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Prudat Y, Luca A, Yazdani S, Derval N, Jaïs P, Roten L, Berte B, Pruvot E, Vesin JM, Pascale P. Evaluation and optimization of novel extraction algorithms for the automatic detection of atrial activations recorded within the pulmonary veins during atrial fibrillation. BMC Med Inform Decis Mak 2022; 22:225. [PMID: 36031620 PMCID: PMC9420290 DOI: 10.1186/s12911-022-01969-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background and objective The automated detection of atrial activations (AAs) recorded from intracardiac electrograms (IEGMs) during atrial fibrillation (AF) is challenging considering their various amplitudes, morphologies and cycle length. Activation time estimation is further complicated by the constant changes in the IEGM active zones in complex and/or fractionated signals. We propose a new method which provides reliable automatic extraction of intracardiac AAs recorded within the pulmonary veins during AF and an accurate estimation of their local activation times.
Methods First, two recently developed algorithms were evaluated and optimized on 118 recordings of pulmonary vein IEGM taken from 35 patients undergoing ablation of persistent AF. The adaptive mathematical morphology algorithm (AMM) uses an adaptive structuring element to extract AAs based on their morphological features. The relative-energy algorithm (Rel-En) uses short- and long-term energies to enhance and detect the AAs in the IEGM signals. Second, following the AA extraction, the signal amplitude was weighted using statistics of the AA sequences in order to reduce over- and undersensing of the algorithms. The detection capacity of our algorithms was compared with manually annotated activations and with two previously developed algorithms based on the Teager–Kaiser energy operator and the AF cycle length iteration, respectively. Finally, a method based on the barycenter was developed to reduce artificial variations in the activation annotations of complex IEGM signals. Results The best detection was achieved using Rel-En, yielding a false negative rate of 0.76% and a false positive rate of only 0.12% (total error rate 0.88%) against expert annotation. The post-processing further reduced the total error rate of the Rel-En algorithm by 70% (yielding to a final total error rate of 0.28%). Conclusion The proposed method shows reliable detection and robust temporal annotation of AAs recorded within pulmonary veins in AF. The method has low computational cost and high robustness for automatic detection of AAs, which makes it a suitable approach for online use in a procedural context.
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Masè M, Cristoforetti A, Del Greco M, Ravelli F. A Divergence-Based Approach for the Identification of Atrial Fibrillation Focal Drivers From Multipolar Mapping: A Computational Study. Front Physiol 2021; 12:749430. [PMID: 35002755 PMCID: PMC8740027 DOI: 10.3389/fphys.2021.749430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/30/2021] [Indexed: 11/13/2022] Open
Abstract
The expanding role of catheter ablation of atrial fibrillation (AF) has stimulated the development of novel mapping strategies to guide the procedure. We introduce a novel approach to characterize wave propagation and identify AF focal drivers from multipolar mapping data. The method reconstructs continuous activation patterns in the mapping area by a radial basis function (RBF) interpolation of multisite activation time series. Velocity vector fields are analytically determined, and the vector field divergence is used as a marker of focal drivers. The method was validated in a tissue patch cellular automaton model and in an anatomically realistic left atrial (LA) model with Courtemanche-Ramirez-Nattel ionic dynamics. Divergence analysis was effective in identifying focal drivers in a complex simulated AF pattern. Localization was reliable even with consistent reduction (47%) in the number of mapping points and in the presence of activation time misdetections (noise <10% of the cycle length). Proof-of-concept application of the method to human AF mapping data showed that divergence analysis consistently detected focal activation in the pulmonary veins and LA appendage area. These results suggest the potential of divergence analysis in combination with multipolar mapping to identify AF critical sites. Further studies on large clinical datasets may help to assess the clinical feasibility and benefit of divergence analysis for the optimization of ablation treatment.
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Affiliation(s)
- Michela Masè
- Laboratory of Biophysics and Translational Cardiology, Department of Cellular, Computational and Integrative Biology – CIBIO, University of Trento, Trento, Italy
- Institute of Mountain Emergency Medicine, EURAC Research, Bolzano, Italy
| | - Alessandro Cristoforetti
- Laboratory of Biophysics and Translational Cardiology, Department of Cellular, Computational and Integrative Biology – CIBIO, University of Trento, Trento, Italy
| | - Maurizio Del Greco
- Division of Cardiology, Santa Maria del Carmine Hospital, Rovereto, Italy
| | - Flavia Ravelli
- Laboratory of Biophysics and Translational Cardiology, Department of Cellular, Computational and Integrative Biology – CIBIO, University of Trento, Trento, Italy
- CISMed – Centre for Medical Sciences, University of Trento, Trento, Italy
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Nothstein M, Luik A, Jadidi A, Sánchez J, Unger LA, Wülfers EM, Dössel O, Seemann G, Schmitt C, Loewe A. CVAR-Seg: An Automated Signal Segmentation Pipeline for Conduction Velocity and Amplitude Restitution. Front Physiol 2021; 12:673047. [PMID: 34108887 PMCID: PMC8181407 DOI: 10.3389/fphys.2021.673047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/30/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Rate-varying S1S2 stimulation protocols can be used for restitution studies to characterize atrial substrate, ionic remodeling, and atrial fibrillation risk. Clinical restitution studies with numerous patients create large amounts of these data. Thus, an automated pipeline to evaluate clinically acquired S1S2 stimulation protocol data necessitates consistent, robust, reproducible, and precise evaluation of local activation times, electrogram amplitude, and conduction velocity. Here, we present the CVAR-Seg pipeline, developed focusing on three challenges: (i) No previous knowledge of the stimulation parameters is available, thus, arbitrary protocols are supported. (ii) The pipeline remains robust under different noise conditions. (iii) The pipeline supports segmentation of atrial activities in close temporal proximity to the stimulation artifact, which is challenging due to larger amplitude and slope of the stimulus compared to the atrial activity. METHODS AND RESULTS The S1 basic cycle length was estimated by time interval detection. Stimulation time windows were segmented by detecting synchronous peaks in different channels surpassing an amplitude threshold and identifying time intervals between detected stimuli. Elimination of the stimulation artifact by a matched filter allowed detection of local activation times in temporal proximity. A non-linear signal energy operator was used to segment periods of atrial activity. Geodesic and Euclidean inter electrode distances allowed approximation of conduction velocity. The automatic segmentation performance of the CVAR-Seg pipeline was evaluated on 37 synthetic datasets with decreasing signal-to-noise ratios. Noise was modeled by reconstructing the frequency spectrum of clinical noise. The pipeline retained a median local activation time error below a single sample (1 ms) for signal-to-noise ratios as low as 0 dB representing a high clinical noise level. As a proof of concept, the pipeline was tested on a CARTO case of a paroxysmal atrial fibrillation patient and yielded plausible restitution curves for conduction speed and amplitude. CONCLUSION The proposed openly available CVAR-Seg pipeline promises fast, fully automated, robust, and accurate evaluations of atrial signals even with low signal-to-noise ratios. This is achieved by solving the proximity problem of stimulation and atrial activity to enable standardized evaluation without introducing human bias for large data sets.
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Affiliation(s)
- Mark Nothstein
- Institute of Biomedical Engineering (IBT), Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Armin Luik
- Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Amir Jadidi
- Klinik für Kardiologie und Angiologie II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jorge Sánchez
- Institute of Biomedical Engineering (IBT), Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Laura A. Unger
- Institute of Biomedical Engineering (IBT), Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Eike M. Wülfers
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - Olaf Dössel
- Institute of Biomedical Engineering (IBT), Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Gunnar Seemann
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - Claus Schmitt
- Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Axel Loewe
- Institute of Biomedical Engineering (IBT), Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
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Ríos-Muñoz GR, Artés-Rodríguez A, Fernández-Avilés F, Arenal Á. Real-Time Ventricular Cancellation in Unipolar Atrial Fibrillation Electrograms. Front Bioeng Biotechnol 2020; 8:789. [PMID: 32850699 PMCID: PMC7406791 DOI: 10.3389/fbioe.2020.00789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/22/2020] [Indexed: 11/13/2022] Open
Abstract
Unipolar atrial fibrillation (AF) electrograms (EGMs) require far-field ventricle cancellation to recover hidden atrial activations. Current methods cannot achieve real-time cancellation because of the temporal delay they introduce. We propose a new real-time ventricular cancellation (RVC) method based on causal implementation optimized for real-time functioning. The method is similar to the classical average beat subtraction (ABS) method but it computes the ventricular contribution before the ventricular activation finishes. We compare the proposed method to the ABS on synthetic and real EGM databases for the time and frequency domains. All parameters and their optimal values are analyzed and validated. The RVC method provides a good reconstruction of the unipolar EGMs and a better local activation time detection than the classical approach with average F1scores 0.7307 and 0.7125, respectively. The spectral analysis shows that the average power after ventricular cancellation is reduced for frequency bands between 3 and 5.5 Hz, demonstrating that the proposed method removes the ventricular component present in the unipolar EGM signals compared to the ABS method. The phase mapping analysis on the RVC method presented lower error when comparing the annotated EGM cycles with the phase inversion intervals. In terms of performance ABS and RVC behave similarly, but the real-time capability of the latter justifies its preference over the offline implementations. In the clinical environment other online investigations, e.g., rotational activity assessment, dominant frequency or local activation time mapping, might benefit from the real-time potential of the proposed cancellation method.
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Affiliation(s)
- Gonzalo R Ríos-Muñoz
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.,La Red de Terapia Celular (TerCel), Instituto de Salud Carlos III, Madrid, Spain.,Departamento de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Spain
| | - Antonio Artés-Rodríguez
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.,Departamento de Teoría de la Señal y Comunicaciones, Universidad Carlos III de Madrid, Madrid, Spain
| | - Francisco Fernández-Avilés
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.,La Red de Terapia Celular (TerCel), Instituto de Salud Carlos III, Madrid, Spain.,Departamento de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Center for Biomedical Research in Cardiovascular Disease Network (CIBERCV), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Ángel Arenal
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.,La Red de Terapia Celular (TerCel), Instituto de Salud Carlos III, Madrid, Spain.,Center for Biomedical Research in Cardiovascular Disease Network (CIBERCV), Madrid, Spain
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Coveney S, Corrado C, Roney CH, Wilkinson RD, Oakley JE, Lindgren F, Williams SE, O'Neill MD, Niederer SA, Clayton RH. Probabilistic Interpolation of Uncertain Local Activation Times on Human Atrial Manifolds. IEEE Trans Biomed Eng 2020; 67:99-109. [PMID: 30969911 DOI: 10.1109/tbme.2019.2908486] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Local activation time (LAT) mapping of the atria is important for targeted treatment of atrial arrhythmias, but current methods do not interpolate on the atrial manifold and neglect uncertainties associated with LAT observations. In this paper, we describe novel methods to, first, quantify uncertainties in LAT arising from bipolar electrogram analysis and assignment of electrode recordings to the anatomical mesh, second, interpolate uncertain LAT measurements directly on left atrial manifolds to obtain complete probabilistic activation maps, and finally, interpolate LAT jointly across both the manifold and different S1-S2 pacing protocols. METHODS A modified center of mass approach was used to process bipolar electrograms, yielding a LAT estimate and error distribution from the electrogram morphology. An error distribution for assigning measurements to the anatomical mesh was estimated. Probabilistic LAT maps were produced by interpolating on a left atrial manifold using Gaussian Markov random fields, taking into account observation errors and characterizing LAT predictions by their mean and standard deviation. This approach was extended to interpolate across S1-S2 pacing protocols. RESULTS We evaluated our approach using recordings from three patients undergoing atrial ablation. Cross-validation showed consistent and accurate prediction of LAT observations both at different locations on the left atrium and for different S1-S2 intervals. SIGNIFICANCE Interpolation of scalar and vector fields across anatomical structures from point measurements is a challenging problem in biomedical engineering, compounded by uncertainties in measurements and meshes. New methods and approaches are required, and in this paper, we have demonstrated an effective method for probabilistic interpolation of uncertain LAT.
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Vandersickel N, Van Nieuwenhuyse E, Van Cleemput N, Goedgebeur J, El Haddad M, De Neve J, Demolder A, Strisciuglio T, Duytschaever M, Panfilov AV. Directed Networks as a Novel Way to Describe and Analyze Cardiac Excitation: Directed Graph Mapping. Front Physiol 2019; 10:1138. [PMID: 31551814 PMCID: PMC6746922 DOI: 10.3389/fphys.2019.01138] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 08/19/2019] [Indexed: 12/31/2022] Open
Abstract
Networks provide a powerful methodology with applications in a variety of biological, technological and social systems such as analysis of brain data, social networks, internet search engine algorithms, etc. To date, directed networks have not yet been applied to characterize the excitation of the human heart. In clinical practice, cardiac excitation is recorded by multiple discrete electrodes. During (normal) sinus rhythm or during cardiac arrhythmias, successive excitation connects neighboring electrodes, resulting in their own unique directed network. This in theory makes it a perfect fit for directed network analysis. In this study, we applied directed networks to the heart in order to describe and characterize cardiac arrhythmias. Proof-of-principle was established using in-silico and clinical data. We demonstrated that tools used in network theory analysis allow determination of the mechanism and location of certain cardiac arrhythmias. We show that the robustness of this approach can potentially exceed the existing state-of-the art methodology used in clinics. Furthermore, implementation of these techniques in daily practice can improve the accuracy and speed of cardiac arrhythmia analysis. It may also provide novel insights in arrhythmias that are still incompletely understood.
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Affiliation(s)
- Nele Vandersickel
- Department of Physics and Astronomy, Ghent University, Ghent, Belgium
| | | | - Nico Van Cleemput
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Ghent, Belgium
| | - Jan Goedgebeur
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Ghent, Belgium
- Computer Science Department, University of Mons, Mons, Belgium
| | - Milad El Haddad
- Ghent University Hospital Heart Center, Ghent University, Ghent, Belgium
| | - Jan De Neve
- Department of Data Analysis, Ghent University, Ghent, Belgium
| | - Anthony Demolder
- Ghent University Hospital Heart Center, Ghent University, Ghent, Belgium
| | | | - Mattias Duytschaever
- Ghent University Hospital Heart Center, Ghent University, Ghent, Belgium
- Cardiology Department, AZ Sint-Jan, Bruges, Belgium
| | - Alexander V. Panfilov
- Department of Physics and Astronomy, Ghent University, Ghent, Belgium
- Laboratory of Computational Biology and Medicine, Ural Federal University, Ekaterinburg, Russia
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Shariat MH, Gupta D, Gul EE, Glover B, Hashemi J, Abdollah H, Baranchuk A, Simpson C, Michael KA, Redfearn DP. Ventricular substrate identification using close-coupled paced electrogram feature analysis. Europace 2018; 21:492-501. [DOI: 10.1093/europace/euy265] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 10/15/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mohammad Hassan Shariat
- Heart Rhythm Service, Queen’s University, Armstrong 3, Kingston Health Sciences Centre, 76 Stuart Street, Kingston, Ontario, Canada
| | - Divyanshu Gupta
- Heart Rhythm Service, Queen’s University, Armstrong 3, Kingston Health Sciences Centre, 76 Stuart Street, Kingston, Ontario, Canada
| | - Enes E Gul
- Heart Rhythm Service, Queen’s University, Armstrong 3, Kingston Health Sciences Centre, 76 Stuart Street, Kingston, Ontario, Canada
| | - Benedict Glover
- Heart Rhythm Service, Queen’s University, Armstrong 3, Kingston Health Sciences Centre, 76 Stuart Street, Kingston, Ontario, Canada
| | - Javad Hashemi
- Heart Rhythm Service, Queen’s University, Armstrong 3, Kingston Health Sciences Centre, 76 Stuart Street, Kingston, Ontario, Canada
| | - Hoshiar Abdollah
- Heart Rhythm Service, Queen’s University, Armstrong 3, Kingston Health Sciences Centre, 76 Stuart Street, Kingston, Ontario, Canada
| | - Adrian Baranchuk
- Heart Rhythm Service, Queen’s University, Armstrong 3, Kingston Health Sciences Centre, 76 Stuart Street, Kingston, Ontario, Canada
| | - Christopher Simpson
- Heart Rhythm Service, Queen’s University, Armstrong 3, Kingston Health Sciences Centre, 76 Stuart Street, Kingston, Ontario, Canada
| | - Kevin A Michael
- Heart Rhythm Service, Queen’s University, Armstrong 3, Kingston Health Sciences Centre, 76 Stuart Street, Kingston, Ontario, Canada
| | - Damian P Redfearn
- Heart Rhythm Service, Queen’s University, Armstrong 3, Kingston Health Sciences Centre, 76 Stuart Street, Kingston, Ontario, Canada
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8
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De Pooter J, El Haddad M, Wolf M, Phlips T, Van Heuverswyn F, Timmers L, Tavernier R, Knecht S, Vandekerckhove Y, Duytschaever M. Clinical assessment and comparison of annotation algorithms in high-density mapping of regular atrial tachycardias. J Cardiovasc Electrophysiol 2017; 29:177-185. [DOI: 10.1111/jce.13371] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 08/17/2017] [Accepted: 10/04/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Jan De Pooter
- Ghent University Hospital; Heart Center; Ghent Belgium
- Department of Cardiology; Sint-Jan Hospital; Bruges Belgium
| | | | - Michael Wolf
- Department of Cardiology; Sint-Jan Hospital; Bruges Belgium
| | - Thomas Phlips
- Department of Cardiology; Sint-Jan Hospital; Bruges Belgium
| | | | | | - René Tavernier
- Department of Cardiology; Sint-Jan Hospital; Bruges Belgium
| | | | | | - Mattias Duytschaever
- Ghent University Hospital; Heart Center; Ghent Belgium
- Department of Cardiology; Sint-Jan Hospital; Bruges Belgium
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9
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Alcaine A, Soto-Iglesias D, Acosta J, Korshunov V, Penela D, Martínez M, Linhart M, Andreu D, Fernández-Armenta J, Laguna P, Martínez JP, Camara O, Berruezo A. Automatic activation mapping and origin identification of idiopathic outflow tract ventricular arrhythmias. J Electrocardiol 2017; 51:239-246. [PMID: 29242053 DOI: 10.1016/j.jelectrocard.2017.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Indexed: 11/17/2022]
Abstract
PURPOSE Activation mapping is used to guide ablation of idiopathic outflow tract ventricular arrhythmias (OTVAs). Isochronal activation maps help to predict the site of origin (SOO): left vs right outflow tract (OT). We evaluate an algorithm for automatic activation mapping based on the onset of the bipolar electrogram (EGM) signal for predicting the SOO and the effective ablation site in OTVAs. METHODS Eighteen patients undergoing ablation due to idiopathic OTVAs were studied (12 with left ventricle OT origin). Right ventricle activation maps were obtained offline with an automatic algorithm and compared with manual annotation maps obtained during the intervention. Local activation time (LAT) accuracy was assessed, as well as the performance of the 10ms earliest activation site (EAS) isochronal area in predicting the SOO. RESULTS High correlation was observed between manual and automatic LATs (Spearman's: 0.86 and Lin's: 0.85, both p<0.01). The EAS isochronal area were closely located in both map modalities (5.55 ± 3.56mm) and at a similar distance from the effective ablation site (0.15±2.08mm difference, p=0.859). The 10ms isochronal area longitudinal/perpendicular diameter ratio measured from automatic maps showed slightly superior SOO identification (67% sensitivity, 100% specificity) compared with manual maps (67% sensitivity, 83% specificity). CONCLUSIONS Automatic activation mapping based on the bipolar EGM onset allows fast, accurate and observer-independent identification of the SOO and characterization of the spreading of the activation wavefront in OTVAs.
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Affiliation(s)
- Alejandro Alcaine
- BSICoS Group, Aragón Institute of Engineering Research (I3A), IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain; CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - David Soto-Iglesias
- Arrhythmia Section, Cardiology Dept., Thorax Institute, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Juan Acosta
- IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Viatcheslav Korshunov
- Arrhythmia Section, Cardiology Dept., Thorax Institute, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Diego Penela
- IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Mikel Martínez
- Arrhythmia Section, Cardiology Dept., Thorax Institute, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Markus Linhart
- Arrhythmia Section, Cardiology Dept., Thorax Institute, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - David Andreu
- IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | | | - Pablo Laguna
- BSICoS Group, Aragón Institute of Engineering Research (I3A), IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain; CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - Juan Pablo Martínez
- BSICoS Group, Aragón Institute of Engineering Research (I3A), IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain; CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - Oscar Camara
- Physense Group, Dept. of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Antonio Berruezo
- Arrhythmia Section, Cardiology Dept., Thorax Institute, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Spain.
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Shariat MH, Gazor S, Redfearn DP. Bipolar Intracardiac Electrogram Active Interval Extraction During Atrial Fibrillation. IEEE Trans Biomed Eng 2017; 64:2122-2133. [DOI: 10.1109/tbme.2016.2630604] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Alcaine A, Mase M, Cristoforetti A, Ravelli F, Nollo G, Laguna P, Martinez JP, Faes L. A Multi-Variate Predictability Framework to Assess Invasive Cardiac Activity and Interactions During Atrial Fibrillation. IEEE Trans Biomed Eng 2017; 64:1157-1168. [DOI: 10.1109/tbme.2016.2592953] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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12
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Oesterlein TG, Schmid J, Bauer S, Jadidi A, Schmitt C, Dössel O, Luik A. Analysis and visualization of intracardiac electrograms in diagnosis and research: Concept and application of KaPAVIE. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2016; 127:165-173. [PMID: 26774236 DOI: 10.1016/j.cmpb.2015.12.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 12/11/2015] [Accepted: 12/17/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND AND OBJECTIVE Progress in biomedical engineering has improved the hardware available for diagnosis and treatment of cardiac arrhythmias. But although huge amounts of intracardiac electrograms (EGMs) can be acquired during electrophysiological examinations, there is still a lack of software aiding diagnosis. The development of novel algorithms for the automated analysis of EGMs has proven difficult, due to the highly interdisciplinary nature of this task and hampered data access in clinical systems. Thus we developed a software platform, which allows rapid implementation of new algorithms, verification of their functionality and suitable visualization for discussion in the clinical environment. METHODS A software for visualization was developed in Qt5 and C++ utilizing the class library of VTK. The algorithms for signal analysis were implemented in MATLAB. Clinical data for analysis was exported from electroanatomical mapping systems. RESULTS The visualization software KaPAVIE (Karlsruhe Platform for Analysis and Visualization of Intracardiac Electrograms) was implemented and tested on several clinical datasets. Both common and novel algorithms were implemented which address important clinical questions in diagnosis of different arrhythmias. It proved useful in discussions with clinicians due to its interactive and user-friendly design. Time after export from the clinical mapping system to visualization is below 5min. CONCLUSION KaPAVIE(2) is a powerful platform for the development of novel algorithms in the clinical environment. Simultaneous and interactive visualization of measured EGM data and the results of analysis will aid diagnosis and help understanding the underlying mechanisms of complex arrhythmias like atrial fibrillation.
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Affiliation(s)
- Tobias Georg Oesterlein
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany.
| | - Jochen Schmid
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany.
| | - Silvio Bauer
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany.
| | - Amir Jadidi
- Universitäts-Herzzentrum Freiburg-Bad Krozingen, Germany.
| | | | - Olaf Dössel
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany.
| | - Armin Luik
- Städtisches Klinikum Karlsruhe, Karlsruhe, Germany.
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Cantwell CD, Roney CH, Ng FS, Siggers JH, Sherwin SJ, Peters NS. Techniques for automated local activation time annotation and conduction velocity estimation in cardiac mapping. Comput Biol Med 2015; 65:229-42. [PMID: 25978869 PMCID: PMC4593301 DOI: 10.1016/j.compbiomed.2015.04.027] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 04/13/2015] [Accepted: 04/16/2015] [Indexed: 11/24/2022]
Abstract
Measurements of cardiac conduction velocity provide valuable functional and structural insight into the initiation and perpetuation of cardiac arrhythmias, in both a clinical and laboratory context. The interpretation of activation wavefronts and their propagation can identify mechanistic properties of a broad range of electrophysiological pathologies. However, the sparsity, distribution and uncertainty of recorded data make accurate conduction velocity calculation difficult. A wide range of mathematical approaches have been proposed for addressing this challenge, often targeted towards specific data modalities, species or recording environments. Many of these algorithms require identification of activation times from electrogram recordings which themselves may have complex morphology or low signal-to-noise ratio. This paper surveys algorithms designed for identifying local activation times and computing conduction direction and speed. Their suitability for use in different recording contexts and applications is assessed.
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Affiliation(s)
- C D Cantwell
- Department of Aeronautics, Imperial College London, South Kensington Campus, London, UK; National Heart and Lung Institute, Imperial College London, South Kensington Campus, London, UK.
| | - C H Roney
- Department of Bioengineering, Imperial College London, South Kensington Campus, London, UK; National Heart and Lung Institute, Imperial College London, South Kensington Campus, London, UK
| | - F S Ng
- National Heart and Lung Institute, Imperial College London, South Kensington Campus, London, UK
| | - J H Siggers
- Department of Bioengineering, Imperial College London, South Kensington Campus, London, UK
| | - S J Sherwin
- Department of Aeronautics, Imperial College London, South Kensington Campus, London, UK
| | - N S Peters
- National Heart and Lung Institute, Imperial College London, South Kensington Campus, London, UK
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14
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Alcaine A, Soto-Iglesias D, Calvo M, Guiu E, Andreu D, Fernandez-Armenta J, Berruezo A, Laguna P, Camara O, Martinez JP. A Wavelet-Based Electrogram Onset Delineator for Automatic Ventricular Activation Mapping. IEEE Trans Biomed Eng 2014; 61:2830-9. [DOI: 10.1109/tbme.2014.2330847] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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15
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Ravelli F, Masè M, Cristoforetti A, Marini M, Disertori M. The logical operator map identifies novel candidate markers for critical sites in patients with atrial fibrillation. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2014; 115:186-97. [PMID: 25077410 DOI: 10.1016/j.pbiomolbio.2014.07.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 07/17/2014] [Indexed: 11/28/2022]
Abstract
The identification of suitable markers for critical patterns during atrial fibrillation (AF) may be crucial to guide an effective ablation treatment. Single parameter maps, based on dominant frequency and complex fractionated electrograms, have been proposed as a tool for electrogram-guided ablation, however the specificity of these markers is debated. Experimental studies suggest that AF critical patterns may be identified on the basis of specific rate and organization features, where rapid organized and rapid fragmented activities characterize respectively localized sources and critical substrates. In this paper we introduce the logical operator map, a novel mapping tool for a point-by-point identification and localization of AF critical sites. Based on advanced signal and image processing techniques, the approach combines in a single map electrogram-derived rate and organization features with tomographic anatomical detail. The construction of the anatomically-detailed logical operator map is based on the time-domain estimation of atrial rate and organization in terms of cycle length and wave-similarity, the logical combination of these indexes to obtain suitable markers of critical sites, and the multimodal integration of electrophysiological and anatomical information by segmentation and registration techniques. Logical operator maps were constructed in 14 patients with persistent AF, showing the capability of the combined rate and organization markers to identify with high selectivity the subset of electrograms associated with localized sources and critical substrates. The precise anatomical localization of these critical sites revealed the confinement of rapid organized sources in the left atrium with organization and rate gradients towards the surrounding tissue, and the presence of rapid fragmented electrograms in proximity of the sources. By merging in a single map the most relevant electrophysiological and anatomical features of the AF process, the logical operator map may have significant clinical impact as a direct, comprehensive tool to understand arrhythmia mechanisms in the single patient and guide more conservative, step-wise ablation.
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Affiliation(s)
- Flavia Ravelli
- Department of Physics, University of Trento, Povo-Trento, Italy.
| | - Michela Masè
- Department of Physics, University of Trento, Povo-Trento, Italy
| | | | | | - Marcello Disertori
- Division of Cardiology, S. Chiara Hospital, Trento, Italy; Healthcare Research and Innovation Program, PAT-FBK, Trento, Italy
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16
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El Haddad M, Houben R, Stroobandt R, Van Heuverswyn F, Tavernier R, Duytschaever M. Novel Algorithmic Methods in Mapping of Atrial and Ventricular Tachycardia. Circ Arrhythm Electrophysiol 2014; 7:463-72. [DOI: 10.1161/circep.113.000833] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Milad El Haddad
- From the Department of Electrophysiology, Heart Center, Ghent University Hospital, Ghent, Belgium (M.E.H., R.S., F.V.H., M.D.); Cardiology Unit, Applied Biomedical Systems, Maastricht, The Netherlands (R.H.); and Department of Cardiology, Sint-Jan Hospital Bruges, Bruges, Belgium (R.T., M.D.)
| | - Richard Houben
- From the Department of Electrophysiology, Heart Center, Ghent University Hospital, Ghent, Belgium (M.E.H., R.S., F.V.H., M.D.); Cardiology Unit, Applied Biomedical Systems, Maastricht, The Netherlands (R.H.); and Department of Cardiology, Sint-Jan Hospital Bruges, Bruges, Belgium (R.T., M.D.)
| | - Roland Stroobandt
- From the Department of Electrophysiology, Heart Center, Ghent University Hospital, Ghent, Belgium (M.E.H., R.S., F.V.H., M.D.); Cardiology Unit, Applied Biomedical Systems, Maastricht, The Netherlands (R.H.); and Department of Cardiology, Sint-Jan Hospital Bruges, Bruges, Belgium (R.T., M.D.)
| | - Frederic Van Heuverswyn
- From the Department of Electrophysiology, Heart Center, Ghent University Hospital, Ghent, Belgium (M.E.H., R.S., F.V.H., M.D.); Cardiology Unit, Applied Biomedical Systems, Maastricht, The Netherlands (R.H.); and Department of Cardiology, Sint-Jan Hospital Bruges, Bruges, Belgium (R.T., M.D.)
| | - Rene Tavernier
- From the Department of Electrophysiology, Heart Center, Ghent University Hospital, Ghent, Belgium (M.E.H., R.S., F.V.H., M.D.); Cardiology Unit, Applied Biomedical Systems, Maastricht, The Netherlands (R.H.); and Department of Cardiology, Sint-Jan Hospital Bruges, Bruges, Belgium (R.T., M.D.)
| | - Mattias Duytschaever
- From the Department of Electrophysiology, Heart Center, Ghent University Hospital, Ghent, Belgium (M.E.H., R.S., F.V.H., M.D.); Cardiology Unit, Applied Biomedical Systems, Maastricht, The Netherlands (R.H.); and Department of Cardiology, Sint-Jan Hospital Bruges, Bruges, Belgium (R.T., M.D.)
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