Title of Invention

AN APPARATUS FOR LOCATING AN ARRHYTHMOGENIC PATHWAY IN A LOCATION OF A LIVING SUBJECT

Abstract The invention relates to an apparatus for locating an arrhythmogenic focus or pathway in a location of a living subject, comprising a mapping catheter operative for stimulating multiple locations endocardially or epicardially; detecting respective sets of pace-mapped electrocardiographic signals at respective locations of said catheter, said catheter having a position sensor; a position processor receiving position signals from said position sensor and operative for determining said respective locations of said catheter; and an analysis processor, receiving a reference set of electrocardiographic signals and receiving said sets of pace-mapped electrocardiographic signals from said catheter, said reference and pace-mapped sets of electrocardiographic signals each comprising 12-lead electrocardiograms, said analysis processor operative for correlating the leads of said electrocardiograms comprising said sets of pace- mapped electrocardiographic signals with the corresponding leads of said electrocardiograms comprising said reference set of electrocardiographic signals, making a determination that a correlation between a predefined number of leads of said sets of pace-mapped electrocardiographic signals and the corresponding number of leads of said reference set of electrocardiographic signals meets a predefined criterion.
Full Text


CROSS-REFERENCE TO RELATED APPLICATIONS
This application claims the benefit of
U.S. Provisional Application No. 60/884,493 filed
January 11, 2007, which is herein incorporated by
reference.
BACKGROUND OF THE INVENTION
Field of the Invention
This invention relates to the diagnosis
and treatment of cardiac arrhythmias. More particularly,
this invention relates to the identification of
arrhythmogenic foci associated with ventricular
tachycardia.
Description of the Related Art


Cardiac arrhythmias such as ventricular
tachycardia are an important cause of morbidity and
death. Commonly assigned U.S. Patent No. 5,54 6,951, and
U.S. Patent No. 6,690,963, both issued to Ben Haim; and
PCT application WO 96/057 68, all of which are
incorporated herein by reference, disclose methods for
sensing an electrical property of heart tissue, for
example, local activation time, as a function of the
precise location within the heart. Data' are acquired with
one or more catheters having electrical and location
sensors in their distal tips, which are advanced into the
heart. Methods of creating a map of the' electrical
activity of the heart based on these data are disclosed
in commonly assigned U.S. Patent No. 6,226,542, and U.S.
Patent No. 6,301,4 96, both issued to Reisfeld, which are
incorporated herein by reference. As indicated in these
patents, location and electrical activity is typically
initially measured on about 10 to about 20 points on the
interior surface of the heart. These data points are then
generally sufficient to generate a preliminary
reconstruction or map of the cardiac surface. The
preliminary map is often combined with data taken at
additional points in order to generate a more
comprehensive map of the heart's electrical activity.
Indeed, in clinical settings, it is not uncommon to
accumulate data at 100 or more sites to generate a
detailed, comprehensive map of heart chamber electrical
activity. The generated detailed map may then serve as
the basis for deciding on a therapeutic course of action,
for example, tissue ablation, to alter the propagation of

the heart's electrical activity and to restore normal
heart rhythm.
Catheters containing position sensors may
be used to determine the trajectory of points on the
cardiac surface. These trajectories may be used to infer
motion characteristics such as the contractility of the
tissue. As disclosed in U.S. Patent No. 5,738,096, 'issued
to Ben Haim, and incorporated herein in its entirety by
reference, maps depicting such motion characteristics may
be constructed when the trajectory information is sampled
at a sufficient number of points in the heart.
U.S. Patent No. 6,847,839, issued to
Ciaccio, et al., describes a method for identifying and
localizing a reentrant circuit isthmus in a heart of a
subject during sinus rhythm, including: a) receiving
electrogram signals from the heart during sinus rhythm
via electrodes; b) storing the electrogram signals; c)
creating a map based on the electrogram signals; d)
finding a center reference activation location on the
map; e) defining measurement vectors originating from the
center reference activation location; f) selecting from
the measurement vectors a primary axis vector indicating
a location of the reentrant circuit isthmus in the heart;
g) finding threshold points of electrogram signals on the
map; h) connecting the threshold points to form a polygon
indicating a shape of the reentrant circuit isthmus in
the heart.

SUMMARY OF THE INVENTION
Electrical activity at a point in the
heart is typically measured by advancing a catheter-
containing an electrical sensor at or near its distal tip
to that point in the heart, contacting the tissue with
the sensor and acquiring data at that point. One drawback
with mappin.g a cardiac chamber using a catheter
containing only a single, distal tip electrode is the
long period of time required to accumulate data on a
point-by-point basis over the requisite number of points
required for a detailed, map of the chamber as a whole.
Hence, patients with unstable ventricular tachycardia
(VT) can not tolerate a mapping procedure that lasts long
enough to produce an accurate activation map. Therefore,
pace mapping, performed by conventional techniques, is the method used in such cases. This involves pacing the
chamber at a relatively fast rate (typically,, but not
necessarily at the cycle length of the arrhythmia), then
comparing a body surface 12-lead ECG during pacing to the
EGG recorded during clinical arrhythmia, either induced
or previously recorded.
Myocardial scars are known to be
associated with arrhythmic conductive pathways and foci,
e.g., reentrant foci, that are responsible for
ventricular tachycardia. Currently, identification of
such foci using the aforementioned mapping techniques is
a long and tedious procedure, for example, involving
visual comparisons between the complexes associated with

clinical ventricular tachycardia and pace-mapped signals.
Such foci have been the subject of some prior research.
After a patient has recovered from an
episode of ventricular tachycardia, a cardiologist may
perform an electrophysiological study in order to
identify foci of the arrhythmia. During the study, a
pacing catheter is introduced into the heart chamber and
is operated to apply electrical stimulation pulses to the
myocardium at different locations in an attempt to induce
ventricular tachycardia. If pacing at a given site
induces ventricular tachycardia or other arrhythmia, the
arrhythmia is recorded and compared to the pacing from
other sessions.
The VT-related patterns that are induced
by electrophysiological pacing may be transient and
difficult to identify. As a result, the job of searching
for VT foci can be tedious and inaccurate, and it may be.
too difficult for less experienced cardiologists. In
response to these difficulties, embodiments of the
present invention provide methods that can be used to
automate the detection of VT foci by numerically
comparing the characteristic related ECG patterns, i.e.,
between the clinical arrhythmia and the pace mapping
points.
According to disclosed embodiments of the
invention, ventricular tachycardia signals are induced in
a living subject. Pace-mapped signals are then obtained

from multiple points within the ventricle, and
automatically compared numerically with the induced
signals. Recognition of a high degree of cross
correlation between the induced signals and one or more
of the pace-mapped signals identifies arrhythmogenic foci, which may then be ablated. Several mathematical
techniques are employed to obtain the numerical
comparisons and correlations.
An embodiment of the invention provides a
computer-implemented method for locating an
arrhythmogenic focus or pathway in a heart of a living
subject, which is carried out by recording a reference
set of electrocardiographic signals from the subject,
stimulating the heart at multiple locations endocardially
or epicardially, and while stimulating at the multiple
locations, recording respective sets of pace-mapped
electrocardiographic signals. The method is further
carried out by correlating the sets of pace-mapped
electrocardiographic signals with the reference set of
electrocardiographic signals. Responsively, to a
determination that a correlation between one of the sets
of pace-mapped electrocardiographic signals and the
reference set of electrocardiographic signals meets a
predefined criterion, the arrhythmogenic focus or pathway
is identified as the respective location corresponding to
the one pace-mapped set of pace-mapped
electrocardiographic signals.

In one aspect of the method, the reference
set of electrocardiographic signals and the sets of pace-
mapped electrocardiographic signals are recorded remotely
from an analysis location where the signals are
correlated. The method includes transmitting at least one
of the reference set of electrocardiographic signals and
the sets of pace-mapped electrocardiographic signals to
the analysis location.
According to an aspect of the method, the
reference set of electrocardiographic signals is recorded
using an implanted intracardiac device and is transmitted
to the analysis location in realtime.
Yet another aspect of the method includes
recording a historic set of electrocardiographic signals
remotely from the analysis location, transmitting the
historic set of electrocardiographic signals to the
analysis location, and comparing the historic set of
electrocardiographic signals with the reference set of
electrocardiographic signals at the analysis location.
According to still another aspect of the
method, the reference set of electrocardiographic signals
is transmitted to the analysis location at least in part
wirelessly.
In a further aspect of the method,
correlating is performed by calculating respective
numerical comparisons between the sets of pace-mapped

electrocardiographic signals and the reference set of
electrocardiographic signals, and calculating a
corre.l ation coefficient.
According to one aspect of the method, the
criterion is met when the correlation coefficient
exceeds a predefined value.
According to another aspect of the method,
the sets of pace-mapped electrocardiographic signals and
the reference set of electrocardiographic signals
comprise 12-lead electrocardiograms, and the criterion is
met when the correlation coefficient exceeds a predefined
value in a predefined number of leads of the 12-lead
electrocardiograms.
A further aspect of the method includes
constructing a functional map of the heart in which a
degree of correlation between the sets of pace-mapped
electrocardiographic signals and the reference set of
electrocardiographic signals are related to the multiple
locations.
Yet another aspect of the method includes
inducing ventricular tachycardia prior to recording the
reference set of electrocardiographic signals.
An embodiment of the invention provides a
computer-implemented method for locating an
arrhythmogenic abnormality in a heart of a living

subject, which is carried out by stimulating the heart at
multiple locations endocardially or epicardially, and,
recording respective sets of pace-mapped
electrocardiographic signals. The method is further
carried out by detecting an abnormal electrocardiographic
signal pattern in the sets of pace-mapped
electrocardiographic signals indicative of an
arrhythmogenic focus or pathway, memorizing the pattern,
and subseguently automatically identifying a new instance
of the pattern when recording new electrocardiographic
signals.
One aspect of the method includes adding
the pattern to a library for use in subsequent automatic
identifications of a new instance of the pattern.
An additional aspect of the method
includes automatically identifying a new instance of the
pattern by selecting a first time interval containing a
pattern of interest in the new electrocardiographic
signals, computing respective values of a characteristic
of the new electrocardiographic signals in a plurality of
time segments within the first time interval,
concatenating the respective values to form a signature
of the pattern of interest, and identifying a further
occurrence of the pattern of interest in the new
electrocardiographic signals during a second time
interval by matching the new electrocardiographic signals
in the second time interval to the signature.

BRIEF DESCRIPTION OF THE DRAWINGS
For a better understanding of the present
invention, reference is made to the detailed description
of the invention, by way of example, which is to be read
in conjunction with the following drawings, wherein like
elements are given like reference numerals, and wherein:
Fig. 1 is a pictorial illustration of a
system that is adapted to detecting foci and conduction
pathways responsible for ventricular tachycardia and
performing ablative procedures on a heart of a living
subject in accordance with a disclosed embodiment of the
invention;
Fig. 2 is a diagram of an embodiment of
the catheter for use in the system shown in Fig. 1;
Fig. 3 is a diagram illustrating phases of
a procedure for detecting arrhythmogenic foci and
pathways associated with ventricular tachycardia in
accordance with a disclosed embodiment of the invention;
Fig. 4 is a flow chart of a method of
detecting arrhythmogenic foci and pathways associated
with ventricular tachycardia in accordance with a
disclosed embodiment of the invention;
Fig. 5 is a detailed flow chart of a
method for correlating pace-mapped electrocardiographic
signals with induced electrocardiographic signals, in
accordance with a disclosed embodiment of the invention;
Fig. 6 illustrates a correlation display
of electrocardiographic signals, in accordance with a
disclosed embodiment of the invention;

Fig. 7 is a composite graphic display of
correlation results in accordance with a disclosed
embodiment of the invention;
Fig. 8 is an exemplary 12-lead tracing
showing an induced signal, in accordance with a disclosed
embodiment of the invention;
Fig. 9 is a series of tracings similar to
Fig. 9, with superimposition of two series of signals, in
accordance with a disclosed embodiment of the invention.
Fig. 10 is a functional map of the left
ventricle of a heart, illustrating cross-correlation
between a pace-mapped signal and an induced signal in
accordance with a disclosed embodiment of the invention;
Fig. 11 is another functional map of the
left ventricle shown in Fig. 10, in accordance with a
disclosed embodiment of the invention;
Fig. 12 is a flow chart of a method for
identifying abnormal ECG patterns such as VT patterns in
accordance with an alternate embodiment of the invention;
Fig. 13 is a diagram that schematically
illustrates an exemplary display of an ECG signal
analysis system, in accordance with an embodiment of the
present invention;
Fig. 14 is a flow chart that schematically
illustrates a method for analyzing ECG signals, in
accordance with an embodiment of the present invention;
and
Fig. 15 is a pictorial diagram of an
arrangement for remotely identifying abnormal ECG

patterns in accordance with an alternate embodiment of
the invention.
DETAILED DESCRIPTION OF THE INVENTION
In the following description, numerous
specific details are set forth in order to provide a
thorough understanding of the present invention. It will
be apparent to one skilled in the art, however, that the
present invention may be practiced without these specific
details. In other instances, well-known circuits, control
logic, and the details of computer program instructions
for conventional algorithms and processes have not been
shown in detail in order not to obscure the present
invention unnecessarily.
Software programming code, which embodies
aspects of the present invention, is typically maintained
in permanent storage, such as a computer readable medium.
In a client/server environment, such software programming
code may be stored on a client or a server. The software
programming code may be embodied on any of a variety of
known media for use with a data processing system, such
as a diskette, or hard drive, or CD-ROM. The code may be
distributed on such media, or may be distributed to users
from the memory or storage of one computer system over a
network of some type to other computer systems for use by
users of such other systems.
System Architecture
Turning now to the drawings, reference is
initially made to Fig. 1, which is a pictorial

illustration of a system 10 that is adapted to detecting
areas in a heart 12 of a living subject that are
associated with an arrhythmia and performing ablative
procedures in accordance with a disclosed embodiment of
the invention. The system comprises a probe, typically a
catheter 14, which is percutaneously inserted by an
operator 16, who is typically a physician, through the
patient's vascular system into a chamber or vascular
structure of the heart. The operator 16 brings the
catheter's distal tip 18 into contact with the heart wall
at a target site that is to be evaluated. Electrical
activation maps are then prepared,' according to the
methods disclosed in the above-noted U.S. Patent
Nos. 6,226,542, and 6,301,496, and in commonly assigned
U.S. Patent No. 6,892,091, whose disclosure is herein
incorporated by reference.
Areas determined to be abnormal by
evaluation of the electrical maps can be ablated
application of thermal energy, e.g., by passage of
radiof requency electrical current through wires in the
catheter to one or more electrodes at the distal tip 18,
which apply the radiofrequency energy to the myocardium.
The energy is absorbed in the tissue, heating it to a
point (typically about 50°C) at which it permanently loses
its electrical excitability. When successful, this
procedure creates non-conducting lesions in the cardiac
tissue, which disrupt the abnormal electrical pathway
causing the arrhythmia. Alternatively, other known
methods of applying ablative energy can be used, e.g.,

ultrasound energy, as disclosed in U.S. Patent
Application Publication No. 2004/0102769, whose
disclosure is herein incorporated by reference. The
principles of the invention are disclosed with respect to
atrial complex fractionated electrograms, but can be
applied to all heart chambers, to epicardial as well as
endocardial approaches, and to mapping in sinus rhythm,
and when many different cardiac arrhythmias are present.
The catheter 14 typically comprises a
handle 20, having suitable controls on the handle to
enable the operator 16 to steer, position and orient the
distal end of the catheter as desired to the ablation. To
aid the operator 16, the distal portion of the
catheter 14 contains position sensors (not shown) that
provide signals to a positioning processor 22, located in
a console 24. The catheter 14, may be adapted, mutatis
mutahdjs, from the ablation catheter described in
commonly assigned U.S. Patent No. 6,669,692, whose
disclosure is herein incorporated by reference. The
console 24 typically contains an ablation power
generator 43, The console 24 also includes a processor 23
that performs signal correlation and analysis functions,
which are described in further detail hereinbelow. In
some embodiments, the processor 22 and processor 23 can
be integrated into a single processor. The processor 23
can be realized as a general purpose computer.
The positioning processor 22 is an element
of a positioning subsystem that measures location and

orientation coordinates of the catheter 14. Throughout
this patent application, the term "location" refers to
the spatial coordinates of the catheter, and the term
"orientation" refers 'to its angular coordinates. The term
"position" refers to the full positional information of
the catheter, comprising both location and orientation
coordinates.
In one embodiment, the positioning
subsystem 2 6 comprises a magnetic position tracking
system that determines the position and orientation of
the catheter 14. The positioning subsystem 26 generates
magnetic fields in a predefined working volume its
vicinity and senses these fields at the catheter. The
positioning subsystem 2 6 typically comprises a set of
external radiators, such as field generating coils 28,
which are located in fixed, known positions external to
the patient. The coils 28 generate fields, typically
electromagnetic fields, in the vicinity of the heart 12.
In an alternative embodiment, a radiator
in the catheter 14, such as a coil, generates
electromagnetic fields, which are received by sensors
(not shown) outside the patient's body.
Some position tracking systems that may be
used for this purpose are described, for example, in the
above-noted U.S. Patents 6,690,963, and in commonly
assigned U.S. Patent Nos. 6,618,612 and 6,332,089, and
U.S. Patent Application Publications 2004/0147920,

and 2004/0068178, whose disclosures are all incorporated
herein by reference. Although the positioning
subsystem 2 6 shown in Fig. 1 uses magnetic fields, the
methods described below may be implemented using any
other suitable positioning subsystem, such as systems
based on electromagnetic fields, acoustic or ultrasonic
measurements.
Reference is now made to Fig. 2, which is
a diagram of an embodiment of the catheter 14 for use in
the system 10 (Fig. 1) . The catheter 14 is a mapping and
therapeutic delivery catheter for insertion into the
human body, and into a chamber of the heart 12 (Fig. 1) .
The catheter shown is exemplary; many other types of
catheters can be used as the catheter 14. The catheter 14
includes a body 30. An electrode 32 is at a distal
portion 34 disposed for measuring the electrical
properties of the heart tissue. The electrode 32 is also
useful for sending electrical signals to the heart for
diagnostic purposes, e.g., for electrical mapping, and/or
for therapeutic purposes, e.g., for ablating defective
cardiac tissue. The distal portion 34 further includes an
array 36 of non-contact electrodes 38 for measuring far
field electrical signals in the heart chamber. The
array 36 is a linear array in that the non-contact
electrodes 38 are linearly arranged along the
longitudinal axis of the distal portion 34. The distal
portion 34 further includes at least one position
sensor 40 that generates signals used to determine the
position and orientation of the distal tip 18 within the

body. The position sensor 40 is preferably adjacent to
the distal tip 18. There is a fixed positional and
orientational relationship of the position sensor 40, the
distal tip 18 and the electrode 32.
The position sensor 4 0 transmits, in
response to the fields produced by the positioning
subsystem 26 (Fig. 1), position-related electrical
signals over a cable 42 running through the catheter 14
to the console 24 .. Alternatively, the position sensor 40
in the catheter 14 may transmit signals to the console 2 4
over a wireless link, as described in U.S. Patent
Application Publication Nos. 2003/0120150
and 2005/0099290, the disclosures of which are herein
incorporated by reference. The positioning processor 22
then calculates the location and orientation of the
distal portion 34 of the catheter 14 based on the signals
sent by the position sensor 40. The positioning
processor 22 typically receives, amplifies, filters,
digitizes, and otherwise processes signals from the
catheter 14. The positioning processor 22 also provides a
signal output to a display 44 that provides a visual
indication, of the position of the distal portion 34
and/or the distal tip 18 of the catheter 14 relative to
the site chosen for ablation.
The handle 2 0 of the catheter 14 includes
controls 4 6 to steer or deflect the distal portion 34, or
to orient it as desired.

The cable 42 comprises a receptacle 48,
which connects to the handle 20. The receptacle 48 is
preferably configured to receive catheters of a specific
model, and preferably includes user-evident
identification of the specific model. One of the
advantages in using the cable 42 is the ability to
connect different models and types of catheters, such as
those catheters having different handle configurations,
to the same console 24 (Fig. 1) . Another advantage in
having a separate cable 42 is in the fact that it does
not come into contact with patients, so that it is
possible to reuse the cable 42 without sterilization. The
cable 42 further contains one or more isolation
transformers (not shown), which electrically isolate the
catheter 14 from the console 24. The isolation
transformers may be contained in the receptacle 48.
Alternatively, isolation transformers may be contained in
the system electronics of the console 24.
Referring again to Fig. 1, the system 10
can be realized as the above-mentioned CARTO XP FP
Navigation and Ablation System, suitably modified to
execute the procedures described herein.
General Operation
Reference is now made to Fig. 3, which is
a diagram illustrating phases of a procedure for
detecting arrhythmogenic foci or pathways associated with
ventricular tachycardia in accordance with a disclosed

embodiment of the invention. In a first induction
phase 50, ventricular tachycardia is induced (or observed
without induction. Alternatively, traces may be imported
by any suitable means, i.e., scanning, electronic
transmission from other systems, which may be remote.
Conventional 12-lead electrocardiographic signals are
initially recorded and constitute a reference set of
electrocardiographic signals. In a mapping phase 52,
general mapping of the left ventricular anatomy and
electrical characteristics are undertaken. This includes
mapping of the chamber in order to identify possible
locations of channels or focal points that may trigger
the ventricular tachycardia (or other arrhythmia). This
can be done by acquiring voltage maps or recording other
electrical properties of the tissue, e.g., mid-diastolic
potentials. Additionally or alternatively, the mapping
may be carried out by merging or importing images that
were acquired by other modalities.
In a pace-mapping phase 54, selected
points are stimulated and electrocardiographic signals
obtained to observe the effect of the stimulation. Then,
in a comparison phase 56, some numerical measure of
similarity is automatically determined between the
electrocardiographic signals obtained in the induction
phase 50 and the pace-mapping phase 54. In one
embodiment, the measure of numerical correlation is
derived from the covariance, {cov(X, Y)) of the two ECG
signals (X, Y), as explained in further detail
hereinbelow.

In another embodiment, a numerical method
known as "principal component analysis" (PCA) is used to
determine the correlation. This is described in further
detail below. Briefly, the analysis is performed on a 12-
lead body surface ECG recording of an induced signal.
Three or four vectors are obtained, of which a
combination can represent each of the induced signals
recorded on a 12-lead body surface ECG. Similarity of the
combination of the three or four vectors obtained in the
principal component analysis (PCA) applied to the
recorded induced signal can be used as a presentation of
the 12-lead body surface ECG Pace Mapping. The normalized
difference between the pace mapping and the represented
pace mapping (using the vectors received from the
principal component analysis on the induced signals
recorded on the 12-lead body surface ECG) form the
correlation values between corresponding leads.
Reference is now made to Fig. 4, which is
a flow chart of a method of automatically detecting and
quantifying arrhythmogenic foci associated with
ventricular tachycardia in accordance with a disclosed
embodiment of the invention. The method can be used
similarly in focal and reentry variants that are known to
be associated with ventricular tachycardia.
Alternatively, the method can be applied using
entrainment stimulation. Indeed, the method can be
applied, to any arrhythmia that requires a comparison of
signals for its evaluation. The order of the steps may be

varied in practical embodiments. For example, recordings
and correlation computations may be grouped.
At initial - step 58 an ECG is obtained
while the subject is experiencing ventricular
tachycardia. This may be a clinical episode.
Alternatively, ventricular tachycardia may be induced
conventionally, e.g., pharmacologically or invasively,
using a combination of fast and early stimuli. In order
to obtain induced signals, or subsequent to recording
spontaneous or pharmacologically induced ventricular
tachycardia, a catheter, e.g., the catheter 14 (Fig. 2)
is introduced into the ventricular chamber. An
electrocardiographic tracing showing ventricular
tachycardia is obtained, typically a 12-lead
electrocardiogram. Conventional signal . processing is
applied to the electrocardiogram to obtain a digitized
version. However, it will be apparent that the method is
amenable to analog implementations. The following
procedure is suitable for recording induced signals:
record approximately 2.5 seconds of a 12-lead body
surface ECG, independently of the . status of any mapping
catheters. A beat buffer is used for induced signals,
i.e., the last two to three minutes are loop recorded and
can be stopped at any time in order to catch a transient
arrhythmia. The operator can select relevant ECG
components to save as a template. After saving the chosen
beat, the non-selected beats may be discarded. Template
construction is described in further detail hereinbelow.

At step 60, pace mapping is performed at a
trial location in the ventricle, and a digitized
electrocardiographic record obtained.
Preprocessing is carried out next at
step 61. First, the pacemaker spike is removed. This can
be done using a median filter. The pacemaker spike, if
left in place, can distort the correlations that are to
be calculated, and thereby produce misleading results.
Next, one of the leads is selected for evaluation. First,
a maximum peak is identified. Then all other peaks having
a magnitude that differs by at least 0.1 mm from that of
the maximum are identified. Subsequent correlation
analysis is carried out to obtain the best correlation in
a window-of-interest (WOI) of the induced signal with a
WOI in the pace-mapped signals around a found peak usi.ng
a shift of +-20ms. The procedure for calculating the
correlation between induced signal (IS), . which defines a
template, and the pace-mapped signal (PM) is as follows:
1. A user-defined PM correlation
threshold (between 0 and 1) and a user defined
Minimum Number of Leads (Min-PML) are set. By
default the PMCT = 0.8, and Min-PML = 10). 2. Each lead of the PM set is
compared by cross correlation with the
corresponding lead of the region of interest
marked on all templates. All comparisons are
at the same timing within the PM signal. This

results in a set of 12 numbers for each PM-Template pair.
3. The IS has a defined WOI.
4. Calculate all the peaks in the PM in a selected load.
5. Calculate the correlation between the IS with WOI and the PM with WOI
defined around each peak with shift of +-20 ms.
6. Select the WOI with the best average correlation of all 12 leads.
7. Compare each lead's with the PMCT.
8. If at least Min-PML lads have correlations greater than PMCT, the average
correlation us displayed, e.g., in a 3-dimensional map.
At step 62 correlation coefficients are automatically determined between the
records obtained in step 58 as explained above. The correlation coefficient is
given by:

where


and

Control now proceeds to decision step 64, where it is determined if the
correlation coefficients determined in step 62 satisfy pre-defined criteria. Details
of this determination are presented in further details hereinbelow.
If the determination at decision step 64 is affirmative, then control proceeds to
step 64 is affirmative, then control proceeds to step 66. The current location is
marked as a possible arrhythmia triggering point or a possible point of a reentry
path, and becomes a candidate for ablation. The time internal containing the
correlated pattern is also marked.
After performing step 66, or if the determination at decision step 64 was
negative, control proceeds to decision step 68, where it is determined if more
locations in the ventricle are to be studied. Typically many points, typically about
24 or so are pace-mapped. Usually only a few of these become candidates for

ablation. If the determination at decision step 68 is
affirmative, then control returns to step 60.
If the determination at decision step 68
is affirmative, then control proceeds to final step 70.
The locations identified at step 66 may be ablated if
medically indicated.
Reference is now made to Fig. 5, which is
a detailed flow chart of a method for correlating pace-
mapped electrocardiographic signals (PM) with induced
electrocardiographic signals (IS), in accordance with a
disclosed embodiment of the invention. The method is
essentially an elaboration of step 62 (Fig. 4). The
description that follows applies to one IS template;
however, the procedure is typically iterated for each IS
template that was generated, i.e., for each existing
clinical arrhythmia.
The process steps are shown in a
particular linear sequence in Fig. 5 for clarity of
presentation. However, it will be evident that the leads
may be ' efficiently be evaluated in parallel, and the
order of the steps may be varied in practice. At initial
step 72, a digitized 12-lead induced electrocardiographic
signal and a digitized 12-lead pace-mapped
electrocardiographic signal are obtained as described
above.

Each lead of a PM signal taken from a
location is compared by cross correlation with the
corresponding lead of the region of .interest marked on a
template. All comparisons are at the same timing within
the PM signal. This results in a set of 12 numbers for
each PM-Template pair compared.
Each lead' s correlation with its
corresponding lead is automatically evaluated
numerically. At step 74, a lead is selected.
Corresponding induced and pace-mapped signals recorded at
this lead are used in step 7 6, where a correlation
coefficient is computed as described above between the
induced and pace-mapped signals.
Control now proceeds to decision step 78,
where it is determined if a predefined pace-mapped
correlation threshold (PMCT) was equaled or exceeded in
the computation of step 76. Suitable values for the PMCT
are about 0.9 or higher, and can be user defined.
If the determination at decision step 78
is affirmative, then control proceeds to step 80. The
number of qualifying leads (QL) is incremented.
After performing step 80, or if the
determination at decision step 78 is negative, control
proceeds to decision step 82, where it is determined if
more leads are to be evaluated.

If the determination at decision step 82
is affirmative, then control returns to step 7 4 for
another iteration.
If the determination at decision step 82
is affirmative, then control proceeds to decision
step 84, where it is determined whether the number of
qualifying leads that have been accumulated in iterations
of step 80 is at least a pre-defined minimum number of
leads (Min-PML). Suitable values for Min-PML
are about 10-11. These values can be modified by the user
if desired.
If the determination at step decision
step 84 is affirmative, then control proceeds to final
step 86. The location associated with the PM signal is
identified as an abnormal focus or pathway (channel)
associated with ventricular tachycardia.
If the determination at decision step 84
is negative, then control proceeds to final step 88. The
procedure has failed to associate the location associated
with the PM signal as an abnormal focus or pathway
associated with ventricular tachycardia.
Correlation Displays
Correlation displays are generated
indicating the correlation of pace-mapped ECG's with the
ECG obtained in initial step 58 (Fig. 4) . Reference is

now made to Fig..'6, which illustrates a correlation
display of electrocardiographic signals as a comparison
window 90, in accordance with a disclosed embodiment of
the invention. VT templates as shown on the window 90 are
prepared for each type of VT complex recorded as an
induced signal or spontaneously. In this example, a point
PM.l has been selected. The display provides an option to
scroll through all the PM's (whether their correlation is
above or below the PMCT) . For each lead, the correlation
between the current template and the PM is displayed, as
well as the average correlation for all leads. Colors
differentiate IS from PM signals. By default, both
signals are superimposed so that the portions of the
signals on which the correlation was calculated are on
top of each other. In one embodiment, it is possible to
horizontally scroll the display of the PM signal, while
the iS signal remains static. Thus, the PM to IS
correlations, which appears to "slide" in real time, can
be explored visually as shown in Fig. 9 (described
below) . Additionally any IS may be superimposed over
another IS in order to assist the user in judging their
similarity and validate the automatic assessment of
template identification.
Once the user has released a scrolling
control, all correlations for the current VT template-PM
pair are recalculated and saved. Furthermore, the
automatic correlation between the IS and PM signal may be
recalculated at any time at the user's option.

Any VT template-PM pair having a negative
correlation is automatically marked "not for display".
This sotting cannot be overridden unless the .user has
manually found a positive correlation. It is possible to
change the time, scale in a window. Any such change
affects all leads at the same time.
Reference is now made to Fig. 7, which is
a composite graphic display of correlation results in
accordance with a disclosed embodiment of the invention.
This display is typically prepared following performance
of the methods disclosed above. Three ECG vector •
representations 92, 94, 96 are shown. Similarity results
are indicated by asterisks on each vector. Negative
correlations are marked on the negative side of the axis.
Template Construction
Templates are constructed from induced
signals recording. As noted above, one records
approximately 2.5 seconds of 12-lead body surface ECG
recording during the setup phase, and independent of the
status of any internal catheters to ensure an accurate
visual framework for mapping diagnostic procedures. These
signals are not associated with any catheter location.
As noted above, it is desirable to have a
beat buffer for IS signals, similar to the current beat
buffer for the points, i.e., 10 beats are frozen with
each signal, the user can select the beat to save. After
saving, the non-selected beats are lost. While typically

done by a human operator, in some embodiments the
selection may be done automatically using conventional
morphologic analysis techniques, e.g., pattern
recognition.
The time of acquisition is recorded with
the IS signal (hh:mm).
Typically, about five induced signals are
recorded. A maximum of 4 0 IS may normally be recorded.
Reference is now made to Fig. 8, which is an
exemplary 12-lead tracing showing an induced signal, in accordance with a disclosed embodiment of the invention.
A stimulus is referenced by an arrow 98 and a resulting
ventricular complex indicated by an arrow 100. A window
of interest is framed by vertical lines 102, 104.
Reference is now made to Fig. 9, which is
a series of tracings similar to Fig. 8, with
superimposition of two series of signals to visually
indicate correlations, in accordance with a disclosed
embodiment of the invention.
For the first IS signal, the user marks
the complex of interest with horizontal calipers or a
similar tool. The default is from the first peak of the
lead II (positive or negative) +/- 150 ms. If the first
peak on lead II is less than 150 ms from the beginning of
the data recording, the next peak is used. Alternatively,
the complex of interest can be identified automatically

using conventional peak recognition techniques in the
art, after which the operator confirms the result.
The first IS signal is automatically
marked as a template.
Each additional IS is automatically
checked for similarity with the window of interest of all
existing templates. Similarity is checked with cross
correlation for each lead separately, and for all leads
on the same section of the signal (from a timing point of
view).
There is a user defined IS correlation
threshold (between 0 and 1) and a user-defined minimum
number of leads (Min-ISL) . The default I.SCT - 0.9;'
default Min-ISL = 10-11. Each lead's correlation is
tested against the ISCT.
If at least Min-ISL have correlation
coefficients that are greater than ISCT, the signals are
considered similar and the new IS is not marked as a
template .-
Otherwise, the new IS is marked as a
template. The default area of interest is that found by
the correlation, and it can be changed by the user.
The average correlation - coefficient is
calculated and presented.

The user may override the automatic
template assignment (i.e., if the SW marked it as a
template, it may be unmarked, and vice versa) .
Each IS can have a unique label of four or
fewer characters. The label will not be removed if the IS
is selected or deselected as a template. If ISCT or Min-
ISL are changed while acquiring templates, the system
recalculates correlations and marks the IS as templates
accordingly.
Manual selections (or deselections) by the
user may be saved.
Pace-mapping Procedure
One records approximately 2.5 seconds
of 12-lead body surface ECG without the need to "freeze"
a point O'f the tracing in time.
It is desirable to have a beat buffer for
PM signals, similar to the current beat buffer for the
points, i.e., 10 beats are frozen with each signal. The
user can select the beat to save. After saving, the non-
selected beats are normally discarded.
The time of acquisition is recorded with
the PM signal.

One associates the PM signals with a
point, i.e., a location. If no point is selected, the PM
is associated with the last point acquired.
A PM tag is added to the point with a PM
associated with it. If CardioLabw integration is
available, this tag is also sent to the CardioLab system.
The above-noted beat buffer from the same or a different
study may be stored on the CardioLab (or similar) system,
and can be imported when required.
Beside each PM tag a label indicates to
which template it best correlates.
The PM tag label is shown independently to
the other tag labels. PM signals are numbered
consecutively.
Only one PM signal may be associated with
each point. A PM signal cannot be associated with more
than one point.
When a point is copied or moved to another
map, all its links are copied with it.
When a point is deleted, all the links for
this point are deleted. If the point is restored, the
links need to be re-established automatically.

PM signals are normally saved with the
study.
PM 12 lead signals may be printed. The
name of the patient, date and time of acquisition are
printed with it.
Functional Maps
In one aspect of the invention maps are
displayed showing in which correlations of pace-mapped
locations and IS templates are indicated by a color
scale. Construction of functional maps may be
accomplished using known methods; for example, those
taught in the above-noted U.S. Patent Nos. 6,226,542,
and 6,301,496.
Reference is now made to Fig. 10, which is
a functional map of the left ventricle of a heart,
illustrating cross-correlation between a pace-mapped
signal and an induced signal in accordance with a
disclosed embodiment of the invention. Correlation
parameters and measurements are shown in a dialog box 106
in the upper left portion of the figure. The degree of
cross correlation may be interpreted with reference to a
color scale 108. On the correlation map, a pacing point
is defined as the best average correlation value between
induced signals and a pace-mapped signal.

Superimposition of a correlation map with
a CARTO map used to define a scarred area assists the
operator in choosing a site for ablation, and choosing
the order of points to ablate.
Reference is now made to Fig. 11, which is
a functional map. of the left ventricle shown in Fig. 10.
Here color-coded balls 118, also known as "point tags",
represent pace-mapped points that exceed the correlation
threshold of significance. Differently color-coded
balls 120 represent points designated for ablation.
Alternatively, other types of markings may be substituted
for the balls 118, 120.
Principal Component Analysis
In the above-noted PCA correlation method,
the algorithm objective is to locate similarity between a
first set of signals - identified with the relevant
tachycardia (training set) and a second set of body
surface ECG leads signals, while pacing from the heart
(tested set).
The training set is used to generate a set
of signals, that encapsulate most of the information.
Principle component analysis and optionally Independent
Component Analysis (ICA) are used to generate a set of
base functions. Both of these techniques are well-known
computational methods, and are therefore not further
discussed herein. These functions are validated to span

the whole instances of the training set where the input
signal is estimated as with good enough accuracy. In
order tor PCA and ICA to operate optimally, preprocessing
is performed that cuts the signals into segments that
represent only one cycle of the ECG. A scaling and offset
removal transfers the sections into a more uniform signal
space, which results in the set. Using the base functions
encapsulates most of the information, while rejecting
sections of sparse morphology.
To look for correlation between a test set
and the training, the test set passes the through above-
described preprocessing procedure, and sections are
generated. The base functions are then used to estimate
the coefficients that best represent the signal.
If the representation is not accurate
enough, it is assumed to be non-correlated with the
training set. Otherwise, a correlation is made over all
the leads simultaneously. In this way the regulation of
the base function improves the observability between
signals with different morphology by excluding sections
that are sparse and produce a low correlation for
corresponding signals. On the other hand, it causes a
much smaller correlation in unlike signals due to
amplification of the common dissimilar morphology.

Alternate Embodiment 1
Referring again to Fig. 1, in this
embodiment a cardiologist paces the heart at different
locations in the ventricle while observing a 12-lead
body-surface ECG, as described above. Upon observing a
suspicious pattern in the ECG (containing tachycardia or
other arrhythmic components), the cardiologist signals
the system 10 to mark the time interval containing the
suspicious pattern as well as the pacing location at
which the pattern occurred. Multiple intervals may be
marked in this manner. The system 10 then learns the
characteristics of the suspicious ECG pattern.
Subsequently, the cardiologist scans the
pacing catheter over the inner wall of the ventricle,
while the system 10 monitors and analyzes the ECG signals
to detect further occurrences of the pattern it has
learned. The system 10 marks any locations at which the
pattern recurs as possible VT foci. The cardiologist may
then ablate these foci or conduct further studies around
the focal locations.
The system 10 may learn the pattern of the
local electrograms sensed using the catheter 14 at the
suspected VT foci that are marked by the cardiologist.
The catheter signal at different locations in the
ventricle may then be analyzed for recurrence of this
local electrogram pattern, in addition to or instead of
the ECG.

Reference is now made to Fig. 12, which is
a flow chart of a method for identifying abnormal ECG
patterns such as VT patterns in accordance with an
alternate embodiment of the invention. At initial
step 22 9, pacing is performed at trial locations, as
described above.
Control now proceeds to decision step 231,
where it is determined if a suspicious pattern has been
detected. If the determination at decision step 231 is
negative, then control returns to initial step 229 and
pacing continues at new locations. VT patterns that are
identified or automatically identified and confirmed by
expert cardiologists may be stored in a library of
patterns. This library may then be distributed to other
cardiologists for their use in automatic identification
and treatment of possible VT foci at decision step 231.
If the determination at decision step 231
is affirmative, then control proceeds to step 233, where
the new pattern is learned automatically.
Subsequently, at final step 235, which may
be performed, for example, after an attempt at ablation,
pacing is repeated at new locations in the heart, in
order to determine whether the abnormal pattern persists
or has recurred.

In this embodiment, a reference signal is
obtained as described above. Referring again to Fig. 1,
the processor 23 displays the measured ECG signals to a
physician. The physician identifies an exemplary
occurrence of a pattern of interest in the displayed
signals and indicates the time interval containing the
pattern to the system. The methods and systems of this
embodiment relieve the physician of the tedious and time-
consuming task of manually scanning lengthy ECG signal
traces to detect a pattern of interest. Moreover, these
methods and systems are based on automatic analysis of an
exemplary pattern and not on an explicit quantitative
definition of the pattern, which is sometimes difficult
to specify.
The processor 23 operates as a pattern
processor, which analyzes the time interval and produces
a characteristic signature of the pattern. Typically, the
processor divides the time interval into multiple
segments along the time axis and calculates a signal
characteristic in each of the segments. The processor
uses the sequence of signal characteristics of the
different segments as the pattern signature. For example,
the signal characteristic may comprise an indication
whether the signal increases or decreases in the segment.
The processor 23 scans the ECG signal and
detects other occurrences of the pattern of interest. The
processor 23 identifies time intervals, in which the
signal matches the pattern signature. The pattern

signature may comprise a string, in which the signal
characteristic value of each segment is represented by a
corresponding character. In these embodiments, the
processor detects occurrences of the pattern using a
string matching process. The detected pattern occurrences
are marked and displayed to the physician.
Additionally or alternatively, the pattern
of: interest may be provided externally, such as from a
library of characteristic ECG patterns. The system 10 can
also be used to define a library of patterns that have
been found to be associated with certain types of
pathologies or events. This library may be distributed to
other cardiologists or systems for use in processing ECG
signals gathered from other patients.
Reference is now made to Fig. 13, which is
a diagram that schematically illustrates an exemplary
screenshot display of system 10, as displayed to the
physician on display 44, in accordance with an embodiment
of the present invention. The figure shows twelve ECG
signals originating from twelve electrodes 32' (Fig. 1).
Two patterns of interest, denoted "new signal 2" and "new
signal 4" have been previously defined by the physician.
Processor 23 simultaneously detects occurrences of the
two patterns in the ECG signals. In the present example,
the detected occurrences are marked using shaded areas on
the displayed ECG signals. Alternatively, the occurrences
can be marked using any other suitable indication, such
as using different color, icons or highlighted areas.

Occurrences of the "new signal 2" pattern
are denoted 50A and marked with a certain shading
pattern, while occurrences of the "new signal 4" pattern
are denoted SOB and marked with a different pattern. The
quality or confidence level of the match is indicated as
a percentage next to each occurrence.
A fitting window 52 shows the matching of
a particular occurrence to the pattern of interest.
Curves 54 and 56 respectively show the pattern and one of
the occurrences, laid one on top of the other. Various
controls 58 enable the physician to freeze the displayed
ECG signals, select a particular occurrence, add another
pattern of interest, etc. In alternative embodiments, any
other suitable man-machine interface features and methods
can be used.
ECG signal analysis method
Reference is now made to Fig. 14, which is
a flow chart that schematically illustrates a method for
analyzing ECG signals, in accordance with an embodiment
of the present invention. The method begins with
system 10 acquiring an ECG signal, at an acquisition
step 60. The acquired signal is displayed to the
operator, either in real time or off-line. The operator
identifies and marks a time interval that contains a
pattern of interest, at a pattern indication step 62.

Processor 23 divides the time interval,
marked by the operator .into multiple segments, at a
segmentation step 64. The pattern processor characterizes
the KCG signal in each of the segments and produces a
pattern signature based on the sequence of signal
characteristics, at a signature generation step 66. For
example, the processor may determine, for each segment,
whether the signal increases or decreases along the
segment. The processor can then generate a sequence of
"ascending" and "descending" indications, which is used
as a characteristic signature of the pattern of interest.
In these embodiments, the number of segments is typically
selected with sufficient resolution, so that the signal.
insi.de each segment is likely to be monotonous.
Additionally or alternatively, the
processor 23 can use any other suitable parameter in
order to characterize the different segments, such as the
positive' or negative slope of the signal within the
segment. In some embodiments, processor 23 represents the
pattern signature as a string, in which each segment is
represented by a character. For example, a segment in
which the signal increases can be represented by a "U" .
character. A segment in which the signal decreases can be
represented by a "D" character. The characters
representing the segments are then concatenated to form a
string such as "UDDUUDUDU...UUD", which is used as a
signature.

In some embodiments, processor 23 measures
one or more scaling parameters of the ECG signal in the
marked time interval. These scaling parameters are stored
together with the signature and are later used for
matching other occurrences of the pattern. For example,
the mean amplitude of the signal can be used as a scaling
parameter. Additionally or alternatively, the processor
may calculate a spectrum of the pattern of interest and
determine one or more dominant frequencies in the
spectrum. The dominant frequencies can be used as scaling
parameters.
Having generated the pattern signature,
processor 23 scans the ECG signal and attempts to detect
other occurrences of the pattern of interest, at a
scanning step 68. Depending on the system configuration
used, processor 23 may monitor real time or buffered ECG
measurements as they are acquired, or scan in an off-line
manner through a body of previously measured ECG signals.
The processor scales a portion of the
scanned ECG signal responsively to the scaling parameters
of the pattern of interest, at a scaling step 70. For
example, the processor may normalize the mean amplitude
of the scanned signal to match the mean amplitude of the
pattern of interest. As another example, the processor
may perform spectral scaling of the scanned signal, so
that its dominant frequencies match the dominant
frequencies of the pattern of interest. Spectral scaling
can be viewed as scaling (i.e., stretching or

compressing) the time axis of the scanned signal with
respect to the time axis of the pattern of interest. The
processor may compute a fast Fourier transform (FFT) of
the scanned signal portion for this purpose.
Processor 23 attempts to find intervals in
the scanned ECG signal that match the pattern signature,
at a matching step 72. For example, when the pattern of
interest is represented using a string, the processor
divides the scanned and scaled signaJ. portion into
segments, characterizes each segment and assigns a
character to each segment. The scanned signal portion is
thus represented by a long string of characters. Then,
the processor attempts to find the sub-string that
represents the pattern signature in the string that
represents the scanned signal portion. Any suitable
string matching process known in the art can be used for
this purpose. Each match is considered to be an
occurrence of the pattern in the scanned signal.
Processor 23 marks the detected
occurrences on display 44, at an occurrence indication
step 74. Typically, the processor marks the time
intervals that are detected as pattern occurrences. Since
the processor may search for several patterns
simultaneously, the pattern being detected is indicated
next to each occurrence. In some embodiments, each
occurrence is also given a unique name or number that is
displayed. The processor may also display a confidence

level or a quality metric of the match next to each
detected occurrence.
Although the description of this
embodiment mainly addresses identifying patterns in an
ECG signal, the principles of the present invention can
also be used for detecting- patterns in • other
physiological signals, such as electroencephalogram (EEG)
and respiratory signals.
Alternate Embodiment 2
In this embodiment, instead of using a
conventional body surface electrocardiogram,
electrocardiographic signals are captured using remote
interrogation of implanted patient devices, typically
intracardiac devices (ICDs) such as defibrillators,
cardioverters, and pacemakers. Such devices may be
provided with memories for storing signals that reflect
cardiac events. Historic signals are downloaded as
recorded (historic) signals or in realtime to a
processing system and compared with induced signal
patterns (a first type of realtime signal) and with pace
mapped patterns (a second type of realtime signal). The
historic signals may include spontaneous episodes of
ventricular tachycardia. In some embodiments, the signals
may be transmitted to and stored on a server and then
transferred to the processing system. A suitable
intracardiac device for capturing the signals is the

Medtronic InSync® ICD. Other suitable devices are
commercially available.
Reference is now made to Fig. 15, which is
a pictorial diagram of a representative arrangement for
remotely identifying abnormal ECG patterns in. accordance
with an alternate embodiment of the invention. Other
conventional methods of transferring data between an
ICD 250 and processing system 2 60, for example USB
communications or even removable storage media.
Alternatively, the communication may be achieved by a
dedicated device that is adapted to directly interrogate
the ICD 250.
To capture a realtime electrocardiographic
signal, the ICD 250 band-pass filters (e.g., 2.5 - 100
Hz) and samples the signals at 128 - 256 Hz. A sampling
rate of 256 Hz or higher is preferable. A processing and
programming device 255 is used to receive the sampled
signal, and then upsampled. A first upsampling to 4 00 Hz
and a second to about .7 kHz are suitable. A
Medtronic 2090 programmer may be used as the device 255
for interrogation of the ICD 250 and wired or linked by
wireless telemetry to the processing system 260, which
can be the above-noted CARTO XP EP Navigation and
Ablation System. Different combinations of wired and
wireless links between the ICD 250, the device 255 and
the processing system 260 may be used.

According to one alternative, the
upsampled signal is then converted into an analog
signal 2 62, for example using a model 7 808 digital-to-
analog converter (DAC) (not shown) , which is then
telemetered to the processing system 260.
In another alternative, the upsampled
signal is converted from serial data 2 65 by a
converter 270 (C-box) to a digital format 275 suitable
for network transmission, for example the Ethernet
protocol. The processing system 260 is provided with a
suitable receiver for accepting the Ethernet signals (or
analog signals) . This method has the advantage of using
an industry standard, but does present time
synchronization issues. In the current embodiment, the
Ethernet protocol can concurrently support up to 10 ECG
channels. Command exchange between the processing
system 260 and the device 255 requires a separate
channel 28 5.
The signals received by the device 255 are
processed by processing system 260 for comparison with
another set of electrocardiographic signals captured by
the ICD 250 during a current or previous pace mapping
session. The results may be correlated with IS signals
captured by the ICD leads or with VT morphologies in ICD-
stored events, captured from the ICD 250 or from a
different source. Alternatively, the signals can be

correlated with a library of patterns, both alternatives
being described above.
In some embodiments, the location at which
correlation and analysis is done may even be remote from
the site at which pace-mapping is done. In such case, the
pace-mapped signals described above may also be
transmitted to the analysis location using the same or a
different communications protocol.
It will be appreciated by persons skilled
in the art that the present invention is not limited to
what has been particularly shown and described
hereinabove. Rather, the scope of the present invention
includes both combinations and sub-comb.lnat.ions of the
various features described hereinabove, as well as
variations and modifications thereof that are not in the
prior art, which would occur to persons skilled in the
art upon reading the foregoing description.

WE CLAIM
1. An apparatus for locating an arrhythmogenic pathway in a location of a
living subject, comprising:
a mapping catheter operative for stimulating said location multiple
locations endocardially or epicardially;
detecting respective sets of pace-mapped electrocardiographic signals at
respective locations of said catheter, said catheter having a position
sensor;
a position processor receiving position signals from said position sensor
and operative for determining said respective locations of said catheter;
and
an analysis processor, receiving a reference set of electrocardiographic
signals and receiving said sets of pace-mapped electrocardiographic
signals from said catheter, said reference and pace-mapped sets of
electrocardiographic signals each comprising 12-lead electrocardiograms,
said analysis processor operative for correlating the leads of said
electrocardiograms comprising said sets of pace-mapped
electrocardiographic signals with the corresponding leads of said
electrocardiograms comprising said reference set of electrocardiographic
signals, making a determination that a correlation between a predefined
number of leads of said sets of pace-mapped electrocardiographic signals

and the corresponding number of leads of said reference set of
electrocardiographic signals meets a predefined criterion;
wherein the apparatus is enabled esponsively to said determination,
identify said arrhythmogenic focus or pathway at said respective location
corresponding to said one set of pace-mapped electrocardiographic
signals.
2. The apparatus as claimed in claim 1, comprising a receiver linked to said
analysis processor and adapter to receive said reference set of
electrocardiographic signals from an implanted intercardiac device in
realtime.
3. The apparatus as claimed in claim 1, wherein said analysis processor is
adapted to construct a functional map of said location in which a degree
of correlation between said sets of pace-mapped electrocardiographic
signals and said reference set of electrocardiographic signals are related
to said multiple locations.



ABSTRACT


TITLE: "AN APPARATUS FOR LOCATING AN ARRHYTHMOGENIC
PATHWAY IN A LOCATION OF A LIVING SUBJECT"
The invention relates to an apparatus for locating an arrhythmogenic focus or
pathway in a location of a living subject, comprising a mapping catheter operative for stimulating multiple locations endocardially or epicardially;
detecting respective sets of pace-mapped electrocardiographic signals at
respective locations of said catheter, said catheter having a position sensor; a
position processor receiving position signals from said position sensor and
operative for determining said respective locations of said catheter; and an
analysis processor, receiving a reference set of electrocardiographic signals and
receiving said sets of pace-mapped electrocardiographic signals from said
catheter, said reference and pace-mapped sets of electrocardiographic signals
each comprising 12-lead electrocardiograms, said analysis processor operative
for correlating the leads of said electrocardiograms comprising said sets of pace-
mapped electrocardiographic signals with the corresponding leads of said
electrocardiograms comprising said reference set of electrocardiographic signals,
making a determination that a correlation between a predefined number of leads
of said sets of pace-mapped electrocardiographic signals and the corresponding
number of leads of said reference set of electrocardiographic signals meets a
predefined criterion.

Documents:

00094-kol-2008-abstract.pdf

00094-kol-2008-claims.pdf

00094-kol-2008-correspondence others.pdf

00094-kol-2008-description complete.pdf

00094-kol-2008-drawings.pdf

00094-kol-2008-form 1.pdf

00094-kol-2008-form 2.pdf

00094-kol-2008-form 3.pdf

00094-kol-2008-form 5.pdf

00094-kol-2008-gpa.pdf

94-KOL-2008-(29-05-2012)-ABSTRACT.pdf

94-KOL-2008-(29-05-2012)-AMANDED CLAIMS.pdf

94-KOL-2008-(29-05-2012)-CORRESPONDENCE.pdf

94-KOL-2008-(29-05-2012)-OTHERS.pdf

94-KOL-2008-(29-05-2012)-PA-CERTIFIED COPIES.pdf

94-KOL-2008-ABSTRACT.pdf

94-KOL-2008-AMANDED CLAIMS.pdf

94-kol-2008-CANCELLED PAGES .pdf

94-kol-2008-CORRESPONDENCE 1.4.pdf

94-KOL-2008-CORRESPONDENCE OTHERS 1.1.pdf

94-KOL-2008-CORRESPONDENCE OTHERS 1.2.pdf

94-KOL-2008-CORRESPONDENCE OTHERS-1.3.pdf

94-KOL-2008-DESCRIPTION (COMPLETE).pdf

94-KOL-2008-DRAWINGS.pdf

94-KOL-2008-EXAMINATION REPORT REPLY RECIEVED.pdf

94-kol-2008-EXAMINATION REPORT.pdf

94-KOL-2008-FORM 1-1.1.pdf

94-KOL-2008-FORM 1.pdf

94-kol-2008-form 18.pdf

94-KOL-2008-FORM 2.pdf

94-KOL-2008-FORM 3.pdf

94-kol-2008-GPA.pdf

94-kol-2008-GRANTED-ABSTRACT.pdf

94-kol-2008-GRANTED-CLAIMS.pdf

94-kol-2008-GRANTED-DESCRIPTION (COMPLETE).pdf

94-kol-2008-GRANTED-DRAWINGS.pdf

94-kol-2008-GRANTED-FORM 1.pdf

94-kol-2008-GRANTED-FORM 2.pdf

94-kol-2008-GRANTED-FORM 3.pdf

94-kol-2008-GRANTED-FORM 5.pdf

94-kol-2008-GRANTED-SPECIFICATION-COMPLETE.pdf

94-KOL-2008-OTHERS.pdf

94-KOL-2008-PETITION UNDER RULE 137-1.1.pdf

94-KOL-2008-PETITION UNDER RULE 137.pdf

94-KOL-2008-PRIORITY DOCUMENT 1.1.pdf

94-KOL-2008-PRIORITY DOCUMENT.pdf

94-kol-2008-REPLY TO EXAMINATION REPORT.pdf

94-kol-2008-TRANSLATED COPY OF PRIORITY DOCUMENT.pdf

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Patent Number 262599
Indian Patent Application Number 94/KOL/2008
PG Journal Number 36/2014
Publication Date 05-Sep-2014
Grant Date 29-Aug-2014
Date of Filing 11-Jan-2008
Name of Patentee BIOSENSE WEBSTER, INC.
Applicant Address 3333 DIAMOND CANYON ROAD, DIAMOND BAR CA
Inventors:
# Inventor's Name Inventor's Address
1 SILVIA STOLARSKI KASHTAN 2, HAIFA 34984
2 RONNIE ABBO 10 HA'ZAYIT ST., GIVAT ADA 37808
3 YARON EPHRATH TZAFRIRIM 30, KARKUR 35170
4 ANDRES CLAUDIO ALTMANN SHIMSHON 13/9, HAIFA 34614
5 MEIR BAR-TAL ARCHIRTA 17, ZICHRON YA'ACOV 30900
6 ASSAF GOVARI VITZO 1, HAIFA 34400
7 AHARON TURGEMAN SAPIR 4A, ZICHRON YA'ACOV 30900
PCT International Classification Number A61B5/0402; A61B5/00
PCT International Application Number N/A
PCT International Filing date
PCT Conventions:
# PCT Application Number Date of Convention Priority Country
1 11/970,803 2008-01-08 U.S.A.
2 11/884,493 2007-01-11 U.S.A.