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Masè M, Ravelli F. Electrogram Morphology Recurrence and Cycle Length in AF Mapping: From Recurring Concepts to Clinical Practice? JACC Basic Transl Sci 2023; 8:234. [PMID: 36908669 PMCID: PMC9998453 DOI: 10.1016/j.jacbts.2022.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Affiliation(s)
- Michela Masè
- Laboratory of Biophysics and Translational Cardiology, Department of Cellular, Computational and Integrative Biology, University of Trento, Via Sommarive 9, Povo, 38123 Trento, Italy
| | - Flavia Ravelli
- Laboratory of Biophysics and Translational Cardiology, Department of Cellular, Computational and Integrative Biology, University of Trento, Via Sommarive 9, Povo, 38123 Trento, Italy
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Kantharia BK, Lip GYH, Martin DT. Alterations in atrial electrogram amplitude as steady sinus rhythm transitions to paroxysmal atrial fibrillation during continuous monitoring in patients with implantable cardiac devices: Insights from the IMPACT study. J Cardiovasc Electrophysiol 2021; 32:1357-1363. [PMID: 33709486 DOI: 10.1111/jce.14997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/04/2021] [Accepted: 02/09/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES We aimed to evaluate whether device measured amplitudes of atrial electrogram (AEGM) would change when measured in sinus rhythm (SR) transitioning to paroxysmal atrial fibrillation (AF) from previous steady SR, and significance of such change. METHODS From the IMPACT trial's database we selected two groups; (A) those who developed AF (n = 164), and (B) propensity-matched control (n = 459) who stayed in SR during continuous Home Monitoring (HM) to compare AEGMs amplitudes at baseline SR and transition phase. RESULTS During 420.0 ± 349.2 days (mean ± SD) from first postenrollment HM transmission to AF event transmission in Group A, and corresponding 515.3 ± 407.0 days in Group B, baseline and transition AEGM amplitude were 2.88 ± 1.146 and 2.74 ± 1.186 mV, respectively, for Group A (p = .1), and 2.88 ± 1.155 and 2.79 ± 1.145, respectively, for Group B (p < .005). Comparison of differences of AEGM amplitude, 0.14 ± 1.072 mV in Group A and 0.09 ± 0.893 mV in Group B were insignificant (p = .3). Age, sex, and hypertension identified as confounders had no association to AEGM changes (p = NS). CONCLUSIONS Independent of age, sex, and hypertension, AEGMs amplitudes decline over a long period of time in patients with defibrillators and substrate for AF. The significance of such change remains unclear as it occurs whether patients develop AF or not, but raises a possibility of progressive atrial myopathy that patients with substrate for AF may be predisposed to.
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Affiliation(s)
- Bharat K Kantharia
- Cardiovascular and Heart Rhythm Consultants, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gregory Y H Lip
- University of Liverpool Centre for Cardiovascular Science, Liverpool, UK
| | - David T Martin
- Brigham and Women's Hospital, Boston, Massachusetts, USA
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3
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van Staveren LN, de Groot NMS. Exploring Refractoriness as an Adjunctive Electrical Biomarker for Staging of Atrial Fibrillation. J Am Heart Assoc 2020; 9:e018427. [PMID: 33238778 PMCID: PMC7763798 DOI: 10.1161/jaha.120.018427] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Patients diagnosed with the same subtype of atrial fibrillation according to our current classification system may differ in symptom severity, severity of the arrhythmogenic substrate, and response to antiarrhythmic therapy. Hence, there is a need for an electrical biomarker as an indicator of the arrhythmogenic substrate underlying atrial fibrillation enabling patient‐tailored therapy. The aim of this review is to investigate whether atrial refractoriness, a well‐known electrophysiological parameter that is affected by electrical remodeling, can be used as an electrical biomarker of the arrhythmogenic substrate underlying atrial fibrillation. We discuss methodologies of atrial effective refractory period assessment, identify which changes in refractoriness‐related parameters reflect different degrees of electrical remodeling, and explore whether these parameters can be used to predict clinical outcomes.
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Alcaraz R, Sörnmo L, Rieta JJ. Reference database and performance evaluation of methods for extraction of atrial fibrillatory waves in the ECG. Physiol Meas 2019; 40:075011. [PMID: 31216525 DOI: 10.1088/1361-6579/ab2b17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study proposes a reference database, composed of a large number of simulated ECG signals in atrial fibrillation (AF), for investigating the performance of methods for extraction of atrial fibrillatory waves (f-waves). APPROACH The simulated signals are produced using a recently published and validated model of 12-lead ECGs in AF. The database is composed of eight signal sets together accounting for a wide range of characteristics known to represent major challenges in f-wave extraction, including high heart rates, high morphological QRST variability, and the presence of ventricular premature beats. Each set contains 30 5 min signals with different f-wave amplitudes. The database is used for the purpose of investigating the statistical association between different indices, designed for use with either real or simulated signals. MAIN RESULTS Using the database, available at the PhysioNet repository of physiological signals, the performance indices unnormalized ventricular residue (uVR), designed for real signals, and the root mean square error, designed for simulated signals, were found to exhibit the strongest association, leading to the recommendation that uVR should be used when characterizing performance in real signals. SIGNIFICANCE The proposed database facilitates comparison of the performance of different f-wave extraction methods and makes it possible to express performance in terms of the error between simulated and extracted f-wave signals.
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Affiliation(s)
- Raúl Alcaraz
- Research Group in Electronic, Biomedical and Telecommunication Engineering, University of Castilla-La Mancha, Cuenca, Spain
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Paliakaitė B, Petrėnas A, Henriksson M, Skibarkienė J, Kubilius R, Sörnmo L, Marozas V. Atrial fibrillation frequency tracking in ambulatory ECG signals: The significance of signal quality assessment. Comput Biol Med 2018; 102:227-233. [PMID: 30236913 DOI: 10.1016/j.compbiomed.2018.08.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/27/2018] [Accepted: 08/27/2018] [Indexed: 11/16/2022]
Abstract
An approach to atrial fibrillation (AF) frequency tracking in long-term ambulatory ECG recordings is presented, comprising f-wave extraction, dominant atrial frequency (DAF) tracking, and signal quality assessment. Since poor signal quality is commonly encountered in ambulatory monitoring, a recently proposed index is employed to assess f-wave signal quality in a database containing 38 patients with permanent AF. The index ensures that DAF outliers, typically associated with poor-quality segments, are excluded from further analysis. 40% of all 5-s signal segments were excluded from the database due to poor quality. The exclusion of DAF outliers significantly reduces the standard deviation of the frequency estimates (p≤0.01), allowing more reliable evaluation of the difference between day- and night-time DAF. The results show that signal quality assessment plays a central role in DAF tracking, and therefore should be employed in ambulatory monitoring.
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Affiliation(s)
- Birutė Paliakaitė
- Biomedical Engineering Institute, Kaunas University of Technology, Kaunas, Lithuania.
| | - Andrius Petrėnas
- Biomedical Engineering Institute, Kaunas University of Technology, Kaunas, Lithuania
| | - Mikael Henriksson
- Department of Biomedical Engineering and Center for Integrative Electrocardiology (CIEL), Lund University, Lund, Sweden
| | - Jurgita Skibarkienė
- Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
| | - Raimondas Kubilius
- Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
| | - Leif Sörnmo
- Department of Biomedical Engineering and Center for Integrative Electrocardiology (CIEL), Lund University, Lund, Sweden
| | - Vaidotas Marozas
- Biomedical Engineering Institute, Kaunas University of Technology, Kaunas, Lithuania; Department of Electronics Engineering, Kaunas University of Technology, Kaunas, Lithuania
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6
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Petrenas A, Marozas V, Sološenko A, Kubilius R, Skibarkiene J, Oster J, Sörnmo L. Electrocardiogram modeling during paroxysmal atrial fibrillation: application to the detection of brief episodes. Physiol Meas 2017; 38:2058-2080. [PMID: 28980979 DOI: 10.1088/1361-6579/aa9153] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE A model for simulating multi-lead ECG signals during paroxysmal atrial fibrillation (AF) is proposed. SIGNIFICANCE The model is of particular significance when evaluating detection performance in the presence of brief AF episodes, especially since annotated databases with such episodes are lacking. APPROACH The proposed model accounts for important characteristics such as switching between sinus rhythm and AF, varying P-wave morphology, repetition rate of f-waves, presence of atrial premature beats, and various types of noise. MAIN RESULTS Two expert cardiologists assessed the realism of simulated signals relative to real ECG signals, both in sinus rhythm and AF. The cardiologists identified the correct rhythm in all cases, and considered two-thirds of the simulated signals as realistic. The proposed model was also investigated by evaluating the performance of two AF detectors which explored either rhythm only or both rhythm and morphology. The results show that detection performance is strongly dependent on AF episode duration, and, consequently, demonstrate that the model can play a significant role in the investigation of detector properties.
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Affiliation(s)
- Andrius Petrenas
- Biomedical Engineering Institute, Kaunas University of Technology, Kaunas, Lithuania
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7
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Masè M, Disertori M, Marini M, Ravelli F. Characterization of rate and regularity of ventricular response during atrial tachyarrhythmias. Insight on atrial and nodal determinants. Physiol Meas 2017; 38:800-818. [DOI: 10.1088/1361-6579/aa6388] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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van der Does LJME, Yaksh A, Kik C, Knops P, Lanters EAH, Teuwen CP, Oei FBS, van de Woestijne PC, Bekkers JA, Bogers AJJC, Allessie MA, de Groot NMS. QUest for the Arrhythmogenic Substrate of Atrial fibRillation in Patients Undergoing Cardiac Surgery (QUASAR Study): Rationale and Design. J Cardiovasc Transl Res 2016; 9:194-201. [PMID: 26935733 PMCID: PMC4873535 DOI: 10.1007/s12265-016-9685-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 02/17/2016] [Indexed: 01/19/2023]
Abstract
The heterogeneous presentation and progression of atrial fibrillation (AF) implicate the existence of different pathophysiological processes. Individualized diagnosis and therapy of the arrhythmogenic substrate underlying AF may be required to improve treatment outcomes. Therefore, this single-center study aims to identify the arrhythmogenic areas underlying AF by intra-operative, high-resolution, multi-site epicardial mapping in 600 patients with different heart diseases. Participants are divided into 12 groups according to the underlying heart diseases and presence of prior AF episodes. Mapping is performed with a 192-electrode array for 5–10 s during sinus rhythm and (induced) AF of the entire atrial surface. Local activation times are converted into activation and wave maps from which various electrophysiological parameters are derived. Postoperative cardiac rhythm registrations and a 5-year follow-up will show the incidence of postoperative and persistent AF. This project provides the first step in the development of a tool for individual AF diagnosis and treatment.
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Affiliation(s)
- Lisette J M E van der Does
- Translational Electrophysiology, Department of Cardiology, Erasmus Medical Center, Thorax Center, PO Box 2040, s Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Ameeta Yaksh
- Translational Electrophysiology, Department of Cardiology, Erasmus Medical Center, Thorax Center, PO Box 2040, s Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Charles Kik
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Paul Knops
- Translational Electrophysiology, Department of Cardiology, Erasmus Medical Center, Thorax Center, PO Box 2040, s Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Eva A H Lanters
- Translational Electrophysiology, Department of Cardiology, Erasmus Medical Center, Thorax Center, PO Box 2040, s Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Christophe P Teuwen
- Translational Electrophysiology, Department of Cardiology, Erasmus Medical Center, Thorax Center, PO Box 2040, s Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Frans B S Oei
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Jos A Bekkers
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Maurits A Allessie
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Natasja M S de Groot
- Translational Electrophysiology, Department of Cardiology, Erasmus Medical Center, Thorax Center, PO Box 2040, s Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
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Julián M, Alcaraz R, Rieta JJ. Application of Hurst exponents to assess atrial reverse remodeling in paroxysmal atrial fibrillation. Physiol Meas 2015; 36:2231-46. [DOI: 10.1088/0967-3334/36/11/2231] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Masè M, Marini M, Disertori M, Ravelli F. Dynamics of AV coupling during human atrial fibrillation: role of atrial rate. Am J Physiol Heart Circ Physiol 2015; 309:H198-205. [DOI: 10.1152/ajpheart.00726.2014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 04/21/2015] [Indexed: 11/22/2022]
Abstract
The causal relationship between atrial and ventricular activities during human atrial fibrillation (AF) is poorly understood. This study analyzed the effects of an increase in atrial rate on the link between atrial and ventricular activities during AF. Atrial and ventricular time series were determined in 14 patients during the spontaneous acceleration of the atrial rhythm at AF onset. The dynamic relationship between atrial and ventricular activities was quantified in terms of atrioventricular (AV) coupling by AV synchrogram analysis. The technique identified n: m coupling patterns ( n atrial beats in m ventricular cycles), quantifying their percentage, maximal length, and conduction ratio (= m/ n). Simulations with a difference-equation AV model were performed to correlate the observed dynamics to specific atrial/nodal properties. The atrial rate increase significantly affected AV coupling and ventricular response during AF. The shortening of atrial intervals from 185 ± 32 to 165 ± 24 ms ( P < 0.001) determined transitions toward AV patterns with progressively decreasing m/ n ratios (from conduction ratio = 0.34 ± 0.09 to 0.29 ± 0.08, P < 0.01), lower occurrence (from percentage of coupled beats = 27.1 ± 8.0 to 21.8 ± 6.9%, P < 0.05), and higher instability (from maximal length = 3.9 ± 1.5 to 2.8 ± 0.7 s, P < 0.01). Advanced levels of AV block and coupling instability at higher atrial rates were associated with increased ventricular interval variability (from 123 ± 52 to 133 ± 55 ms, P < 0.05). AV pattern transitions and coupling instability in patients were predicted, assuming the filtering of high-rate irregular atrial beats by the slow recovery of nodal excitability. These results support the role of atrial rate in determining AV coupling and ventricular response and may have implications for rate control in AF.
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Affiliation(s)
- M. Masè
- Department of Physics, University of Trento, Povo-Trento, Italy
| | - M. Marini
- Division of Cardiology, Santa Chiara Hospital, Trento, Italy; and
| | - M. Disertori
- Division of Cardiology, Santa Chiara Hospital, Trento, Italy; and
- Healthcare Research and Innovation Program, PAT-FBK, Trento, Italy
| | - F. Ravelli
- Department of Physics, University of Trento, Povo-Trento, Italy
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Platonov PG, Corino VDA, Seifert M, Holmqvist F, Sornmo L. Atrial fibrillatory rate in the clinical context: natural course and prediction of intervention outcome. Europace 2014; 16 Suppl 4:iv110-iv119. [DOI: 10.1093/europace/euu249] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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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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Ravelli F, Masè M. Computational mapping in atrial fibrillation: how the integration of signal-derived maps may guide the localization of critical sources. ACTA ACUST UNITED AC 2014; 16:714-23. [DOI: 10.1093/europace/eut376] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Aunes M, Egstrup K, Frison L, Berggren A, Stridh M, Sörnmo L, Edvardsson N. Rapid slowing of the atrial fibrillatory rate after administration of AZD7009 predicts conversion of atrial fibrillation. J Electrocardiol 2013; 47:316-23. [PMID: 24508473 DOI: 10.1016/j.jelectrocard.2013.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Effects on the atrial fibrillatory rate (AFR) were studied during infusion with the combined potassium and sodium channel blocker AZD7009. METHODS AND RESULTS Patients with persistent atrial fibrillation (AF) were randomized to AZD7009 or placebo. Thirty-five patients converted to sinus rhythm (SR) and were matched to 35 non-converters. The mean AFR before conversion was 231 fibrillations per minute (fpm), having decreased by 41%; in non-converters, it was 296 fpm at the end of infusion, having decreased by 26%. The rate of decrease was greater in converters at 5 min, -88 vs. -66 fpm (p=0.02), and at 10 min, -133 vs. -111 fpm (p=0.048). The AFR-SD and the exponential decay decreased. A small left atrial area was the only baseline predictor of conversion to SR. CONCLUSIONS AZD7009 produced a significantly more rapid decrease of the AFR in converters than in non-converters, but the AFR at baseline was not predictive of conversion.
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Affiliation(s)
| | | | | | | | - Martin Stridh
- Department of Electrical and Information Technology and Center for Integrative Electrocardiology, Lund University, Lund, Sweden
| | - Leif Sörnmo
- Department of Electrical and Information Technology and Center for Integrative Electrocardiology, Lund University, Lund, Sweden
| | - Nils Edvardsson
- Sahlgrenska Academy at the Sahlgrenska University Hospital, Göteborg, Sweden
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Nonlinear synchronization assessment between atrial and ventricular activations series from the surface ECG in atrial fibrillation. Biomed Signal Process Control 2013. [DOI: 10.1016/j.bspc.2013.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Masè M, Glass L, Disertori M, Ravelli F. The AV synchrogram: A novel approach to quantify atrioventricular coupling during atrial arrhythmias. Biomed Signal Process Control 2013. [DOI: 10.1016/j.bspc.2013.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ravelli F, Masè M, Cristoforetti A, Del Greco M, Centonze M, Marini M, Disertori M. Anatomic localization of rapid repetitive sources in persistent atrial fibrillation: fusion of biatrial CT images with wave similarity/cycle length maps. JACC Cardiovasc Imaging 2013; 5:1211-20. [PMID: 23236970 DOI: 10.1016/j.jcmg.2012.07.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Revised: 07/12/2012] [Accepted: 08/01/2012] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the anatomic distribution of critical sources in patients with atrial fibrillation (AF) by fusion of biatrial computed tomography (CT) images with cycle length (CL) and wave similarity (WS) maps. BACKGROUND Experimental and clinical studies show that atrial fibrillation (AF) may originate from rapid and repetitive (RR) sources of activation. Localization of RR sources may be crucial for an effective ablation treatment. Atrial electrograms showing rapid and repetitive activations can be identified by combining WS and CL analysis. METHODS Patients with persistent AF underwent biatrial electroanatomic mapping and pre-procedural CT cardiac imaging. WS and CL maps were constructed in 17 patients by calculating the degree of repetitiveness of activation waveforms (similarity index [S]) and the cycle length at each atrial site. WS/CL maps were then integrated with biatrial 3-dimensional CT reconstructions by a stochastic approach. RESULTS Repetitive sources of activation (S ≥ 0.5) were present in most patients with persistent AF (94%) and were mainly located at the pulmonary veins (82% of patients), at the superior caval vein (41%), on the anterior wall of the right atrium (23%), and at the left atrial appendage (23%). Potential driver sources showing both rapid and repetitive activations (CL = 140.7 ± 25.1 ms, S = 0.65 ± 0.15) were present only in a subset of patients (65%) and were confined to the pulmonary vein region (47% of patients) and left atrial appendage (12%). Differently, the repetitive activity of the superior caval vein was characterized by a slow activation rate (CL = 184.7 ± 14.6 ms). CONCLUSIONS The identification and localization of RR sources is feasible by fusion of biatrial anatomic images with WS/CL maps. Potential driver sources are present only in a subset of patients with persistent AF and are mainly located in the pulmonary vein region.
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Affiliation(s)
- Flavia Ravelli
- Department of Physics, University of Trento, Trento, Italy.
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Analysis of atrial fibrillatory rate during spontaneous episodes of atrial fibrillation in humans using implantable loop recorder electrocardiogram. J Electrocardiol 2012; 45:723-6. [PMID: 22698889 DOI: 10.1016/j.jelectrocard.2012.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Indexed: 11/22/2022]
Abstract
Atrial fibrillatory rate (AFR) can predict outcome of interventions for atrial fibrillation (AF); however, AFR behavior at AF onset in humans is poorly described. We studied AFR during spontaneous AF episodes in patients with lone paroxysmal AF who received implantable loop recorders and had AF episodes of 1 hour or more recorded (n = 4). Mean AFR per minute was assessed from continuous implantable loop recorder electrocardiogram using spatiotemporal QRST cancellation and time-frequency analysis. Atrial fibrillatory rate increased from 290 ± 20 to 326 ± 39 fibrillations per minute during the first 3 hours (P<.05) and reached plateau then. Atrial fibrillatory rate beyond the initial 3 hours can, therefore, be considered stable and may be evaluated for prediction of intervention effect.
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Atienza F, Calvo D, Almendral J, Zlochiver S, Grzeda KR, Martínez-Alzamora N, González-Torrecilla E, Arenal A, Fernández-Avilés F, Berenfeld O. Mechanisms of fractionated electrograms formation in the posterior left atrium during paroxysmal atrial fibrillation in humans. J Am Coll Cardiol 2011; 57:1081-92. [PMID: 21349400 DOI: 10.1016/j.jacc.2010.09.066] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 08/12/2010] [Accepted: 09/15/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of this paper was to study mechanisms of formation of fractionated electrograms on the posterior left atrial wall (PLAW) in human paroxysmal atrial fibrillation (AF). BACKGROUND The mechanisms responsible for complex fractionated atrial electrogram formation during AF are poorly understood. METHODS In 24 patients, we induced sustained AF by pacing from a pulmonary vein. We analyzed transitions between organized patterns and changes in electrogram morphology leading to fractionation in relation to interbeat interval duration (systolic interval [SI]) and dominant frequency. Computer simulations of rotors helped in the interpretation of the results. RESULTS Organized patterns were recorded 31 ± 18% of the time. In 47% of organized patterns, the electrograms and PLAW activation sequence were similar to those of incoming waves during pulmonary vein stimulation that induced AF. Transitions to fractionation were preceded by significant increases in electrogram duration, spike number, and SI shortening (R(2) = 0.94). Similarly, adenosine infusion during organized patterns caused significant SI shortening leading to fractionated electrograms formation. Activation maps during organization showed incoming wave patterns, with earliest activation located closest to the highest dominant frequency site. Activation maps during transitions to fragmentation showed areas of slowed conduction and unidirectional block. Simulations predicted that SI abbreviation that heralds fractionated electrograms formation might result from a Doppler effect on wave fronts preceding an approaching rotor or by acceleration of a stationary or meandering, remotely located source. CONCLUSIONS During induced AF, SI shortening after either drift or acceleration of a source results in intermittent fibrillatory conduction and formation of fractionated electrograms at the PLAW.
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Affiliation(s)
- Felipe Atienza
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Alcaraz R, Hornero F, Rieta JJ. Noninvasive time and frequency predictors of long-standing atrial fibrillation early recurrence after electrical cardioversion. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 34:1241-50. [PMID: 21605132 DOI: 10.1111/j.1540-8159.2011.03125.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Several clinical factors have been studied to predict atrial fibrillation (AF) recurrence after electrical cardioversion (ECV) with limited predictive value. METHODS A method able to predict robustly long-standing AF early recurrence by characterizing noninvasively the electrical atrial activity (AA) with parameters related to its time course and spectral features is presented. To this respect, 63 patients (20 men and 43 women; mean age 73.4 ± 9.0 years; under antiarrhythmic drug treatment with amiodarone) who were referred for ECV of persistent AF were studied. During a 4-week follow-up, AF recurrence was observed in 41 patients (65.1%). RESULTS RR variability and the studied AA spectral features, including dominant atrial frequency (DAF), its first harmonic and their amplitude, provided poor statistical differences between groups. On the contrary, f waves power (fWP) and Sample Entropy (SampEn) of the AA behaved as very good predictors. Patients who relapsed to AF presented lower fWP (0.036 ± 0.019 vs 0.081 ± 0.029 n.u.(2) , P < 0.001) and higher SampEn (0.107 ± 0.022 vs 0.086 ± 0.033, P < 0.01). Furthermore, fWP presented the highest predictive accuracy of 82.5%, whereas SampEn provided a 79.4%. The remaining features revealed accuracies lower than 70%. A stepwise discriminant analysis (SDA) provided a model based on fWP and SampEn with 90.5% of accuracy. CONCLUSIONS The fWP has proved to predict long-standing AF early recurrence after ECV and can be combined with SampEn to improve its diagnostic ability. Furthermore, a thorough analysis of the results allowed outlining possible associations between these two features and the concomitant status of atrial remodeling.
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Affiliation(s)
- Raúl Alcaraz
- Innovation in Bioengineering Research Group, University of Castilla-La Mancha, Cuenca, Spain.
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21
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Alcaraz R, Hornero F, Rieta JJ. Surface ECG organization time course analysis along onward episodes of paroxysmal atrial fibrillation. Med Eng Phys 2011; 33:597-603. [PMID: 21227732 DOI: 10.1016/j.medengphy.2010.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Revised: 12/15/2010] [Accepted: 12/16/2010] [Indexed: 10/18/2022]
Abstract
The complete understanding of the mechanisms leading to the initiation, maintenance and self-termination of atrial fibrillation (AF) still is an unsolved challenge for cardiac electrophysiology. Studies in which AF has been induced have shown that electrophysiological and structural remodeling of the atria during the arrhythmia could play an important role in the transition from paroxysmal to persistent AF. However, to this day, the time course of the atrial remodeling along onward episodes of non-induced paroxysmal AF has not been investigated yet. In this work, a non-invasive method, based on the regularity estimation of AF through sample entropy (SampEn), has been used to assess the organization evolution along onward episodes of paroxysmal AF. Given that AF organization has been associated to the number of existing wavelets wandering throughout the atrial tissue, SampEn could be considered as a concomitant estimator of atrial remodeling. The achieved results, in close agreement with previous findings obtained from invasive recordings, proved several relevant aspects of arial remodeling. Firstly, a progressive disorganization increase (SampEn increase) along onward episodes of AF has been observed for 63% of the analyzed patients, whereas a stable AF organization degree has been appreciated in the remaining 37%. Next, a positive correlation between episode duration and SampEn has been obtained (R=0.541, p<0.01). Finally, a remarkable influence of the fibrillation-free interval, preceding each episode, on the corresponding level of AF organization at the onset of the subsequent AF episode has been observed, with a correlation between these two indices of R=0.389 (p<0.01). As a consequence, it could be considered that atrial electrophysiological dynamics that occur along onward paroxysmal AF episodes are reflected and can be quantified from ECG recordings through non-invasive organization estimation.
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Affiliation(s)
- Raúl Alcaraz
- Innovation in Bioengineering Research Group, University of Castilla-La Mancha, Spain.
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Alcaraz R, Hornero F, Rieta JJ. Noninvasive organization analysis along consecutive episodes of paroxysmal atrial fibrillation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2011; 2011:1467-1470. [PMID: 22254596 DOI: 10.1109/iembs.2011.6090340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice. Although its mechanisms are incompletely understood, electrophysiological and structural remodeling of the atria seem to play an important role in the arrhythmia transition from paroxysmal to persistent. However, the time course of the atrial remodeling along onward episodes of non-induced paroxysmal AF has not been investigated yet. In this work, a non-invasive method, based on the regularity estimation of AF through sample entropy (SampEn), has been used to assess the organization evolution along onward episodes of paroxysmal AF. Given that AF organization has been associated to the number of existing wavelets wandering throughout the atrial tissue, SampEn could be considered as a concomitant estimator of atrial remodeling. The achieved results, in close agreement with previous findings obtained from invasive recordings, showed a progressive disorganization increase along onward episodes of AF for 63% of the analyzed patients and a stable AF organization degree in the remaining 37%. Additionally, a positive correlation between episode duration and SampEn was also noticed (R = 0.541, p < 0.01). As a consequence, it could be considered that atrial electrophysiological dynamics that occur along onward paroxysmal AF episodes are reflected and can be quantified from ECG recordings through non-invasive organization estimation.
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Affiliation(s)
- Raúl Alcaraz
- Innovation in Bioengeeniering Research Group, University of Castilla-La Mancha, Campus Universitario, 16071 Cuenca, Spain.
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23
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Ravelli F, Masè M. A time-domain approach for the identification of atrial fibrillation drivers. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2011; 2011:5527-5530. [PMID: 22255590 DOI: 10.1109/iembs.2011.6091410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The localization of atrial fibrillation (AF) driver sources, characterized by rapid and regular electrical activity, is crucial for an effective ablation treatment. This work proposes a double-criteria approach for the identification of AF drivers based on a time-domain evaluation of atrial rate and AF organization. These two features are quantified by the measurement of atrial cycle length (ACL) and wave-similarity (WS). Based on ACL/WS formalism, AF drivers can be operatively defined as sites displaying electrical activity with high-rate and high-similarity (HR AND HS). The capability of ACL/WS analysis to identify AF driver sites and distinguish them from non-critical areas is shown in representative examples. The double-criteria evaluation for the identification of AF drivers, provided by our time-domain approach, might open new perspectives for the development of electrogram-guided ablation strategies in the single patient.
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Affiliation(s)
- Flavia Ravelli
- Biosignals and Biophysics Laboratory, Department of Physics and BIOtech, University of Trento, Trento, Italy.
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Masè M, Graffigna A, Sinelli S, Pallaoro G, Nollo G, Ravelli F. Long-term biatrial recordings in post-operative atrial fibrillation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2010; 2010:2654-7. [PMID: 21096191 DOI: 10.1109/iembs.2010.5626541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Although atrial fibrillation (AF) is a common complication of cardiac surgery, its pathophysiology remains unclear. The study of post-operative AF demands for the recording of cardiac electrical activity in correspondence of AF onset and progression. Long-term recordings in post-surgery patients could provide this information, but, to date, have been limited to surface signals, which precludes a characterization of the arrhythmic triggers and substrate. In this study we demonstrate the feasibility of a continuous long-term recording of atrial electrical activities from the right and left atria in post-surgery patients. Local atrial epicardial electrograms are acquired by positioning temporary pacing wires in the right and left atria at the end of the intervention, while three day recordings are obtained by a digital holter recorder, adapted to epicardial signal features. The capability of the system to map local atrial activity and the possibility to obtain quantitative information on atrial rate and synchronization from the processed epicardial signals are proven in representative examples. The quantitative description of local atrial properties opens new perspective in the investigation of post-surgery AF.
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Affiliation(s)
- M Masè
- Biosignals and Biophysics Lab, Department of Physics and BIOtech, Trento, Italy.
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25
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Alcaraz R, Rieta J. A review on sample entropy applications for the non-invasive analysis of atrial fibrillation electrocardiograms. Biomed Signal Process Control 2010. [DOI: 10.1016/j.bspc.2009.11.001] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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DE VOS CEESB, PISON LAURENT, PISTERS RON, SCHOTTEN ULRICH, CHERIEX EMILEC, PRINS MARTINH, DELHAAS TAMMO, CRIJNS HARRYJ, TIELEMAN ROBERTG. Atrial Fibrillatory Wall Motion and Degree of Atrial Remodeling in Patients with Atrial Fibrillation: A Tissue Velocity Imaging Study. J Cardiovasc Electrophysiol 2009; 20:1374-81. [DOI: 10.1111/j.1540-8167.2009.01628.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Alcaraz R, Rieta JJ. The application of nonlinear metrics to assess organization differences in short recordings of paroxysmal and persistent atrial fibrillation. Physiol Meas 2009; 31:115-30. [DOI: 10.1088/0967-3334/31/1/008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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28
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Alcaraz R, Rieta JJ. Non-invasive organization variation assessment in the onset and termination of paroxysmal atrial fibrillation. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2009; 93:148-154. [PMID: 18950894 DOI: 10.1016/j.cmpb.2008.09.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Revised: 05/28/2008] [Accepted: 09/01/2008] [Indexed: 05/27/2023]
Abstract
Atrial Fibrillation (AF) is the most common supraventricular tachyarrhythmia. Recently, it has been suggested that AF is partially organized on its onset and termination, thus being more suitable for antiarrhythmia and to avoid unnecessary therapy. Although several invasive and non-invasive AF organization estimators have been proposed, the organization time course in the first and last minutes of AF has not been quantified yet. The aim of this work is to study non-invasively the organization variation within the first and last minutes of paroxysmal AF. The organization was evaluated making use of sample entropy, which can robustly estimate electrical atrial activity organization from surface ECG recordings. This work proves an organization decrease in the first minutes of AF onset and an increase within the last minute before spontaneous AF termination. These results are in agreement with the conclusions reported by other authors who made use of invasive recordings.
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Affiliation(s)
- Raúl Alcaraz
- Innovation in Bioengineering Research Group, University of Castilla-La Mancha, Spain.
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Alcaraz R, Rieta JJ, Hornero F. Caracterización no invasiva de la actividad auricular durante los instantes previos a la terminación de la fibrilación auricular paroxística. Rev Esp Cardiol 2008. [DOI: 10.1157/13116203] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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30
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Mainardi L, Sörnmo L, Cerutti S. Understanding Atrial Fibrillation: The Signal Processing Contribution, Part II. ACTA ACUST UNITED AC 2008. [DOI: 10.2200/s00153ed1v01y200809bme025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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31
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Current World Literature. Curr Opin Cardiol 2008; 23:72-8. [DOI: 10.1097/hco.0b013e3282f40209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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32
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Non-Invasive Characterization of Atrial Activity Immediately Prior to Termination of Paroxysmal Atrial Fibrillation. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/s1885-5857(08)60091-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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