Reconstruction of a surface electrocardiogram based upon an endocardial electrogram

1. A process for processing signals representative of cardiac myocardium depolarization potentials, said signals being collected by a plurality of endocardial electrodes of an active implantable medical device including an implantable pacemaker, device for resynchronization, cardioversion and/or defibrillation, the process comprising:

a) acquiring a plurality of endocardial electrogram signals (EGM) through a plurality of leads, each lead of the plurality of leads being collected between at least a pair of endocardial electrodes selected from the plurality of endocardial electrodes;

b) calculating, through a combination of the plurality of endocardial electrogram signals (EGM) acquired at step a), a corresponding endocardial vectogram (VGM);

d) estimating, based upon the endocardial vectogram calculated at step b), a reconstructed surface vectocardiogram (VCG reconstructed ); and

e) reconstructing surface electrocardiogram signals (ECG) corresponding to said reconstructed surface vectocardiogram (VCG reconstructed ),

wherein the step d) of estimating the reconstructed surface vectocardiogram (VCG reconstructed ) further comprises applying a linear filtering to the endocardial vectogram calculated at step b).

2. The process of claim 1 , further comprising estimating a linear filter.

3. The process of claim 2 , wherein said linear filter is estimated in the sense of a Wiener filter.

4. The process of claim 1 , further comprising a preliminary calibration step comprising determining parameters of said linear filtering.

5. The process of claim 4 , wherein determining linear filtering parameters further comprises:

i) obtaining a set of reference data through simultaneous acquisition of endocardial electrogram signals (EGM) and surface electrocardiogram signals (ECG);

ii) calculating, through a combination of the surface electrocardiogram signals (ECG) acquired at step i), a corresponding surface vectocardiogram (VCG real );

iii) calculating, through a combination of endocardial electrogram signals (EGM) acquired at step i), a corresponding endocardial vectogram (VGM);

iv) conducting an angular resealing of an orthonormalized mark of the endocardial vectogram (VGM) upon that of the surface vectocardiogram (VCG real )

v) estimating, through applying linear filtering to the endocardial vectogram calculated at step iii), a reconstructed surface vectocardiogram (VCG reconstructed ); and

vi) adjusting the linear filtering parameters of step v) so as to minimize the deviation between the surface vectocardiogram (VCG real ) calculated at step ii) and the reconstructed surface vectocardiogram (VCG reconstructed ) calculated at step v).

6. The process of claim 1 , wherein applying linear filtering further comprises selecting the linear filtering to be one of a time domain linear filter and a frequency domain linear filter.

7. The process of claim 1 , wherein the plurality of endocardial electrodes of the active implantable medical device comprises two to four endocardial electrodes implanted to a patient.

8. Apparatus for processing signals representative of cardiac myocardium depolarization potentials, comprising:

a) means for acquiring a plurality of endocardial electrogram signals (EGM) representative of a plurality of endocardial or intravascular derivations leads ;

b) means for calculating, based on a combination of said acquired endocardial electrogram signals (EGM), a corresponding endocardial vectogram (VGM);

c) means for estimating, based upon the calculated endocardial vectogram, a reconstructed surface vectocardiogram (VCG reconstructed ); and

d) means for calculating surface electrocardiogram signals (ECG) corresponding to said reconstructed surface vectocardiogram (VCG reconstructed ),

wherein the means for estimating the reconstructed surface vectocardiogram (VCG reconstructed ) further comprises means for applying a linear filtering to the calculated endocardial vectogram.

9. The apparatus of claim 8 , wherein said means for linear filtering further comprises means for estimating a linear filter.

10. The apparatus of claim 8 , wherein the plurality of endocardial electrodes of the active implantable medical device comprises two to four endocardial electrodes implanted to a patient.

11. A process for continuous calculation of a reconstructed surface vectocardiogram (VCG reconstructed ) comprising:

estimating a matrix for converting a first collection of endocardial electrogram signals (EGM) to a corresponding endocardial vectogram (VGM), acquiring at least one second collection of EGM subsequent to said first collection of EGM through a plurality of endocardial or intravascular leads, defined based upon said endocardial electrodes;

applying said estimated matrix to each said at least one second collection of EGM to determine a corresponding estimated VGM,

estimating, based upon the estimated VGM, a reconstructed surface vectocardiogram (VCG reconstructed ); and

calculating a surface electrocardiogram signals (ECG) corresponding to said reconstructed surface vectocardiogram (VCG reconstructed ),

wherein said estimating step further comprises employing a linear filtering of the first collection of EGM signals.