Patent Description:
Cardiac arrhythmia includes different types of abnormal or irregular heart rhythms, such as, for example, atrial fibrillation (AF), which is characterized by rapid and irregular beating. Under normal heart conditions, a heartbeat is produced by electrical pulses (i.e., signals) which originate in the upper chambers (i.e., atria) of the heart and pass through the atria through the atrioventricular (AV) node to a pair of lower chambers (i.e., ventricles) of the heart. As the signals pass through the atria, the atria contract and pump blood from the atria into the ventricles. As the signals pass through the AV node to the ventricles, the ventricles are caused to contract, pumping out blood from the heart to the body. During conditions of AF, however, the signals in the atria become chaotic and cause the heart to beat irregularly.

AF can negatively affect the physical, psychological and emotional quality of a person's life. AF can progressively increase in severity and frequency and, if left untreated, may lead to chronic fatigue, congestive heart failure or stroke. One type of AF treatment includes prescribed medications, such as rhythm control medications and medications used to manage the increased risk of stroke. These medications must be taken daily and indefinitely. Another type of AF treatment includes cardioversion, which attempts to restore a normal heart rhythm by providing electric shocks to the heart through electrodes placed on the chest. In some persistent types of AF, cardioversion is either ineffective or cannot be attempted.

Recent approaches for treating AF include minimally invasive ablation procedures (e.g., catheter ablation) in which the heart tissue is ablated to terminate electrical pathways and block faulty electrical impulses that can cause heart rhythm disorders. <CIT> discloses a method for visualization of electrophysiology information that includes storing electroanatomic data in memory, the electroanatomic data representing electrical activity on an anatomic region within a patient's body over a time period. An interval within the time period is selected in response to a user selection. A visual representation of physiological information for the user selected interval can be generated by applying at least one analysis method to the electroanatomic data. The visual representation can spatially represented on a graphical representation of the anatomic region within the patient's body. <CIT> discloses imaging apparatus for imaging a heart. An imaging apparatus for imaging a heart is provided, wherein the imaging of the heart is improved such that conclusions about regions of the heart having an abnormal behaviour can be made more accurate and more optimal. The imaging apparatus comprises a first site determination unit for determining a first site of the heart comprising a first property type like a fractionated electrogram (<NUM>,<NUM>,<NUM>,<NUM>) and a second site determination unit for determining a second site comprising a second property type like a ganglionated plexus (<NUM>,<NUM>). The first site and the second site are causally related and displayed on a display unit. Since the displayed first and second sites are causally related to each other, a further information is given, i.e. the causal relation, which assists a user in finding regions of the heart showing an abnormal behaviour. <CIT> discloses integrated analysis of electrophysiological data. A method can include analyzing non-invasive electrical data for a region of interest (ROI) of a patient's anatomical structure to identify one or more zones within the ROI that contain at least one mechanism of distinct arrhythmogenic electrical activity. The method also includes analyzing invasive electrical data for a plurality of signals of interest at different spatial sites within each of the identified zones to determine intracardiac signal characteristics for the plurality of sites within each respective zone. The method also includes generating an output that integrates the at least one mechanism of distinct arrhythmogenic electrical activity for the one or more zones with intracardiac signal characteristics for the plurality of sites within each respective zone.

The present invention provides a system, a non-transitory computer readable medium and a computer program product as defined in the appended claims. A method of determining target heart ablation regions is provided which includes detecting, via a plurality of sensors, electro-cardiogram (ECG) signals. Each ECG signal is detected via one of the plurality of sensors and indicates electrical activity of a heart over time. The method also includes determining, for each of the plurality of ECG signals, a plurality of local activation times (LATs) occurring over time. Each LAT indicates a time of electrical activation for an area the heart. The method further includes generating, based on the determined plurality of LATs of each of the plurality of ECG signals, mapping information for one or more maps representing the electrical activity of the heart and determining a region of interest (ROI) of the heart by identifying the ROI as a region of the heart exhibiting conditions indicative of cardiac arrhythmia based on the generated mapping information for the one or more maps representing the electrical activity of the heart.

A system for determining target heart ablation regions is provided which includes a plurality of sensors each configured to detect one of a plurality of electro-cardiogram (ECG) signals each indicating electrical activity of a heart over time. The system also includes a processing device which includes one or more processors configured to determine, for each of the plurality of ECG signals, a plurality of local activation times (LATs) occurring over time. Each LAT indicates a time of electrical activation for an area the heart. The one or more processors are further configured to generate, based on the determined plurality of LATs of each of the plurality of ECG signals, mapping information for one or more maps representing the electrical activity of the heart and determine a region of interest (ROI) of the heart by identifying the ROI as a region of the heart exhibiting conditions indicative of cardiac arrhythmia based on the generated mapping information for the one or more maps representing the electrical activity of the heart.

A non-transitory computer readable medium is provided which includes instructions for causing a computer to execute a method of determining target heart ablation regions. The instructions include detecting, via a plurality of sensors, electro-cardiogram (ECG) signals. Each ECG signal is detected via one of the plurality of sensors and indicates electrical activity of the heart over time. The instructions also include determining, for each of the plurality of ECG signals, a plurality of local activation times (LATs) occurring over time. Each LAT indicates a time of electrical activation for an area the heart. The instructions further include generating, based on the determined plurality of LATs of each of the plurality of ECG signals, mapping information for one or more maps representing the electrical activity of the heart and determining a region of interest (ROI) of the heart by identifying the ROI as a region of the heart exhibiting conditions indicative of cardiac arrhythmia based on the generated mapping information for the one or more maps representing the electrical activity of the heart.

Conventional methods and systems used for catheter ablation typically include inserting the catheter through an incision in the skin and guided up to the heart. Before ablation is performed, intra-cardiac electrocardiogram (IC ECG) signals of the heart are acquired via electrodes placed at different areas of the heart. The signals are monitored and used to provide information to determine whether one or more areas of the heart are causing the irregular heart rhythm. The conventional methods and systems used to determine these areas to be ablated, however, are time consuming (e.g., several hours) and rely on medical personnel with specific expertise and experience (typically requiring many hours of training).

Embodiments disclosed herein employ systems, apparatuses and methods of determining potential regions of interest (ROIs) to be targeted for ablation. Various mapping techniques are utilized to generate mapping information for one or more maps of the electro-physical conditions of the AF substrate and mapping information for one or more maps representing a spatio-temporal manifestation of the AF process to provide efficient and accurate determination of potential or target ablation ROIs. Mapping techniques utilize various parameters (e.g., cycle, earliness, R-S complex, conduction velocity (CV), block and fractionation) of acquired IC ECG signals and detected local activation times (LATs) to identify potential evidence of drivers and perpetuators of the AF substrate. Identification of the evidence of potential drivers and perpetuators is used to provide mapping (e.g., driver maps and perpetuator maps) of the AF substrate. Mapping techniques also include utilizing the various parameters of the acquired IC ECG signals and detected local activation times to generate mapping information for providing maps (e.g., activation/wave maps, CV maps, fractionation maps, voltage maps and block maps) which potentially represents the spatio-temporal manifestation of the AF process. The mapping of the spatio-temporal manifestation of the AF process can be used in addition to, or alternative to, the mapping of the AF substrate to identify potential ablation ROIs. The mapping techniques are used to potentially reduce AF map analysis training time, increase success rates resulting from ablation and facilitate efficient interpretation of AF maps. For simplification purposes, embodiments described herein refer to systems and methods used for the treatment of AF. It is noted however, embodiments may be used for the treatment of any type of cardiac arrhythmia including different types of abnormal or irregular heart rhythms.

<FIG> is a block diagram illustrating an exemplary classification of AF used with embodiments disclosed herein. The exemplary classification in <FIG> distinguishes between critical and non-critical AF as well as between drivers and perpetuators of AF and their relative spatio-temporal patterns.

For example, as shown in <FIG>, an irregular heart rhythm characterized as AF <NUM> is classified as critical <NUM> or non-critical <NUM>. Examples of non-critical AF <NUM> include paroxysmal (i.e., intermittent) irregular heart rhythm episodes in which the heartbeat often normalizes as quickly as within a few seconds or after a few hours, and persistent irregular heart rhythm episodes in which a normal heart may be restored by rhythm medical therapy or a procedure (e.g., cardioversion). Examples of critical AF <NUM> include longstanding persistent irregular heart rhythm episodes that continue for longer periods of time (e.g., more than a year) in which the heart is in a constant state of AF and the condition is considered permanent.

Critical AF can be classified according to characteristics (e.g., areas of activation) that can be derived from IC ECG signals. Areas of activation may be identified as potential contributing factors to AF. As shown in <FIG>, critical AF is classified according to different areas of activation, including a potential driver of AF (hereinafter "driver") or potential source of AF (hereinafter "source") <NUM> and a potential perpetuator <NUM> of AF (hereinafter "perpetuator"). A driver <NUM> is an area of activation (e.g., in the atria) where electrical pulses originate to stimulate the heart to contract and which can potentially contribute to AF, for example, by producing fibrillatory conduction to other areas of the atria. A perpetuator <NUM> is an area of sustained activation (e.g., electrophysiological process/substrate) which can also potentially contribute to AF.

Drivers <NUM> and perpetuators <NUM> may be represented (e.g., mapped) according to their spatio-temporal manifestation. As shown in <FIG>, drivers <NUM> and perpetuators <NUM> are classified by exemplary spatio-temporal manifestation types, including focal sources (foci) <NUM> and localized rotational activation (LRA) sources or rotational activation patterns (RAPs) sources <NUM>. A focal source is a type of driver originating at a small area of the atria which spreads centrifugally from a single point. A RAP <NUM> source is an irregular region of the heart where the electrical pulses rotate at least <NUM> degrees about a center area.

<FIG> also shows different types of perpetuators <NUM>, including one type which exhibits organized conduction delay <NUM> and another which exhibits disorganized conduction delay <NUM>. Another type of perpetuator <NUM> shown in <FIG> includes atrial flutter (AFL) <NUM>, characterized by organized conduction delay <NUM> as well as localized irregular activation (LIA) <NUM>, linear gaps <NUM> and pivots <NUM> (i.e., electrical pulses that rotate less than <NUM> degrees about a center area), characterized by disorganized conduction delay <NUM>. Also, the RAP source <NUM> is shown as both a driver <NUM> and a perpetuator <NUM>. Drivers <NUM> and perpetuators <NUM> are, for example, separately mapped to facilitate identification of driver types and/or perpetuator types and provide efficient and accurate determination of potential ablation ROIs.

Mapping and identification of drivers <NUM> and perpetuators <NUM> can also be based on one or more additional factors which may potentially contribute to AF or parameters which may potentially characterize the AF substrate (i.e., the AF process itself) and/or the manifestation of the AF process. For example, AF parameters or AF factors used to identify potential focal sources <NUM> include omnidirectional activation spread of activation from a point, earliness (e.g., focal source which starts after an excitable gap), triggers such as fast firing (e.g., short cycle-length and high dominant frequency) foci and breakthroughs (e.g., pulmonary veins (PV), free wall and transmural, endocardial and epicardial) and micro re-entry circuit which manifests as focal source and short-radius re-entry circuits which can manifest as a driver <NUM> depending on the specific anisotropic structure of the central obstacle.

AF parameters or AF factors used to map and identify RAP sources <NUM> include, for example, repetitive cycles, rotors which can manifest as a driver source <NUM>, structural or functional anisotropy (e.g., localized or distributed), and short-radius re-entry circuits which can manifest as either a driver <NUM> or a perpetuator <NUM>, depending on specific anisotropic structure of the central obstacle.

AF parameters or AF factors used to map and identify perpetuators <NUM> include, for example, extension (increased) path length, anatomical (pathological) block lines, fibrosis, stable functional block lines (e.g., areas of prolonged refractoriness), criticality (e.g., shortest path around block line > path length) and fibrillatory conduction factors (e.g., dissociated waves, re-entry circuit factors).

<FIG> is a block diagram illustrating an exemplary system <NUM> used to determine AF ROIs for ablation for use with embodiments disclosed herein. As shown in <FIG>, the system <NUM> includes a catheter <NUM>, a processing device <NUM> and a display device <NUM>. Catheter <NUM> includes an array of catheter sensors (e.g., electrodes) each configured to detect electrical activity (electrical signals) of an area of the heart over time. When an IC ECG is performed, each electrode detects the electrical activity of an area of the heart in contact with the electrode. The system <NUM> also includes extra-cardiac sensors <NUM> (e.g., electrodes on the skin of a patient) configured to detect electrical activity of the heart via detection of electrical changes on the skin due to the electro-physiologic pattern of the heart.

The detected IC ECG signals and the detected extra-cardiac signals are processed (e.g., recorded over time, filtered, fractionated, mapped, combined, interpolated, etc.) by processing device <NUM> and displayed on display device <NUM>.

Embodiments may include any number of sensors <NUM> used to detect ECG signals, including sensors used to detect IC ECG signals and extra-cardiac ECG signals. For simplification purposes, systems and methods described herein refer to the detection and use of IC ECG signals. It is noted, however, that embodiments may utilize IC ECG signals or extra-cardiac ECG signals or a combination of both IC ECG signals and extra-cardiac ECG signals.

Processing device <NUM> may include one or more processors each configured to process the ECG signals. Each processor of processing device <NUM> may be configured to record ECG signals over time, filter ECG signals, fractionate ECG signals into signal components (e.g., slopes, waves, complexes), map ECG signals, combine ECG signal information, map and interpolate mapping information, etc..

Display device <NUM> may include one or more displays each configured to display ECG signals, ECG signal information, maps of the AF process and maps representing a spatio-temporal manifestation of the AF process.

The catheter sensors <NUM> and the extra cardiac sensors <NUM> may be in wired or wireless communication with processing device <NUM>. Display device <NUM> may also be in wired or wireless communication with processing device <NUM>.

<FIG> and <FIG> are portions of a flow diagram illustrating an exemplary method <NUM> of determining a potential ablation ROI. The method <NUM> employs a mapping taxonomy which includes, from its core moving outward, an IC ECG layer, a pre-processing layer, a LAT detection layer, a map segmentation layer, a map interpolation layer and a map interpretation layer.

<FIG> illustrates a portion of exemplary method <NUM>. As shown in block <NUM> of <FIG>, the method <NUM> includes, as part of the IC ECG layer, acquiring an IC ECG signal which represents electrical activity of an area of the heart. The IC ECG signal acquired at block <NUM> is, for example, acquired from one of a number of electrodes in contact with different areas of the heart. After acquisition of the IC ECG (<NUM>), the method <NUM> includes, as part of the pre-processing layer, pre-processing of the acquired ECG signal, as shown in block <NUM> of <FIG>, The pre-processing may include execution of one or more algorithms, such as for example, cancellation of ventricular far field signals, baseline correction, and noise reduction. Ventricular far field detection may include, for example, a spatial averaging method (SAM), a temporal averaging method (TAM), a system identification method (SIM) and principal component analysis (PCA).

For each IC ECG signal acquired at block <NUM>, one or more LATs of the corresponding pre-processed IC ECG signal is (are) detected at block <NUM>. The LAT quality (shown as LATQ in <FIG>) of each signal is determined at block <NUM> as part of an exemplary LAT detection layer. The AF complexity (shown as CPLX in <FIG>) of the signal is determined at block <NUM>.

As shown at decision point <NUM>, the method <NUM> includes determining whether to reposition the catheter based on the LAT quality of the signal and the AF complexity. A typical characteristic of high quality IC ECGs is little base line wander (e.g., low baseline vs. IC ECG RMS amplitude, limited ventricular far-field potentials vs. IC ECG RMS amplitude). IC ECG signals characteristics include discernable atrial complexes (e.g., confined (~<NUM>) complexes separated by isoelectric segments repeating slopes, <NUM>-<NUM> interval; about <NUM> median) during AF. High quality complexes characteristic typically have considerable amplitudes and steep downward slopes (vs. upward slopes) within complexes. Characteristics of the IC ECG signals may be combined into a single measurable characteristic or parameter (e.g., having a measurable value of <NUM>%-<NUM>%) to define LAT quality. The LAT quality may be compared to the AF complexity to determine whether to reposition the catheter.

In some embodiments, quality is defined by an ability to map AF for a level of AF complexity. Determining whether to reposition the catheter may include generating a map and determining whether the generated map can be used (e.g., is adequate) to map AF based on whether a level of coverage of a mapping electrode meets (e.g., matches) a level of AF complexity. The ability to map AF for a level of AF complexity may include meeting a map threshold level (e.g., adequate level, trustworthy level). A single parameter (i.e., mapping coverage) is used to define a level of coverage of the mapping electrode. Examples of characteristics that are combined to define the mapping coverage include: (<NUM>) contact of the mapping electrode (e.g., contact with active tissue (wall) related to covered area and LAT accuracy); (<NUM>) resolution of the electrodes (e.g., distances and electrode sensitivity radii between electrodes, including mean, minimum and maximum and distances); and (<NUM>) quality of the IC ECG and associated annotations provided by a detection algorithm.

AF complexity may include complexity of activation during AF creating wave dissociation (block lines), fusion and wave curvature. Accordingly, a map may be determined as a map which can be used (e.g., trustworthy or adequate) to map AF when, given a certain level of AF complexity (e.g., measured along y-axis), the mapping coverage (including signal and annotation quality measured along x-axis) is sufficient to map the AF complexity. If not, the trustworthiness of the map may become compromised or inadequate.

Signals may then be analyzed using the trustworthy or adequate maps to determine whether the catheter should be repositioned. If it is determined at decision point <NUM> to reposition the catheter, the catheter (e.g., catheter <NUM>) is repositioned at block <NUM> and a new IC ECG signal is acquired at block <NUM>. If it is determined at decision point <NUM> that the catheter should be repositioned, the method <NUM> continues to "point A" <NUM> (shown in <FIG> and <FIG>).

<FIG> illustrates the acquiring of a single IC ECG signal for simplification purposes. In practice, however, multiple signals are acquired for each of the plurality of electrodes contacting the heart. Each IC ECG signal acquired at block <NUM> and the one or more LATs detected for each signal at block <NUM> are received at "point A" <NUM>.

<FIG> illustrates exemplary methods which may be used to determine potential ablation ROIs. As shown <FIG>, each acquired IC ECG signal and the one or more detected LATs for each signal are used to generate maps of the AF process that includes the electro-physical conditions of the AF substrate (indicated as the AF Substrate <NUM> in <FIG>) and maps representing a spatio-temporal manifestation of the AF process (indicated as the AF Process <NUM> in <FIG>) as part of an exemplary map segmentation layer.

For example, with regard to the AF Substrate <NUM> shown in <FIG>, the one or more detected LATs are used to independently determine one or more factors or parameters which may contribute to AF. The left side of <FIG> illustrates methods which characterize the AF substrate by collecting information over a predefined window of time while assessing a mean interval (e.g., cycle) based on a difference of subsequent LATs <NUM>, first activated (earliness) <NUM>, and morphological aspects of the IC ECG including RS-ratio <NUM> and fractionation <NUM> (e.g., fractionated electrograms). For example, the detected LATs are used to independently determine cycle information (e.g., cycle lengths) at block <NUM> and earliness information (e.g., earliest activation times, early drivers which start after an excitable gap) at block <NUM>. Each IC ECG signal is also used to independently determine R-S complex information (e.g., ratio of R wave to S wave) at block <NUM> and information obtained by fractionation (e.g., slope information, information indicating an incidence of source behavior presented as the earliest activation from one of a plurality of electrodes, such as showing a percentage that the associated electrode was activated earlier than neighbouring electrodes) of the IC ECG signals at block <NUM> and CV Block information (e.g., information indicating slowed or blocked conduction (i.e., progression) of electrical impulses through the heart, such as the conduction time (CT) for the electrical pulse to travel a distance in the heart, the path length (i.e., the distance) and the CV of the electrical pulse) at block <NUM>.

As shown, a driver map <NUM> is generated from the cycle information <NUM>, the earliness information <NUM> and the R-S complex information <NUM>. A perpetuator map <NUM> is generated from the CV Block information <NUM> and the fractionation information <NUM>. As shown, the information used to generate the driver map <NUM> and the information used to generate the perpetuator map <NUM> are combined (e.g., a single map, overlaid maps or adjacent maps in one display area) to generate a combined driver/perpetuator map <NUM>. The combined driver/perpetuator map <NUM> may then be used (e.g., interpolated as part of an exemplary map interpolation layer) to determine one or more ablation ROIs <NUM>.

With regard to the AF Process <NUM> shown in <FIG>, the one or more detected LATs are used to independently generate activation/wave maps <NUM>, CV maps <NUM> (e.g., maps generated from the CT, the path length and/or the CV of the electrical pulse) and block maps <NUM> (e.g., maps generated from information indicating a block in the conduction of the signal).

Activation/wave maps may, for example, include a map representing an incidence of source behavior presenting the earliest activation of one of a plurality of electrodes restricted by the same wave, such as indicating a percentage of activation waves detected by a corresponding electrode activated earlier than neighboring electrodes though restricted by neighbors activated by the same wave. Activation Wave maps may, for example, also include a map representing the incidence of electrode positions associated with a fibrillation wave start.

Each IC ECG signal is used to independently generate voltage maps <NUM> and fraction maps <NUM>. The information used to generate maps <NUM>-<NUM> is combined to provide combined maps or video <NUM>. In some embodiments, the information used to generate the activation/wave maps <NUM> and Voltage maps <NUM> is combined to generate a combined activation/wave/voltage map or video and the information used to generate the CV maps <NUM>, the block maps <NUM> and the fraction maps <NUM> are combined to generate a combined CV/block/fraction map or video. The combined maps/video <NUM> are analyzed (e.g., interpreted by medical personnel as part of an exemplary map interpretation layer) at block <NUM> to determine ROIs to be ablated at block <NUM>. The combined maps/video <NUM> represent a spatio-temporal manifestation of the AF process which can be easily visualized and interpreted, facilitating an efficient and accurate process for determination of ROIs for ablation. Determined ROIs may be represented (e.g., displayed), for example, by color, by <NUM>-D contour on a <NUM>-D map, by icons (e.g., dynamically changing icons), etc..

In some embodiments, both the combined driver/perpetuator map <NUM> and the combined maps/video <NUM> are used to determine ROIs for ablation at block <NUM>. In some embodiments either the combined driver/perpetuator map <NUM> or the combined maps/video <NUM> are used to determine ROIs for ablation at block <NUM>. For example, the combined driver/perpetuator map <NUM> can be used to determine ROIs for ablation at block <NUM> without using (e.g., viewing, analyzing) the combined maps/video <NUM>.

In some embodiments, the quality map <NUM> is also used in combination with the combined driver/perpetuator map <NUM> and/or the combined maps/video <NUM> to determine ROIs for ablation at block <NUM>. The quality map <NUM> is used to determine the trustworthiness of the generated maps (e.g., driver map <NUM>, perpetuator map <NUM> and driver/perpetuator map <NUM>) related to AF substrate <NUM> and the generated maps (e.g., activation/wave maps <NUM>, CV maps <NUM>, fraction maps <NUM>, voltage maps <NUM> and block maps <NUM>) related to the AF process <NUM> parameters. If the quality of the quality map is low, the generated maps are less trusted and appointing an ablation ROI (<NUM>) must be regarded with an increase level of care (e.g., by a physician) compared to when the quality map indicates high quality signals (IC ECGs) as the basis for the generated maps.

In some embodiments, determining ROIs for ablation at block <NUM> includes appointing or selecting one or more ablation sites for use in determining one or more ROIs for ablation. For example, ablation sites may be appointed or selected from driver evidence and perpetuator evidence (e.g., determined from the driver map <NUM>, the perpetuator map <NUM> or the combined driver/perpetuator map <NUM>) and ROIs may be determined based on the appointed sites.

The maps and mapping techniques disclosed herein potentially: (i) reduce AF map analysis training time; (ii) reduce time to determine ROIs for ablation; (iii) facilitate efficient interpretation of AF maps; and (iv) increase ablation success rates for ablation aimed at isolation and extinguishing of drivers, path lengthening, slowing of re-entry circuits, fibrillatory conduction and fractionated potentials.

It should be understood that many variations are possible based on the disclosure herein. Although features and elements are described above in particular combinations, each feature or element can be used alone without the other features and elements or in various combinations with or without other features and elements.

The methods provided include implementation in a general purpose computer, a processor, or a processor core. Suitable processors include, by way of example, a general purpose processor, a special purpose processor, a conventional processor, a digital signal processor (DSP), a plurality of microprocessors, one or more microprocessors in association with a DSP core, a controller, a microcontroller, Application Specific Integrated Circuits (ASICs), Field Programmable Gate Arrays (FPGAs) circuits, any other type of integrated circuit (IC), and/or a state machine. Such processors can be manufactured by configuring a manufacturing process using the results of processed hardware description language (HDL) instructions and other intermediary data including netlists (such instructions capable of being stored on a computer readable media). The results of such processing can be maskworks that are then used in a semiconductor manufacturing process to manufacture a processor which implements methods described herein.

Claim 1:
A system (<NUM>) for determining target heart ablation regions, the system comprising:
a plurality of sensors (<NUM>, <NUM>) configured to detect a plurality of electro-cardiogram (ECG) signals each indicating electrical activity of a heart over time, each of the plurality of sensors configured to detect one of the ECG signals;
a processing device (<NUM>) comprising one or more processors configured to:
determine, for each of the plurality of ECG signals, a plurality of local activation times (LATs) occurring over time, each LAT indicating a time of electrical activation for an area the heart;
generate, based on the determined plurality of LATs of each of the plurality of ECG signals, mapping information for one or more maps representing the electrical activity of the heart; and
determine a region of interest (ROI) of the heart by identifying the ROI as a region of the heart exhibiting conditions indicative of cardiac arrhythmia based on the generated mapping information for the one or more maps representing the electrical activity of the heart,
wherein the ROI is identified as exhibiting conditions indicative of atrial fibrillation (AF),
wherein generated mapping information for the one or more generated maps representing the electrical activity of the heart comprises generating driver mapping information indicating potential AF drivers of AF, and
wherein the driver mapping information is generated according to time intervals between the LATs, information indicating earliness of the LATs and ratios of amplitudes of R-waves of the ECG signals and amplitudes of S-waves of the ECG signals.