This application is a National Stage Application of PCT/ES2009/000194, filed 14 Apr. 2009, which claims benefit of Serial No. P200801074, filed 15 Apr. 2008 in Spain and which applications are incorporated herein by reference. To the extent appropriate, a claim of priority is made to each of the above disclosed applications.
The object of the present invention is a new system for reconstruction of the cardiac electric activity from cardiac electric signals recorded with a vector (array) of intracardiac catheters and adequate processing media. This invention permits the visualization of the position of cardiac electrical activity, which consist of estimating the endocardial or epicardial electric sources (transmembrane voltage or current) from remote measurements (intracardiac electrograms) in catheters or electrodes.
The field of the invention is that one of systems for generating and visualizing medical images, specifically, the graphical representation of the electric activity in medical systems used in electrocardiology and cardiac electrophysiology.
Systems for the Inverse Problem in Cardiology.
Cardiac arrhythmias are one of the main causes of mortality in the world. Current therapies have their fundamentals on a partial knowledge of the mechanisms of the most usual arrhythmias (atrial and ventricular tachicardias, atrial and ventricular fibrillation, and others), and though these therapies reach high levels of effectiveness, the detailed knowledge of a fast arrhythmia (tachyarrhythmia) is the key for creating new anti-arrhythmic therapies or for improving the actual ones.
Nevertheless, the knowledge of the arrhythmic mechanism in a given patient is limited by the fact that the physical magnitude involved is the electric impulse propagation throughout the cardiac cells. The visualization of electric activity in the internal surface of the heart (endocardium) is troublesome, given that current technology only gives indirect measurements, consisting of electric voltage measured in catheters inside the heart (electrograms). These measurements record the electric field that is induced by the cardiac currents at a given distance of atrial or ventricular walls, and hence, mathematical calculations are required for estimated the numerical values of the cardiac currents in the endocardial surface.
Intracardiac navigation systems allow the spatial reconstruction of one or several cardiac cavities and a representation of myocardial electrical activity changes with time, using the electric signal recordings in diverse points and the detection of the spatial location of the catheter from different spatial location media. Currently, several cardiac navigation systems are used to reconstruct the cardiac electric activity in the myocardium from measurements in catheters. The most relevant are the following:
Probably, the reason why Ensite has not gained wider acceptance and use in practice, despite its theoretical advantages, is that it gives an estimation of bioelectrical currents with an associated uncertainty. Improvement of this uncertainty would make a system of this family having a widespread acceptation in the clinical practice. Other problems are the catheters dimensions, its complicated manipulation, its price, and the fact that the accurate information is limited to the proximal zone of the electrode.
In the current state of technique, several systems are described including the use of catheters for cardiac mapping. Among them, we can consider the patents U.S. Pat. No. 6,892,091, U.S. Pat. No. 5,297,549, and U.S. Pat. No. 5,311,866.
The system for the reconstruction and visualization of cardiac electric activity, object of the present invention, may include, at least:
Where the SVM subsystem includes a statistical learning algorithm that is derived from the structural risk minimization principle. Two of the main advantages of the SVM are regularization and robustness, which are ideal conditions for the requirements of the inverse problem in electrocardiography.
The said system generates a plurality of signals whose physical origin is in that system, and they are subsequently used in the method, hence we have that:
A second aspect of the present invention is the method for reconstruction and visualization of cardiac activity that includes, at least, the next stages:
We next describe (very briefly) a series of plots which aim to help to better understand the invention, and that are related with a realization of said invention that is presented as a non-limiting example.
FIG. 1.—Block diagram of the system for reconstruction and visualization of cardiac electric activity, object of the present invention.
FIG. 2.—Representation of a unidimensional simulation of the system for reconstruction and visualization of the cardiac electrical activity, object of the present invention.
FIG. 3.—Reconstruction of the signal of the system for reconstruction and visualization of cardiac electric activity, object of the present invention.
The system for reconstruction and visualization of cardiac electric activity, object of the present invention, may include at least:
Where the SVM subsystem consists of a statistical learning algorithm derived from the structural risk minimization principle. Two of the main advantages of the sVM are regularization and robustness, ideal conditions for the requirements of the inverse problem in electrocardiography.
Said system generates a plurality of signals with physical origin on that system, and they are subsequently used, hence, we have that:
In
A second aspect of the present invention is the method of reconstruction and visualization of the cardiac activity, which includes, at least, the following stages:
The SVM stage, which is the responsible of restoring the electric cardiac activity, is described more in detail with a set of equations which are necessary for defining said stage.
i. Signal Model.
The voltage sensing in catheters, for a given time instant, can be written as:
egm(t0)=M·im(t0)
where M represents the distance matrix relating (according to the volume conductor model) the transmembrane current (im) with the voltage that is recorded in different points of the cardiac substrate (egm). In matrix form:
egm(t0)=M·im(t0)v=H·iv=iT·H
where v is a [K×1] matrix, i is a [L×1] matrix, and H is a [L×K] matrix, with L≧K. Explicitly, we have:
In
where (·) denotes the dot product. This function is also depicted in
Given that hk[n] can be expressed as h0[n−k], and by defining the impulse response as h[n]=h0[n], the system is perfectly characterized by the convolution between the current and transfer function h[n]:
The problem of cardiac activity reconstruction, as shown next, consists then in finding that current i[k] better approximating the voltage measured in the exterior points of the volume conductor v[k].
ii. Signal Model in the Primal Problem
Be the truncated time series {vk, k=0, . . . , K−1} the set of values of voltage observed as a result of convolving the unknown time series of the myocites currents {ik, k=0, . . . , K−1} with the known transfer function {hk, k=0, . . . , K−1}, so that the next model is obtained:
Where the problem of current estimation can be expressed as the minimization of:
Where
Therefore, the previous functional can be expressed as:
Which has to be minimized with respect to {ik} and {ε(*)k}, constrained to:
For k=0, . . . , k−1 and where {ε(*)k} are slack variables or losses, and I1 (I2) are the indices of the residuals that can be found in the quadratic (linear) cost zone.
The solution to the previous optimization problem is given by the saddle point of the corresponding Lagrangian function:
subject to the following constraints:
together with Karush-Kuhn-Tucker conditions:
Since {εk(*)} are slack variables, then εkε*k=0, and therefore αkα*k=0. By deriving the Lagrangian with respect to the primal variables, we can obtain the dual problem, which is the next stage of the method.
iii. Signal Model in the Dual Problem
For the optimization of
Using a change of variables and having nj=αj−α*j′, we have:
which can be expressed in matrix form as:
where hj-k=[1×K], and hence
î=H(α−α*)
where H(m,p)=hp-m with indices {m,p=1, . . . , K} and hence:
Moreover, given that
∥i∥2=iTi∥i∥2=(α−α*)THTH(α−α*)
∥i∥2=(α−α*)TK(α−α*)
K=HTH
Explicitly,
which can be expressed in a compressed form as
where m, p, z are indices taking values in {1, . . . , K}, and taking n=m−p, previous equation can be written as:
so that signal R can be defined as
which is the autocorrelation of hk.
On the other hand, in the optimization of
we have that:
1.—kεl1: cuadratic zone:
*βk(*)=0 according to KKT, since in the cuadratic zone ξk(*)=0
*either ξk or ξ*k are different than zero, but not at the same time. Therefore:
ξk(*)=δαk(*)
It can be demonstrated that (using αkα*k=0)
2.—kεl2: linear zone. As in the previous case we have:
βk(*)=0 par ξk(*)≠0
then,
αk(*)=C
iv. Solution for the Primal Signal Model
The solution of the primal signal model is depicted in
vk=îk*hk+ek={circumflex over (v)}k+ek
whose solution is
îk=nk*ĥk=nk*h−k
we get that
{circumflex over (v)}k=îk*hk=nk*Rkh
v. Dual Signal Model
Be the set of measurements {vk}, modeled by a nonlinear regression from a set of given locations (k). This regression uses a nonlinear transformation Ø:R→H, which maps the set of locations (real scalars) to a Reproducing Hilbert Kernel Space (RKSH) H, or feature space. By choosing an adequate φ, we can build a linear regression model in H, given by:
vkw,φ(k)+ek
where wεH is the weight vector.
vi. Primal Problem for the Dual Signal Model
By developing the primal problem, functional is given by:
To be minimized with respect to {ωl}y{εk(*)}, and constrained to:
vl−w,φ(l)≦ε+ξl
−vl+w,φ(l)≦ε+ξ*l
ξl,ξ*l≧0
By obtaining the Lagrangian and taking the derivatives with respect to primal variables, we get to:
Hence, voltage can be expressed as
And by using the kernel trick,
This last equality is fulfilled as far as K is given by a suitable Mercer kernel.
vi. Dual Problem for the Dual Signal Model
By defining
G(j,k)=φ(j),φ(k)=k(j,k)
where the following functional has to be maximized:
and taking into account the convolutional model, then the voltage recorded in different K points {k=0, . . . , K−1} is
Comparing the equations of vk, and identifying terms, we can express
K(j−k)=hj-k
îk=nk
and then,
{circumflex over (v)}k=nk*Kk=nk*hk
Therefore, taking î(k)=n(k) we find that the convolutive model emerges naturally for the relationship between the impulse response and the sparse signal (some few samples are different from zero).
Number | Date | Country | Kind |
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200801074 | Apr 2008 | ES | national |
Filing Document | Filing Date | Country | Kind | 371c Date |
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PCT/ES2009/000194 | 4/14/2009 | WO | 00 | 4/1/2011 |
Publishing Document | Publishing Date | Country | Kind |
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WO2009/127755 | 10/22/2009 | WO | A |
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