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Meo M, Pambrun T, Derval N, Dumas-Pomier C, Puyo S, Duchâteau J, Jaïs P, Hocini M, Haïssaguerre M, Dubois R. Noninvasive Assessment of Atrial Fibrillation Complexity in Relation to Ablation Characteristics and Outcome. Front Physiol 2018; 9:929. [PMID: 30065663 PMCID: PMC6056813 DOI: 10.3389/fphys.2018.00929] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/25/2018] [Indexed: 01/01/2023] Open
Abstract
Background: The use of surface recordings to assess atrial fibrillation (AF) complexity is still limited in clinical practice. We propose a noninvasive tool to quantify AF complexity from body surface potential maps (BSPMs) that could be used to choose patients who are eligible for AF ablation and assess therapy impact. Methods: BSPMs (mean duration: 7 ± 4 s) were recorded with a 252-lead vest in 97 persistent AF patients (80 male, 64 ± 11 years, duration 9.6 ± 10.4 months) before undergoing catheter ablation. Baseline cycle length (CL) was measured in the left atrial appendage. The procedural endpoint was AF termination. The ablation strategy impact was defined in terms of number of regions ablated, radiofrequency delivery time to achieve AF termination, and acute outcome. The atrial fibrillatory wave signal extracted from BSPMs was divided in 0.5-s consecutive segments, each projected on a 3D subspace determined through principal component analysis (PCA) in the current frame. We introduced the nondipolar component index (NDI) that quantifies the fraction of energy retained after subtracting an equivalent PCA dipolar approximation of heart electrical activity. AF complexity was assessed by the NDI averaged over the entire recording and compared to ablation strategy. Results: AF terminated in 77 patients (79%), whose baseline AF CL was 177 ± 40 ms, whereas it was 157 ± 26 ms in patients with unsuccessful ablation outcome (p = 0.0586). Mean radiofrequency emission duration was 35 ± 21 min; 4 ± 2 regions were targeted. Long-lasting AF patients (≥12 months) exhibited higher complexity, with higher NDI values (≥12 months: 0.12 ± 0.04 vs. <12 months: 0.09 ± 0.03, p < 0.01) and short CLs (<160 ms: 0.12 ± 0.03 vs. between 160 and 180 ms: 0.10 ± 0.03 vs. >180 ms: 0.09 ± 0.03, p < 0.01). More organized AF as measured by lower NDI was associated with successful ablation outcome (termination: 0.10 ± 0.03 vs. no termination: 0.12 ± 0.04, p < 0.01), shorter procedures (<30 min: 0.09 ± 0.04 vs. ≥30 min: 0.11 ± 0.03, p < 0.001) and fewer ablation targets (<4: 0.09 ± 0.03 vs. ≥4: 0.11 ± 0.04, p < 0.01). Conclusions: AF complexity can be noninvasively quantified by PCA in BSPMs and correlates with ablation outcome and AF pathophysiology.
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Affiliation(s)
- Marianna Meo
- Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Pessac-Bordeaux, France.,University of Bordeaux, CRCTB, U1045, Bordeaux, France.,INSERM, CRCTB, U1045, Bordeaux, France
| | - Thomas Pambrun
- Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Pessac-Bordeaux, France.,Bordeaux University Hospital Centre Hospitalier Universitaire, Electrophysiology and Ablation Unit, Pessac, France
| | - Nicolas Derval
- Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Pessac-Bordeaux, France.,Bordeaux University Hospital Centre Hospitalier Universitaire, Electrophysiology and Ablation Unit, Pessac, France
| | | | - Stéphane Puyo
- Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Pessac-Bordeaux, France.,Bordeaux University Hospital Centre Hospitalier Universitaire, Electrophysiology and Ablation Unit, Pessac, France
| | - Josselin Duchâteau
- Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Pessac-Bordeaux, France.,University of Bordeaux, CRCTB, U1045, Bordeaux, France.,INSERM, CRCTB, U1045, Bordeaux, France.,Bordeaux University Hospital Centre Hospitalier Universitaire, Electrophysiology and Ablation Unit, Pessac, France
| | - Pierre Jaïs
- Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Pessac-Bordeaux, France.,University of Bordeaux, CRCTB, U1045, Bordeaux, France.,INSERM, CRCTB, U1045, Bordeaux, France.,Bordeaux University Hospital Centre Hospitalier Universitaire, Electrophysiology and Ablation Unit, Pessac, France
| | - Mélèze Hocini
- Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Pessac-Bordeaux, France.,University of Bordeaux, CRCTB, U1045, Bordeaux, France.,INSERM, CRCTB, U1045, Bordeaux, France.,Bordeaux University Hospital Centre Hospitalier Universitaire, Electrophysiology and Ablation Unit, Pessac, France
| | - Michel Haïssaguerre
- Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Pessac-Bordeaux, France.,University of Bordeaux, CRCTB, U1045, Bordeaux, France.,INSERM, CRCTB, U1045, Bordeaux, France.,Bordeaux University Hospital Centre Hospitalier Universitaire, Electrophysiology and Ablation Unit, Pessac, France
| | - Rémi Dubois
- Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Pessac-Bordeaux, France.,University of Bordeaux, CRCTB, U1045, Bordeaux, France.,INSERM, CRCTB, U1045, Bordeaux, France
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Godoy EJ, Lozano M, García-Fernández I, Ferrer-Albero A, MacLeod R, Saiz J, Sebastian R. Atrial Fibrosis Hampers Non-invasive Localization of Atrial Ectopic Foci From Multi-Electrode Signals: A 3D Simulation Study. Front Physiol 2018; 9:404. [PMID: 29867517 PMCID: PMC5968126 DOI: 10.3389/fphys.2018.00404] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 04/04/2018] [Indexed: 12/13/2022] Open
Abstract
Introduction: Focal atrial tachycardia is commonly treated by radio frequency ablation with an acceptable long-term success. Although the location of ectopic foci tends to appear in specific hot-spots, they can be located virtually in any atrial region. Multi-electrode surface ECG systems allow acquiring dense body surface potential maps (BSPM) for non-invasive therapy planning of cardiac arrhythmia. However, the activation of the atria could be affected by fibrosis and therefore biomarkers based on BSPM need to take these effects into account. We aim to analyze the effect of fibrosis on a BSPM derived index, and its potential application to predict the location of ectopic foci in the atria. Methodology: We have developed a 3D atrial model that includes 5 distributions of patchy fibrosis in the left atrium at 5 different stages. Each stage corresponds to a different amount of fibrosis that ranges from 2 to 40%. The 25 resulting 3D models were used for simulation of Focal Atrial Tachycardia (FAT), triggered from 19 different locations described in clinical studies. BSPM were obtained for all simulations, and the body surface potential integral maps (BSPiM) were calculated to describe atrial activations. A machine learning (ML) pipeline using a supervised learning model and support vector machine was developed to learn the BSPM patterns of each of the 475 activation sequences and relate them to the origin of the FAT source. Results: Activation maps for stages with more than 15% of fibrosis were greatly affected, producing conduction blocks and delays in propagation. BSPiMs did not always cluster into non-overlapped groups since BSPiMs were highly altered by the conduction blocks. From stage 3 (15% fibrosis) the BSPiMs showed differences for ectopic beats placed around the area of the pulmonary veins. Classification results were mostly above 84% for all the configurations studied when a large enough number of electrodes were used to map the torso. However, the presence of fibrosis increases the area of the ectopic focus location and therefore decreases the utility for the electrophysiologist. Conclusions: The results indicate that the proposed ML pipeline is a promising methodology for non-invasive ectopic foci localization from BSPM signal even when fibrosis is present.
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Affiliation(s)
- Eduardo Jorge Godoy
- Computational Multiscale Simulation Lab, Department of Computer Science, Universitat de Valencia, Valencia, Spain
| | - Miguel Lozano
- Computational Multiscale Simulation Lab, Department of Computer Science, Universitat de Valencia, Valencia, Spain
| | - Ignacio García-Fernández
- Computational Multiscale Simulation Lab, Department of Computer Science, Universitat de Valencia, Valencia, Spain
| | - Ana Ferrer-Albero
- Computational Multiscale Simulation Lab, Department of Computer Science, Universitat de Valencia, Valencia, Spain
| | - Rob MacLeod
- Department of Bioengineering, Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States
| | - Javier Saiz
- Centro de Investigación en Bioingeniería, Universitat Politécnica de Valencia, Valencia, Spain
| | - Rafael Sebastian
- Computational Multiscale Simulation Lab, Department of Computer Science, Universitat de Valencia, Valencia, Spain
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Ferrer-Albero A, Godoy EJ, Lozano M, Martínez-Mateu L, Atienza F, Saiz J, Sebastian R. Non-invasive localization of atrial ectopic beats by using simulated body surface P-wave integral maps. PLoS One 2017; 12:e0181263. [PMID: 28704537 PMCID: PMC5509320 DOI: 10.1371/journal.pone.0181263] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 06/28/2017] [Indexed: 01/22/2023] Open
Abstract
Non-invasive localization of continuous atrial ectopic beats remains a cornerstone for the treatment of atrial arrhythmias. The lack of accurate tools to guide electrophysiologists leads to an increase in the recurrence rate of ablation procedures. Existing approaches are based on the analysis of the P-waves main characteristics and the forward body surface potential maps (BSPMs) or on the inverse estimation of the electric activity of the heart from those BSPMs. These methods have not provided an efficient and systematic tool to localize ectopic triggers. In this work, we propose the use of machine learning techniques to spatially cluster and classify ectopic atrial foci into clearly differentiated atrial regions by using the body surface P-wave integral map (BSPiM) as a biomarker. Our simulated results show that ectopic foci with similar BSPiM naturally cluster into differentiated non-intersected atrial regions and that new patterns could be correctly classified with an accuracy of 97% when considering 2 clusters and 96% for 4 clusters. Our results also suggest that an increase in the number of clusters is feasible at the cost of decreasing accuracy.
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Affiliation(s)
- Ana Ferrer-Albero
- Centro de Investigación e Innovación en Bioingeniería (Ci2B), Universitat Politècnica de València, Valencia, Spain
- * E-mail:
| | - Eduardo J. Godoy
- Computational Multiscale Physiology Lab (CoMMLab), Department of Computer Science, Universitat de Valencia, Valencia, Spain
| | - Miguel Lozano
- Computational Multiscale Physiology Lab (CoMMLab), Department of Computer Science, Universitat de Valencia, Valencia, Spain
| | - Laura Martínez-Mateu
- Centro de Investigación e Innovación en Bioingeniería (Ci2B), Universitat Politècnica de València, Valencia, Spain
| | | | - Javier Saiz
- Centro de Investigación e Innovación en Bioingeniería (Ci2B), Universitat Politècnica de València, Valencia, Spain
| | - Rafael Sebastian
- Computational Multiscale Physiology Lab (CoMMLab), Department of Computer Science, Universitat de Valencia, Valencia, Spain
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Alday EAP, Colman MA, Langley P, Butters TD, Higham J, Workman AJ, Hancox JC, Zhang H. A new algorithm to diagnose atrial ectopic origin from multi lead ECG systems--insights from 3D virtual human atria and torso. PLoS Comput Biol 2015; 11:e1004026. [PMID: 25611350 PMCID: PMC4303377 DOI: 10.1371/journal.pcbi.1004026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 11/05/2014] [Indexed: 11/19/2022] Open
Abstract
Rapid atrial arrhythmias such as atrial fibrillation (AF) predispose to ventricular arrhythmias, sudden cardiac death and stroke. Identifying the origin of atrial ectopic activity from the electrocardiogram (ECG) can help to diagnose the early onset of AF in a cost-effective manner. The complex and rapid atrial electrical activity during AF makes it difficult to obtain detailed information on atrial activation using the standard 12-lead ECG alone. Compared to conventional 12-lead ECG, more detailed ECG lead configurations may provide further information about spatio-temporal dynamics of the body surface potential (BSP) during atrial excitation. We apply a recently developed 3D human atrial model to simulate electrical activity during normal sinus rhythm and ectopic pacing. The atrial model is placed into a newly developed torso model which considers the presence of the lungs, liver and spinal cord. A boundary element method is used to compute the BSP resulting from atrial excitation. Elements of the torso mesh corresponding to the locations of the placement of the electrodes in the standard 12-lead and a more detailed 64-lead ECG configuration were selected. The ectopic focal activity was simulated at various origins across all the different regions of the atria. Simulated BSP maps during normal atrial excitation (i.e. sinoatrial node excitation) were compared to those observed experimentally (obtained from the 64-lead ECG system), showing a strong agreement between the evolution in time of the simulated and experimental data in the P-wave morphology of the ECG and dipole evolution. An algorithm to obtain the location of the stimulus from a 64-lead ECG system was developed. The algorithm presented had a success rate of 93%, meaning that it correctly identified the origin of atrial focus in 75/80 simulations, and involved a general approach relevant to any multi-lead ECG system. This represents a significant improvement over previously developed algorithms.
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Affiliation(s)
- Erick A. Perez Alday
- Biological Physics Group, Department of Physics and Astronomy, University of Manchester, Manchester, United Kingdom
| | - Michael A. Colman
- Biological Physics Group, Department of Physics and Astronomy, University of Manchester, Manchester, United Kingdom
| | - Philip Langley
- School of Engineering, University of Hull, Hull, United Kingdom
| | - Timothy D. Butters
- Biological Physics Group, Department of Physics and Astronomy, University of Manchester, Manchester, United Kingdom
| | - Jonathan Higham
- Biological Physics Group, Department of Physics and Astronomy, University of Manchester, Manchester, United Kingdom
| | - Antony J. Workman
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Jules C. Hancox
- Biological Physics Group, Department of Physics and Astronomy, University of Manchester, Manchester, United Kingdom
- School of Physiology and Pharmacology, and Cardiovascular Research Laboratories, School of Medical Sciences, University of Bristol, Bristol, United Kingdom
| | - Henggui Zhang
- Biological Physics Group, Department of Physics and Astronomy, University of Manchester, Manchester, United Kingdom
- School of Computer Science and Technology, Harbin Institute of Technology, Harbin, China
- * E-mail:
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Bauernfeind T, Préda I, Szakolczai K, Szucs E, Kiss RG, Simonyi G, Kerecsen G, Duray G, Medvegy M. Diagnostic value of the left atrial electrical potentials detected by body surface potential mapping in the prediction of coronary artery disease. Int J Cardiol 2011; 150:315-8. [PMID: 20537737 DOI: 10.1016/j.ijcard.2010.04.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Revised: 01/08/2010] [Accepted: 04/17/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND The electrocardiographic diagnosis of significant coronary artery stenosis (CAD) is often based on the investigation of the left ventricular repolarization changes during exercise ECG stress test (EST). Our aim was to prove that the electric activity of the left atrium can indicate the ischemic damage of the left ventricle, and furthermore, it is able to indicate CAD without exercise. METHODS AND RESULTS Patients with chest complaints but without evidence of acute coronary syndrome were investigated by EST and body surface potential mapping (BSPM, 63 leads). CAD was proven in 45 cases (32 men, years 40-76) and excluded in 50 cases (35 men, years 38-72) with coronary angiography. Left atrial electric potentials (EP-LA) before and after 0.08 mg sublingual nitroglycerine administration differed significantly (p<0.001) in the two groups. According to Fischer linear discriminant analysis, this difference in % (EP-LA(d%)) was the best separating parameter: below limit of -14.17% (CAD prevalence was considered) this parameter predicted CAD with 93% sensitivity, 100% specificity, >10 positive and 0.05 negative likelihood ratio (weighted for prevalence). The EST predicted CAD with 71% sensitivity, 78% specificity, 2.43 positive and 0.28 negative likelihood ratios. CONCLUSION The electrical activity changes of the left atrium seemed to be suitable to predict CAD as an EST-alternative resting method.
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Affiliation(s)
- Tamás Bauernfeind
- National Center for Health Services, Department of Cardiology, Budapest, Hungary
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