active after deactivation; and (ii) activating one or more electrodes in the catheter that are not active; performing a second scan of the organ using electrodes in the set that are currently active after performing the tuning, and generating a map of the organ based on data collected as a result of the second scan; and outputting the map of the organ using an output device.
Drawings
The following detailed description of embodiments of the present invention can be better understood when read in conjunction with the following drawings. For the purpose of illustration, there is shown in the drawings embodiments which are presently preferred. It should be understood, however, that the invention is not limited to the precise arrangements and instrumentalities shown. In the drawings:
fig. 1A is a diagram illustrating operation of a system for performing electroanatomical mapping, according to aspects of the present disclosure;
FIG. 1B is a schematic diagram of the system of FIG. 1A, according to aspects of the present disclosure;
fig. 1C is a diagram of an example of a catheter that is part of the system of fig. 1A, according to an aspect of the present disclosure;
FIG. 1D is a diagram of an example of a data structure identifying an active set of electrodes in the catheter of FIG. 1C, in accordance with aspects of the present disclosure;
fig. 2 is a diagram of an example of an organ map produced by the system of fig. 1A, according to an aspect of the present disclosure;
FIG. 3 is a flow chart of an example of a process performed by the system of FIG. 1A, according to aspects of the present disclosure;
FIG. 4 is a flow diagram of an example of a sub-process associated with the process of FIG. 3, in accordance with aspects of the present disclosure;
FIG. 5 is a flow diagram of an example of a sub-process associated with the process of FIG. 3, in accordance with aspects of the present disclosure; and is
FIG. 6 is a flow diagram of an example of a sub-process associated with the process of FIG. 5.
Detailed Description
In accordance with an aspect of the present disclosure, an imaging system is disclosed that includes a diagnostic device and a catheter. The catheter may include a large number of electrodes (e.g., about 200) coupled to a diagnostic device via an exchange circuit. The catheter may be used to examine an organ of a patient, such as the heart, lungs, or kidneys. The diagnostic device may be configured to focus the electrodes in the catheter on a specific region of interest in the patient's organ. The electrodes in the focusing catheter may include one or more of: deactivating electrodes that are not adjacent to the region of interest, activating additional electrodes that are adjacent to the region of interest, and/or deactivating redundant electrodes located adjacent to the region of interest. Examples of different procedures for activating and/or deactivating electrodes in a catheter in order to focus the electrodes in the catheter on a specific region of interest in an organ of a patient are also provided below.
Fig. 1A is a diagram of a system 100 including a diagnostic device 110 coupled to a catheter 120. In this example, the catheter 120 is a lasso catheter. However, it should be understood that alternative implementations are possible, wherein the catheter 120 is any other suitable type of catheter, such as, for example, a basket catheter. In operation of the system 100, the physician 104 may pass the catheter 120 through an artery or vein of the patient 103 to a desired destination for examination with the catheter 120, such as a particular organ of the patient. After the catheter 120 has reached its destination, the diagnostic device 110 may receive signals from electrodes and/or other sensors that are part of the catheter. The diagnostic device 110 may then amplify, filter, digitize, and combine the signals to generate a map of the patient's organ. The map may be a 2D image of a patient organ, a 3D image of a patient organ, and/or any other suitable type of electro-anatomical map of a patient organ. The catheter 120 may be used to scan various organs of the patient 103, such as the patient's lungs, the patient's kidneys, and/or any suitable type of organ.
Fig. 1B is a schematic diagram of a system 100 according to aspects of the present disclosure. As shown, the diagnostic device 110 may include a memory 111, a processor 112, a connector receptacle 113, and an input-output (I/O) device 114. Any of the memory 111, connector receptacle 113, and I/O device 114 may be operatively coupled to the processor via a system bus or another similar device.
The memory 111 may include any suitable type of volatile or non-volatile memory, such as Random Access Memory (RAM), flash memory, a Solid State Drive (SSD), a hard disk drive (HD), Dynamic Random Access Memory (DRAM), and/or an Erasable Programmable Read Only Memory (EPROM). In some implementations, the memory 111 may store the data structure 180. Data structure 180 may identify a series of electrodes currently active in catheter 120. In accordance with the present disclosure, when the electrodes are activated, one or more signals generated by the electrodes in subsequent scans of the patient's organ are used to generate a map of the patient's organ. According to the present disclosure, when the electrodes are deactivated, the signals generated by the electrodes when an organ scan is subsequently performed are not used to generate a map of the patient's organ. Data structure 180 is discussed further below with respect to FIG. 1D.
Processor 112 may include one or more of a general purpose processor (e.g., an x86 processor, a MIPS processor, a RISC processor, etc.), an Application Specific Integrated Circuit (ASIC), a Field Programmable Gate Array (FPGA), a Complex Programmable Logic Device (CPLD), a controller, and/or any other suitable type of processing circuit. Connector hub 113 may include any suitable type of hub for receiving connector 121 of catheter 120. Input/output devices 114 may include one or more of a display, a touchpad, a mouse, a keyboard, a microphone, a camera, a printer, a speaker, and/or any other suitable type of I/O device.
The catheter 120 may include a connector 121, an electrode 122, a temperature sensor 123, a position sensor 124, and an exchange circuit 125. Connector 121 may include any suitable type of connector for inserting catheter 120 into diagnostic device 110. Electrodes 122 may include one or more mapping electrodes for measuring cardiac electrical signals at one or more respective contact points with cardiac tissue of a patient. Additionally or alternatively, in some implementations, the electrodes 122 may include one or more ablation electrodes and/or one or more electrodes capable of performing both mapping and ablation. Position sensor 124 may be disposed near the distal end of catheter 120. Position sensor 124 may interact with a magnetic field generator 106 (shown in fig. 1A) disposed below patient 103 to generate an electrical signal indicative of the position of catheter 120. In some implementations, such signals are also used to detect the position (e.g., location and/or orientation) of a single electrode in an organ being examined by catheter 120.
The switching circuitry 125 may include any suitable type(s) of electronic device configured to select electrodes in the catheter 120 and route signals generated by the selected electrodes to the diagnostic device 110. In some implementations, switching circuitry 125 may include one or more multiplexers arranged to form a switching fabric for each (or at least some) of the individual address electrodes 122. Additionally or alternatively, in some implementations, the switching circuit 125 can include one or more switches arranged to form a switching fabric for each (or at least some) of the individual address electrodes 122. In the interests of brevity, the present disclosure is not limited to any particular manner of implementing the switch circuit 125.
Fig. 1C is a schematic view of catheter 120 showing its structure in further detail. Although in this example, the conduit 120 is depicted as including only 16 electrodes, it should be understood that the conduit 120 may include any suitable number of electrodes (e.g., 30, 50, 100, 200, 300, 500, 700, etc.).
FIG. 1D is an example of a data structure 180 identifying a plurality of electrodes currently active in a catheter. The data structure may include a plurality of portions 182. Each portion 182 may include a respective identifier 184 for a different one of the electrodes 122, and a respective status identifier 186 indicating whether the electrode is valid. As discussed above, when a given electrode is active, the signals generated by the given electrode during an organ scan (by the processor 112 of the diagnostic apparatus 110) are used to generate a map of the organ. In contrast, when a given electrode is inactive, the signals generated by the electrode are not used (by the processor 112 of the diagnostic device 110) to generate a map of the organ.
In some implementations, the processor 112 of the diagnostic device 110 may retrieve the data structure 180 from the memory 111 to determine which electrodes 122 in the catheter 120 are currently active. Diagnostic device 110 may then generate a map of the organ scanned with catheter 120 based solely on the signals generated by the currently active electrodes. In some implementations, the diagnostic device 110 may not sample the electrodes identified as inactive. Additionally or alternatively, in some implementations, the diagnostic device 110 may sample the signals generated by the electrodes identified as invalid and then ignore (or discard) when generating the map. Although electrodes are activated and deactivated in this example by modifying data structure 180, alternative implementations are possible in which inactive electrodes are enabled and disabled using swapping circuit 125. In such implementations, the inactive electrode may be disconnected from processor 112 (or connector 121) using one or more switches as part of switching circuitry 125. Such switches may be located on the electrical path between the electrodes and the processor 112 (or connector 112), and they may be configured to interrupt the electrical path when the electrodes are deactivated. When deactivating an invalid electrode, physical disconnection of the invalid electrode may be performed in addition to or instead of a flag like the invalid electrode in data structure 180.
Although data structure 180 is depicted as a table in this example, this disclosure is not limited to any particular manner of implementing data structure 180. Further, although in this example, portions 182 of data structure 180 are encapsulated in the same data structure, alternative implementations are possible in which each portion 182 is implemented as a separate data structure. In brief, the present disclosure is not limited to any particular manner of storing a respective indication of each of the electrodes 122 that indicates whether the electrode is valid.
Additionally, in this example, each electrode 122 is identified in the data structure 180 by using an ID corresponding to the electrode. However, alternative implementations are possible in which each of the electrodes is identified using an ID corresponding to the particular channel on which the signal from the electrode is received. Additionally or alternatively, in some implementations, each of the electrodes may be identified using one or more identifiers indicative of the location of the electrode in the catheter 120. Additionally or alternatively, in some implementations, each of the electrodes may be identified using an address corresponding to the electrode that is used by the swapping circuit 125 to connect and/or disconnect the electrode 122 from the processor 112 (or connector 121). In brief, the present disclosure is not limited to any particular manner of referencing the electrodes 122 in the catheter 120. The term identifier as used throughout this specification may refer to a number, a string of characters, a string of alphanumeric characters, and/or any other suitable type of identifier. By way of example, and depending on the context, the term "signal" may refer to a digital representation of a waveform generated by an electrode and/or a characteristic of a waveform obtained by sampling and then digitizing the waveform.
Fig. 2 shows an example of a functional electro-anatomical map 109 of a patient's heart generated by the system 100. In map 109, the local activation times are represented by different shading patterns. Superimposed on the patient's heart map is an image of the catheter 120 showing the orientation of the catheter 120 and the corresponding position of the electrode 122 in the patient's heart.
Fig. 3 is a flowchart of an example of a process of electroanatomical mapping performed by the processor 112 of the diagnostic device 110, according to aspects of the present disclosure.
At step 310, a first scan of the organ is performed using the catheter 120 and a first map of the organ (or portion thereof) is generated. In some implementations, scanning the organ may include obtaining ECG signals from the catheter and processing these signals in a well-known manner to generate the first map. In some implementations, the first map may be generated based only on data collected using only currently active electrodes. A first scan of the organ may be performed using a plurality of electrodes currently active in the catheter. In this example, the organ scanned is the heart of the patient 103, and the map is for a particular anatomical region in one of the ventricles.
In some implementations, the set of electrodes currently active when generating the first map may include all of the electrodes 122 available in the catheter 120. Alternatively, in some implementations, the set of electrodes currently active when generating the map may include only some of the electrodes 122. Additionally or alternatively, in some implementations, the processor 112 may generate the first map by retrieving the data structure 180 to identify those electrodes that are currently active prior to performing the first scan of the organ. In some implementations, performing the second scan may include identifying one or more of the currently active electrodes 122 based on the data structure 180, obtaining one or more signals produced by the currently active electrodes, and generating the first map based on the obtained signals in a well-known manner.
At step 320, the set of electrodes currently active in the catheter 120 is reduced by deactivating one or more of the currently active electrodes. The deactivated electrodes may include one or more of the following:
(i) one or more electrodes that are not in direct contact with the tissue of the scanned organ;
(ii) one or more electrodes in direct contact with a non-conductive region of a patient's organ (e.g., a heart valve or sinus ostium);
(iii) one or more electrodes positioned more than a threshold distance away from any of a plurality of regions of interest in an organ of a patient;
(iv) one or more electrodes positioned more than a threshold distance away from a region of interest in an organ of a patient.
In some implementations, electrodes in direct contact with tissue of a patient's organ can be identified using Tissue Proximity Indication (TPI) analysis or signal analysis. TPI, as e.g. in CARTOTMImplemented in a system. Additionally or alternatively, in some implementations, electrodes located in non-conductive regions of a patient's organ can be identified using signal characterization and model-based mapping. As discussed above, the processor 112 may deactivate a given electrode by updating the data structure 180 to indicate that the electrode is inactive. Additionally or alternatively, processor 112 may deactivate a given electrode by causing swapping circuit 125 to interrupt the electrical path between the electrode and diagnostic device 110 (or connector 121).
At step 330, a set of electrodes currently active in the catheter 120 is fine tuned by performing one or more of the following:
(i) activating one or more electrodes positioned within a region of interest in an organ of a patient;
(ii) activating one or more electrodes positioned within a threshold distance from a region of interest in an organ of a patient;
(iii) deactivating one or more electrodes positioned within a region of interest in an organ of a patient;
(iv) deactivating one or more electrodes positioned within a threshold distance from a region of interest in a patient organ;
(v) activating one or more electrodes in the catheter that are not within any region of interest or within a threshold distance from any region of interest; and
(vi) deactivating one or more electrodes of the catheter that are not within any region of interest or within a threshold distance from any region of interest).
By way of example, in some implementations, an electrode may be considered to be positioned within a region of interest of a patient's organ if the electrode is in direct contact with tissue corresponding to the region of interest. Additionally or alternatively, in some implementations, an electrode may be considered to be positioned within a threshold distance from a region of interest in a patient organ if the electrode is within the threshold distance from tissue of the region of interest. In accordance with aspects of the present disclosure, in some implementations, the processor 112 may activate a given electrode by modifying the data structure 180 to indicate that the electrode is valid. Additionally or alternatively, in some implementations, processor 112 may activate a given electrode by causing swapping circuit 125 to close an electrical path connecting the electrode to diagnostic device 110 and/or connector 121. Additional examples of sub-processes for performing step 330 are provided further below with reference to fig. 4-6.
At step 340, a second scan of the organ is performed, and a second map of the patient organ is generated as a result of the second scan. In some implementations, the second map may be generated by processor 112 using only data obtained from electrodes in the catheter that are currently active when performing the second scan. Additionally or alternatively, in some implementations, the processor may identify a currently active electrode based on the data structure 180.
At step 350, a second map is output for presentation to the user by using the I/O device 114 of the diagnostic device 110. In some implementations, outputting the map may include displaying at least a portion of the map on a display device, such as an LCD monitor. Additionally or alternatively, outputting the second map may include generating an acoustic signal (e.g., a voice signal or tone) based on the second map. Additionally or alternatively, in some implementations, outputting the second map can include outputting diagnostic information generated based on the second map.
Fig. 4 is a flow chart of an example of a process 400 for micro-tuning a currently active set of electrodes in catheter 120, as discussed above with respect to step 330 of process 300.
At step 410, a first data set is obtained using the currently active electrodes in the catheter. The first data set may include only data items generated by currently active electrodes in the catheter 120. In some implementations, obtaining the first data set may include retrieving from memory 111 one or more data items generated as a result of the first scan discussed with respect to step 310 of process 300. Additionally or alternatively, in some implementations, obtaining the first data set may include retrieving one or more data items generated as a result of another scan from the memory 111, the another scan being performed with the catheter 120 after performing step 320 of the process 300.
At step 420, one or more regions of interest are identified and an activation index for each of the regions of interest is calculated. In some implementations, a respective first activation index for any of the regions of interest can be calculated based on the first data set. Additionally or alternatively, in some implementations, identifying the region of interest can include performing focus and rotational activation detection to identify a steady wave region. Generally, focal activation may be defined as an early continuous QS wave. The rotation activity may be described as an activated micro-reentry circuit. Further, rotational activation may be defined as an activation pattern that meets criteria including, but not limited to, head-to-tail distance, CL coverage, and temporal stability. When the detected electrical activation meets the algorithmic criteria of a focus or rotational activation pattern, the region is marked as a region of interest (ROI). Additionally or alternatively, when the scanned organ is a patient's heart, calculating an activation index for any of the regions of interest may include calculating a number of heartbeats exhibiting focus or rotational activity. For example, if the focus is active for ten consecutive heartbeats, the activation index will equal ten.
At step 430, one or more regions of interest having a bounding first activation index are identified. According to the present example, if any of the first activation indexes falls within a predetermined range, it may be considered a boundary.
At step 440, one of the regions of interest having a boundary activation index is selected.
At step 450, the currently inactive electrodes associated with the selected region of interest are activated, thereby increasing the currently active set of electrodes in the catheter 120. In some implementations, the activated electrode can be an electrode located within the region of interest. Additionally or alternatively, the activated electrodes may be electrodes located within a threshold distance from the region of interest. In some implementations, the activated electrodes may be electrodes that are active in generating the first map (i.e., electrodes used to generate the first map). Additionally or alternatively, the activated electrodes may be electrodes that were not active in generating the first map (i.e., electrodes that were not used to generate the first map). In some implementations, the processor 112 may activate the electrode by modifying the data structure 180 to indicate that the electrode is valid, according to aspects of the present disclosure. Additionally or alternatively, in some implementations, processor 112 may activate the electrodes by causing swapping circuit 125 to close an electrical path connecting the electrodes to diagnostic device 110 and/or connector 121.
At step 460, a second data set is obtained using at least the currently active electrodes in the selected region of interest, and a second activation index for the region of interest is calculated using the second data set. In some implementations, the second data set may include only data items obtained from currently active electrodes in the catheter 120. As can be readily appreciated, the set of electrodes currently active when performing step 460 may include the electrodes that were activated at step 450. Additionally or alternatively, in some implementations, the second data set can include one or more data items generated using the electrodes activated at step 450, as opposed to the first data set. In some implementations, obtaining the second data set may include retrieving one or more data items generated as a result of a scan from memory 111, the scan being performed with catheter 120 after performing step 450.
At step 470, an increase in the activation index of the selected region of interest resulting from the electrode activation at step 460 is determined. In some implementations, the increase in the activation index may be determined by subtracting the first activation index of the selected region of interest from the second index of the selected region of interest.
At step 480, it is determined whether the increase is less than a threshold. If the increase is less than the threshold, the process 400 returns to step 450 and repeats step 450 and 480 for the other electrode that is currently inactive.
At step 490, it is determined whether there are any other regions of interest in the patient's organ that have a boundary activation index and remain to be processed. If such a region of interest exists, the process 400 returns to step 440 and repeats steps 440-490 for another region of interest in the patient's organ.
Fig. 5 is a flow chart of an example of a process 500 for micro-tuning a currently active set of electrodes in catheter 120, as discussed above with respect to step 330 of process 300.
At step 510, a first data set is obtained using the currently active electrodes in the catheter. The first data set may include only data items generated by currently active electrodes in the catheter 120. In some implementations, obtaining the first data set may include retrieving from memory 111 one or more data items generated as a result of the first scan discussed with respect to step 310 of process 300. Additionally or alternatively, in some implementations, obtaining the first data set may include retrieving one or more data items generated as a result of another scan from the memory 111, the another scan being performed with the catheter 120 after performing step 320 of the process 300.
At step 520, one or more regions of interest are identified. In some implementations, each of the selected regions of interest may be identified based on the first data set, as discussed with respect to step 420 of process 400.
At step 530, a respective first activation index and a respective first set of wave characteristics for each of the regions of interest are calculated. In some implementations, a respective first activation index and a respective first set of wave characteristics for any of the regions of interest can be calculated based on the first data set. In some implementations, multiple regions of interest may be identified, as discussed above with respect to step 420 of process 400. Additionally or alternatively, in some implementations, a respective first activation index for any of the regions of interest can be identified, as discussed above with respect to step 420 of process 400. Additionally or alternatively, in some implementations, the respective first set of wave characteristics of any of the regions of interest can include parameters including, but not limited to, conduction velocity, special morphology sequence, and special morphology shape.
At step 540, one or more regions of interest having respective first indices greater than an activation index threshold are identified.
At step 550, one of the regions of interest having an activation index greater than the activation index threshold is selected.
At step 560, one or more active electrodes associated with the selected region of interest are deactivated. Step 560 is discussed further below with respect to fig. 6.
At step 570, it is determined whether there are any other regions of interest in the patient's organ whose activation index exceeds the activation index threshold and which remain to be processed. If such electrodes are present, the process 500 returns to step 550 and steps 550-570 are repeated for another region of interest in the patient's organ.
Fig. 6 is a flow diagram of an example of a process 600 for identifying and deactivating electrodes associated with a selected region of interest, as discussed with respect to step 560 of process 500. In some implementations, performing the process 600 may cause the electrodes associated with the selected region of interest that have the least impact on the operation of the catheter 120 to become deactivated.
At step 610, the currently active electrode in the catheter 120 is selected. The selected electrodes may be electrodes associated with a particular region of interest. More particularly, in some implementations, the electrodes may be electrodes located in a selected region of interest. Additionally or alternatively, in some implementations, the electrodes may be electrodes located within a predetermined distance from the selected region of interest.
At step 620, the selected electrode is deactivated. In some implementations, deactivating the selected electrode may include updating a data structure to indicate that the selected electrode is invalid. As discussed above, the processor 112 may deactivate a given electrode by updating the data structure 180 to indicate that the electrode is inactive. Additionally or alternatively, processor 112 may deactivate a given electrode by causing swapping circuit 125 to interrupt the electrical path between the electrode and diagnostic device 110 (or connector 121).
At step 630, a second data set is obtained using at least the currently active electrodes in the selected region of interest. In some implementations, the second data set may include only data items generated by currently active electrodes in the catheter. As a result, unlike the first data set, the second data set may not include data items generated by electrodes deactivated at step 620.
At step 640, a second activation index and a second set of wave characteristics for the selected region of interest are calculated based on the second data set. In some implementations, a respective first activation index for any of the regions of interest can be identified, as discussed above with respect to step 420 of process 400. The respective first set of wave characteristics of any of the regions of interest may include at least one of a conduction velocity of the one or more action potential pulses and/or a propagation direction of the one or more action potential pulses across tissue of the selected region of interest.
At step 650, a performance degradation of the catheter 120 caused by the electrode deactivation at step 650 is determined. In some implementations, the performance degradation may be determined based on a metric calculated using at least some of the first activation index for the region of interest, the first set of wave characteristics for the region of interest, the second activation index for the selected region of interest, the second set of wave characteristics for the selected region of interest. The metric may be a number, a string of characters, and/or any other suitable type of alphanumeric string of characters. In some implementations, the metric can be determined based on one or more of the following:
(i) a difference between the first activation index and the second activation index of the selected region of interest;
(ii) a difference between the first set of wave characteristics and the second set of wave characteristics of the selected region of interest;
(iii) a difference between a wave propagation velocity of the selected region of interest before deactivating the electrode and a wave propagation velocity of the selected region of interest after deactivating the electrode; and
(iv) a difference between a wave propagation direction of the selected region of interest before deactivating the electrode and a wave propagation direction of the selected region of interest after deactivating the electrode.
Additionally or alternatively, in some implementations, the metric may be determined by using a fuzzy logic algorithm to compare a first activation index and a first set of wave characteristics of the selected region of interest to a second activation index and a second set of wave characteristics of the selected region of interest.
At step 660, it is determined whether the performance degradation is less than a threshold. In some implementations, the determination may be made by processor 112 comparing the metric calculated at step 650 to a threshold value previously stored in memory 111. If the performance degradation is greater than the threshold, the process proceeds to step 670. Otherwise, the process proceeds to step 680.
At step 670, the electrodes deactivated at step 640 are reactivated. In some implementations, the processor 112 may activate the electrode by modifying the data structure 180 to indicate that the electrode is valid, according to aspects of the present disclosure. Additionally or alternatively, in some implementations, processor 112 may activate the electrodes by causing swapping circuit 125 to close an electrical path connecting the electrodes to diagnostic device 110 and/or connector 121.
At step 680, it is determined whether a predetermined number of electrodes associated with the region of interest have been tested. The predetermined number of electrodes may include all electrodes located in the region of interest and/or any other suitable number of electrodes located within a predetermined distance from the region of interest. If the predetermined number of electrodes have been tested, the process 600 ends. Otherwise, the process 600 returns to step 610 and repeats step 610 and 680 for another electrode in the selected region of interest.
Although in the example of process 600 only one electrode is deactivated/reactivated during each iteration, alternative implementations are possible in which multiple electrodes are deactivated/reactivated. Additionally, it should be understood that process 600 is provided merely as an example of many possible ways to identify electrodes in a region of interest that have a minimal impact on the performance of a catheter and deactivate those electrodes.
For example, in some implementations, deactivated electrodes in the selected region of interest may be selected by: (i) identifying a plurality of different sets of electrodes in the selected region of interest, each set of electrodes comprising one or more electrodes, (ii) determining an effect of deactivating each set of electrodes on the performance of the catheter 120, (iii) selecting one of the sets of electrodes based on the effect of its deactivation on the performance of the catheter 120, and (iv) deactivating the selected set of electrodes. In some implementations, the selected electrode set may be the largest electrode set that, when deactivated, allows the performance of the catheter to remain above a performance threshold. In some implementations, deactivating the effect of each electrode group on the performance of the catheter 120 may be performed by deactivating each electrode group, determining the effect of deactivating the electrode group on the performance of the catheter 120, and reactivating the deactivated electrode group to test another electrode group. The effect of deactivating a particular electrode group on the operation of the catheter may be determined, as discussed with respect to step 650 of process 600.
Fig. 1A-6 are provided as examples only. At least some of the elements discussed with respect to these figures may be arranged in a different order, combined, and/or omitted entirely. It should be understood that the provision of examples described herein, as well as clauses phrased as "such as," "for example," "including," "in some aspects," "in some implementations," and the like, should not be interpreted as limiting the disclosed subject matter to the specific examples.
The methods or flow diagrams provided herein may be implemented in a computer program, software, or firmware incorporated in a non-transitory computer-readable storage medium for execution by a general purpose computer or a processor. Examples of non-transitory computer readable storage media include ROM, Random Access Memory (RAM), registers, cache memory, semiconductor memory devices, magnetic media such as internal hard disks and removable disks, magneto-optical media, and optical media such as CD-ROM disks and Digital Versatile Disks (DVDs).
Having described the invention in detail, those skilled in the art will appreciate that, given the present disclosure, modifications may be made to the invention without departing from the spirit of the inventive concept described herein. Therefore, it is not intended that the scope of the invention be limited to the specific embodiments shown and described.
