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Martinez-Mateu L, Melgarejo-Meseguer FM, Muñoz-Romero S, Gimeno-Blanes FJ, García-Alberola A, Rocher-Ventura S, Saiz J, Rojo-Álvarez JL. Manifold analysis of the P-wave changes induced by pulmonary vein isolation during cryoballoon procedure. Comput Biol Med 2023; 155:106655. [PMID: 36812811 DOI: 10.1016/j.compbiomed.2023.106655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/17/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND/AIM In atrial fibrillation (AF) ablation procedures, it is desirable to know whether a proper disconnection of the pulmonary veins (PVs) was achieved. We hypothesize that information about their isolation could be provided by analyzing changes in P-wave after ablation. Thus, we present a method to detect PV disconnection using P-wave signal analysis. METHODS Conventional P-wave feature extraction was compared to an automatic feature extraction procedure based on creating low-dimensional latent spaces for cardiac signals with the Uniform Manifold Approximation and Projection (UMAP) method. A database of patients (19 controls and 16 AF individuals who underwent a PV ablation procedure) was collected. Standard 12-lead ECG was recorded, and P-waves were segmented and averaged to extract conventional features (duration, amplitude, and area) and their manifold representations provided by UMAP on a 3-dimensional latent space. A virtual patient was used to validate these results further and study the spatial distribution of the extracted characteristics over the whole torso surface. RESULTS Both methods showed differences between P-wave before and after ablation. Conventional methods were more prone to noise, P-wave delineation errors, and inter-patient variability. P-wave differences were observed in the standard leads recordings. However, higher differences appeared in the torso region over the precordial leads. Recordings near the left scapula also yielded noticeable differences. CONCLUSIONS P-wave analysis based on UMAP parameters detects PV disconnection after ablation in AF patients and is more robust than heuristic parameterization. Moreover, additional leads different from the standard 12-lead ECG should be used to detect PV isolation and possible future reconnections better.
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Affiliation(s)
- Laura Martinez-Mateu
- Departamento de Teoría de la Señal y Comunicaciones y Sistemas Telemáticos y Computación, Universidad Rey Juan Carlos, Madrid, Spain.
| | - Francisco M Melgarejo-Meseguer
- Departamento de Teoría de la Señal y Comunicaciones y Sistemas Telemáticos y Computación, Universidad Rey Juan Carlos, Madrid, Spain
| | - Sergio Muñoz-Romero
- Departamento de Teoría de la Señal y Comunicaciones y Sistemas Telemáticos y Computación, Universidad Rey Juan Carlos, Madrid, Spain; D!lemmaLab Ltd Startup, Fuenlabrada, Spain
| | - Francisco-Javier Gimeno-Blanes
- D!lemmaLab Ltd Startup, Fuenlabrada, Spain; Departamento de Ingeniería de Comunicaciones, Universidad Miguel Hernández, Elche, Spain
| | - Arcadi García-Alberola
- Unidad de Arritmias, Hospital Clínico Universitario Virgen de la Arrixaca - IMIB, Murcia, Spain
| | - Sara Rocher-Ventura
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Valencia, Spain
| | - Javier Saiz
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Valencia, Spain
| | - José Luis Rojo-Álvarez
- Departamento de Teoría de la Señal y Comunicaciones y Sistemas Telemáticos y Computación, Universidad Rey Juan Carlos, Madrid, Spain; D!lemmaLab Ltd Startup, Fuenlabrada, Spain
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Matteucci F, Maesen B, De Asmundis C, Parise G, Micali LR, Tuijthof G, Gerits P, Vernooy K, Maessen JG, La Meir M, Gelsomino S. New Biparietal Bipolar Catheter Prototype for Hybrid Atrial Fibrillation Ablation. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 16:181-187. [PMID: 33410714 PMCID: PMC8108111 DOI: 10.1177/1556984520981025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Objective To evaluate the size and depth of linear lesions by in vitro testing with a custom-made radio frequency biparietal bipolar ablation catheter in a single-stage setting. Methods A custom-made catheter was created to generate linear lesions around the left atrium and pulmonary veins of an ex vivo pig. Two frames were made, 1 epicardial and 1 endocardial. A continuous copper braid electrode and an alignment system consisting of 2 parallel rows of neodymium magnets were embedded in a flexible plastic support. After 24 hours of formalin conservation, samples of the left atrium of a freshly slaughtered pig were sliced in a cryotome, thus obtaining a sequence of 100-µm thick layers extending from the endocardial to the epicardial side. After being digitized through a scanner, these layers were evaluated using morphometric computer software. For each slice, we evaluated the maximum length of the lesions, the maximum epicardial length, the maximum endocardial length, the total area of the lesion, and the total volume. Results Forty transmural lesions from 40 specimens were obtained. The results were the following (the number in parenthesis is the interquartile range in mm): lesion maximum length (LMAX) was 7.297 mm (0.006), epicardial maximum length (LEPI) was 7.291 mm (0.014), and endocardial maximum length was 7.291 mm (0.018). The total area and total volume were 1018.50 ± 36.51 mm2 and 101.85 ± 3.65 mm3, respectively. Conclusions Our prototype showed very promising results. The next step will be to enhance the design for clinical application.
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Affiliation(s)
- Francesco Matteucci
- 118066 Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bart Maesen
- 118066 Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, The Netherlands.,5211 Cardiothoracic Department, Maastricht University Hospital, Maastricht, The Netherlands
| | - Carlo De Asmundis
- 60201 Cardiothoracic Department, Brussels University Hospital, Brussels, Belgium
| | - Gianmarco Parise
- 118066 Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Linda Renata Micali
- 118066 Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Gabrielle Tuijthof
- 5211 IDEE Engineering, Maastricht University, Maastricht, The Netherlands
| | - Peter Gerits
- 118066 Maastricht Instruments BV, Maastricht, The Netherlands
| | - Kevin Vernooy
- 5211 Cardiothoracic Department, Maastricht University Hospital, Maastricht, The Netherlands
| | - Jos G Maessen
- 118066 Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, The Netherlands.,5211 Cardiothoracic Department, Maastricht University Hospital, Maastricht, The Netherlands
| | - Mark La Meir
- 118066 Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, The Netherlands.,60201 Cardiothoracic Department, Brussels University Hospital, Brussels, Belgium
| | - Sandro Gelsomino
- 118066 Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, The Netherlands.,60201 Cardiothoracic Department, Brussels University Hospital, Brussels, Belgium
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Matteucci F, Maesen B, De Asmundis C, Bidar E, Parise G, Maessen JG, La Meir M, Gelsomino S. Comparison between biparietal bipolar and uniparietal bipolar radio frequency ablation techniques in a simultaneous procedural setting. J Interv Card Electrophysiol 2020; 61:567-575. [PMID: 32833110 PMCID: PMC8376704 DOI: 10.1007/s10840-020-00852-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 08/12/2020] [Indexed: 11/22/2022]
Abstract
Purpose To make an in vitro evaluation of the lesion size and depth produced in two different sets of radio frequency energy bipolar delivery: simultaneous biparietal bipolar (SBB) and simultaneous uniparietal bipolar (SUB). Methods Two separate prototypes have been built for our purpose: one to be used in SBB mode and the other to be used SUB mode. Forty left atrium samples were taken from the hearts of freshly slaughtered pigs. They were ablated into a simulator ABLABOX, where blood flow, temperature, and contact force were controlled. After being sliced into a cryotome, the samples were digitalized by a flatbed scanner, and the images were analyzed by a computer morphometric software. Results Transmural lesions were achieved in 18/20 samples (90%) in SBB, while SUB showed transmurality in 9/20 samples (45%). Overall maximum diameter (DMAX) resulted larger in SUB than in SBB (2.43 ± 0.30 mm, 1.62 ± 0.14 mm, respectively; p < 0.05): Moreover, maximum epicardial and endocardial diameters (DEPI and DENDO, respectively) were wider in SUB group than SBB group (2.28 ± 0.30 mm, 2.26 ± 0.40 and 1.60 ± 0.14 mm, 1.59 ± 0.15 mm, respectively; p < 0.05). We observed the same tendency in lesion depth: The total area and volume (ATOT and VTOT) were broader in SUB group than in SBB one (581.01 ± 65.38 mm/mm2, 58.10 ± 6.53 mm/mm3 and 521.97 ± 73.05 mm/mm2, 52.19 ± 7.30 mm/mm3. respectively; p < 0.05). Conclusions In contrast with the smaller lesion sizes, the biparietal bipolar group showed a higher transmurality rate. These findings may suggest a better drive of the energy flow when compared with SUB lesions.
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Affiliation(s)
- Francesco Matteucci
- Cardiothoracic Department, Maastricht University Hospital, Maastricht, The Netherlands. .,Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands.
| | - Bart Maesen
- Cardiothoracic Department, Maastricht University Hospital, Maastricht, The Netherlands.,Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands
| | - Carlo De Asmundis
- Cardiothoracic Department, Brussels University Hospital, Brussels, Belgium
| | - Elham Bidar
- Cardiothoracic Department, Maastricht University Hospital, Maastricht, The Netherlands.,Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands
| | - Gianmarco Parise
- Cardiothoracic Department, Maastricht University Hospital, Maastricht, The Netherlands.,Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands
| | - Jos G Maessen
- Cardiothoracic Department, Maastricht University Hospital, Maastricht, The Netherlands.,Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands
| | - Mark La Meir
- Cardiothoracic Department, Maastricht University Hospital, Maastricht, The Netherlands.,Cardiothoracic Department, Brussels University Hospital, Brussels, Belgium
| | - Sandro Gelsomino
- Cardiothoracic Department, Maastricht University Hospital, Maastricht, The Netherlands.,Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands.,Cardiothoracic Department, Brussels University Hospital, Brussels, Belgium
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Sánchez-Quintana D, López-Mínguez JR, Pizarro G, Murillo M, Cabrera JA. Triggers and anatomical substrates in the genesis and perpetuation of atrial fibrillation. Curr Cardiol Rev 2013; 8:310-26. [PMID: 22920484 PMCID: PMC3492815 DOI: 10.2174/157340312803760721] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Revised: 05/14/2012] [Accepted: 05/31/2012] [Indexed: 12/21/2022] Open
Abstract
The definition of atrial fibrillation (AF) as a functional electrical disorder does not reflect the significant underlying structural abnormalities. Atrial and Pulmonary Vein (PV) muscle sleeve microstructural remodeling is present, and establishes a vulnerable substrate for AF maintenance. In spite of an incomplete understanding of the anatomo-functional basis for AF, current evidence demonstrates that this arrhythmia usually requires a trigger for initiation and a vulnerable electrophysiological and/or anatomical substrate for maintenance. It is still unclear whether the trigger mechanisms include focal enhanced automaticity, triggered activity and/or micro re-entry from myocardial tissue. Initiation of AF can be favored by both parasympathetic and sympathetic stimulation, which also seem to play a role in maintaining AF. Finally, evolving clinical evidence demonstrates that inflammation is associated with new-onset and recurrent AF through a mechanism that possibly involves cellular degeneration, apoptosis, and subsequent atrial fibrosis.
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Affiliation(s)
- Damián Sánchez-Quintana
- Departamento de Anatomía y Biología Celular, Facultad de Medicina, Universidad de Extremadura, Badajoz, Spain.
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