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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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Zhong G, Feng X, Yuan H, Yang C. A 3D-CNN with temporal-attention block to predict the recurrence of atrial fibrillation based on body-surface potential mapping signals. Front Physiol 2022; 13:1030307. [DOI: 10.3389/fphys.2022.1030307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 10/20/2022] [Indexed: 11/09/2022] Open
Abstract
Catheter ablation has become an important treatment for atrial fibrillation (AF), but its recurrence rate is still high. The aim of this study was to predict AF recurrence using a three-dimensional (3D) network model based on body-surface potential mapping signals (BSPMs). BSPMs were recorded with a 128-lead vest in 14 persistent AF patients before undergoing catheter ablation (Maze-IV). The torso geometry was acquired and meshed by point cloud technology, and the BSPM was interpolated into the torso geometry by the inverse distance weighted (IDW) method to generate the isopotential map. Experiments show that the isopotential map of BSPMs can reflect the propagation of the electrical wavefronts. The 3D isopotential sequence map was established by combining the spatial–temporal information of the isopotential map; a 3D convolutional neural network (3D-CNN) model with temporal attention was established to predict AF recurrence. Our study proposes a novel attention block that focuses the characteristics of atrial activations to improve sampling accuracy. In our experiment, accuracy (ACC) in the intra-patient evaluation for predicting the recurrence of AF was 99.38%. In the inter-patient evaluation, ACC of 3D-CNN was 81.48%, and the area under the curve (AUC) was 0.88. It can be concluded that the dynamic rendering of multiple isopotential maps can not only comprehensively display the conduction of cardiac electrical activity on the body surface but also successfully predict the recurrence of AF after CA by using 3D isopotential sequence maps.
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McCann A, Luca A, Pascale P, Pruvot E, Vesin JM. Novel spatiotemporal processing tools for body-surface potential map signals for the prediction of catheter ablation outcome in persistent atrial fibrillation. Front Physiol 2022; 13:1001060. [PMID: 36246141 PMCID: PMC9557152 DOI: 10.3389/fphys.2022.1001060] [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: 07/22/2022] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Signal processing tools are required to efficiently analyze data collected in body-surface-potential map (BSPM) recordings. A limited number of such tools exist for studying persistent atrial fibrillation (persAF). We propose two novel, spatiotemporal indices for processing BSPM data and test their clinical applicability through a comparison with the recently proposed non-dipolar component index (NDI) for prediction of single-procedure catheter ablation (CA) success rate in persAF patients.Methods: BSPM recordings were obtained with a 252-lead vest in 13 persAF patients (8 men, 63 ± 8 years, 11 ± 13 months sustained AF duration) before undergoing CA. Each recording was divided into seven 1-min segments of high signal quality. Spatiotemporal ventricular activity (VA) cancellation was applied to each segment to isolate atrial activity (AA). The two novel indices, called error-ratio, normalized root-mean-square error (ERNRMSE) and error-ratio, mean-absolute error (ERABSE), were calculated. These indices quantify the capacity of a subset of BSPM vest electrodes to accurately represent the AA, and AA dominant frequency (DF), respectively, on all BSPM electrodes over time, compared to the optimal principal component analysis (PCA) representation. The NDI, quantifying the fraction of energy retained after removal of the three largest PCs, was also calculated. The two novel indices and the NDI were statistically compared between patient groups based on single-procedure clinical CA outcome. Finally, their predictive power for univariate CA outcome classification was assessed using receiver operating characteristic (ROC) analysis with cross-validation for a logistic regression classifier.Results: Patient clinical outcomes were recorded 6 months following procedures, and those who had an arrhythmia recurrence at least 2 months post-CA were defined as having a negative outcome. Clinical outcome information was available for 11 patients, 6 with arrhythmia recurrence. Therefore, a total of 77 1-min AA-BSPM segments were available for analysis. Significant differences were found in the values of the novel indices and NDI between patients with arrhythmia recurrence post-ablation and those without. ROC analysis showed the best CA outcome predictive performance for ERNRMSE (AUC = 0.77 ± 0.08, sensitivity = 76.2%, specificity = 84.8%).Conclusion: Significant association was found between the novel indices and CA success or failure. The novel index ERNRMSE additionally shows good predictive power for single-procedure CA outcome.
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Affiliation(s)
- Anna McCann
- Applied Signal Processing Group, Department of Electrical Engineering, Swiss Federal Institute of Technology, Lausanne, Switzerland
- *Correspondence: Anna McCann,
| | - Adrian Luca
- Service of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Patrizio Pascale
- Service of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Etienne Pruvot
- Service of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Jean-Marc Vesin
- Applied Signal Processing Group, Department of Electrical Engineering, Swiss Federal Institute of Technology, Lausanne, Switzerland
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Giorgios T, Antonio F, Limite LR, Felicia L, Zweiker D, Cireddu M, Vlachos K, Hadjis A, D'Angelo G, Baratto F, Bisceglia C, Vergara P, Marzi A, Peretto G, Paglino G, Radinovic A, Gulletta S, Sala S, Mazzone P, Bella PD. Bi‐atrial characterization of the electrical substrate in patients with atrial fibrillation. Pacing Clin Electrophysiol 2022; 45:752-760. [PMID: 35403246 PMCID: PMC9322275 DOI: 10.1111/pace.14490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/19/2022] [Accepted: 03/11/2022] [Indexed: 11/30/2022]
Abstract
Background Methods Results Conclusion
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Affiliation(s)
| | | | | | | | - David Zweiker
- Department of Arrhythmology San Raffaele Hospital Milan Italy
| | - Manuela Cireddu
- Department of Arrhythmology San Raffaele Hospital Milan Italy
| | | | - Alexios Hadjis
- Department of Arrhythmology San Raffaele Hospital Milan Italy
| | | | | | | | | | | | | | | | | | - Simone Gulletta
- Department of Arrhythmology San Raffaele Hospital Milan Italy
| | - Simone Sala
- Department of Arrhythmology San Raffaele Hospital Milan Italy
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Zink MD, Laureanti R, Hermans BJM, Pison L, Verheule S, Philippens S, Pluymaekers N, Vroomen M, Hermans A, van Hunnik A, Crijns HJGM, Vernooy K, Linz D, Mainardi L, Auricchio A, Zeemering S, Schotten U. Extended ECG Improves Classification of Paroxysmal and Persistent Atrial Fibrillation Based on P- and f-Waves. Front Physiol 2022; 13:779826. [PMID: 35309059 PMCID: PMC8931504 DOI: 10.3389/fphys.2022.779826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 01/25/2022] [Indexed: 12/12/2022] Open
Abstract
Background The standard 12-lead ECG has been shown to be of value in characterizing atrial conduction properties. The added value of extended ECG recordings (longer recordings from more sites) has not been systematically explored yet. Objective The aim of this study is to employ an extended ECG to identify characteristics of atrial electrical activity related to paroxysmal vs. persistent atrial fibrillation (AF). Methods In 247 participants scheduled for AF ablation, an extended ECG was recorded (12 standard plus 3 additional leads, 5 min recording, no filtering). For patients presenting in sinus rhythm (SR), the signal-averaged P-wave and the spatiotemporal P-wave variability was analyzed. For patients presenting in AF, f-wave properties in the QRST (the amplitude complex of the ventricular electrical activity: Q-, R-, S-, and T-wave)-canceled ECG were determined. Results Significant differences between paroxysmal (N = 152) and persistent patients with AF (N = 95) were found in several P-wave and f-wave parameters, including parameters that can only be calculated from an extended ECG. Furthermore, a moderate, but significant correlation was found between echocardiographic parameters and P-wave and f-wave parameters. There was a moderate correlation of left atrial (LA) diameter with P-wave energy duration (r = 0.317, p < 0.001) and f-wave amplitude in lead A3 (r = -0.389, p = 0.002). The AF-type classification performance significantly improved when parameters calculated from the extended ECG were taken into account [area under the curve (AUC) = 0.58, interquartile range (IQR) 0.50-0.64 for standard ECG parameters only vs. AUC = 0.76, IQR 0.70-0.80 for extended ECG parameters, p < 0.001]. Conclusion The P- and f-wave analysis of extended ECG configurations identified specific ECG features allowing improved classification of paroxysmal vs. persistent AF. The extended ECG significantly improved AF-type classification in our analyzed data as compared to a standard 10-s 12-lead ECG. Whether this can result in a better clinical AF type classification warrants further prospective study.
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Affiliation(s)
- Matthias Daniel Zink
- RWTH University Hospital Aachen, Internal Medicine I, Cardiology and Vascular Medicine, Aachen, Germany
- Cardiovascular Research Institute Maastricht (CARIM), Physiology, Maastricht, Netherlands
| | - Rita Laureanti
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
- Center for Computational Modeling in Cardiology, Lugano, Switzerland
| | - Ben J. M. Hermans
- Cardiovascular Research Institute Maastricht (CARIM), Physiology, Maastricht, Netherlands
| | - Laurent Pison
- Cardiovascular Research Institute Maastricht (CARIM), Physiology, Maastricht, Netherlands
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, Netherlands
- Ziekenhuis Oost Limburg, Genk, Belgium
| | - Sander Verheule
- Cardiovascular Research Institute Maastricht (CARIM), Physiology, Maastricht, Netherlands
| | - Suzanne Philippens
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, Netherlands
| | - Nikki Pluymaekers
- Cardiovascular Research Institute Maastricht (CARIM), Physiology, Maastricht, Netherlands
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, Netherlands
| | - Mindy Vroomen
- Cardiovascular Research Institute Maastricht (CARIM), Physiology, Maastricht, Netherlands
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, Netherlands
| | - Astrid Hermans
- Cardiovascular Research Institute Maastricht (CARIM), Physiology, Maastricht, Netherlands
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, Netherlands
| | - Arne van Hunnik
- Cardiovascular Research Institute Maastricht (CARIM), Physiology, Maastricht, Netherlands
| | - Harry J. G. M. Crijns
- Cardiovascular Research Institute Maastricht (CARIM), Physiology, Maastricht, Netherlands
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, Netherlands
| | - Kevin Vernooy
- Cardiovascular Research Institute Maastricht (CARIM), Physiology, Maastricht, Netherlands
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, Netherlands
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Dominik Linz
- Cardiovascular Research Institute Maastricht (CARIM), Physiology, Maastricht, Netherlands
| | - Luca Mainardi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Angelo Auricchio
- Center for Computational Modeling in Cardiology, Lugano, Switzerland
- Instituto Cardiocentro Ticino, Lugano, Switzerland
| | - Stef Zeemering
- Cardiovascular Research Institute Maastricht (CARIM), Physiology, Maastricht, Netherlands
| | - Ulrich Schotten
- Cardiovascular Research Institute Maastricht (CARIM), Physiology, Maastricht, Netherlands
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Salinet J, Molero R, Schlindwein FS, Karel J, Rodrigo M, Rojo-Álvarez JL, Berenfeld O, Climent AM, Zenger B, Vanheusden F, Paredes JGS, MacLeod R, Atienza F, Guillem MS, Cluitmans M, Bonizzi P. Electrocardiographic Imaging for Atrial Fibrillation: A Perspective From Computer Models and Animal Experiments to Clinical Value. Front Physiol 2021; 12:653013. [PMID: 33995122 PMCID: PMC8120164 DOI: 10.3389/fphys.2021.653013] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/22/2021] [Indexed: 01/16/2023] Open
Abstract
Electrocardiographic imaging (ECGI) is a technique to reconstruct non-invasively the electrical activity on the heart surface from body-surface potential recordings and geometric information of the torso and the heart. ECGI has shown scientific and clinical value when used to characterize and treat both atrial and ventricular arrhythmias. Regarding atrial fibrillation (AF), the characterization of the electrical propagation and the underlying substrate favoring AF is inherently more challenging than for ventricular arrhythmias, due to the progressive and heterogeneous nature of the disease and its manifestation, the small volume and wall thickness of the atria, and the relatively large role of microstructural abnormalities in AF. At the same time, ECGI has the advantage over other mapping technologies of allowing a global characterization of atrial electrical activity at every atrial beat and non-invasively. However, since ECGI is time-consuming and costly and the use of electrical mapping to guide AF ablation is still not fully established, the clinical value of ECGI for AF is still under assessment. Nonetheless, AF is known to be the manifestation of a complex interaction between electrical and structural abnormalities and therefore, true electro-anatomical-structural imaging may elucidate important key factors of AF development, progression, and treatment. Therefore, it is paramount to identify which clinical questions could be successfully addressed by ECGI when it comes to AF characterization and treatment, and which questions may be beyond its technical limitations. In this manuscript we review the questions that researchers have tried to address on the use of ECGI for AF characterization and treatment guidance (for example, localization of AF triggers and sustaining mechanisms), and we discuss the technological requirements and validation. We address experimental and clinical results, limitations, and future challenges for fruitful application of ECGI for AF understanding and management. We pay attention to existing techniques and clinical application, to computer models and (animal or human) experiments, to challenges of methodological and clinical validation. The overall objective of the study is to provide a consensus on valuable directions that ECGI research may take to provide future improvements in AF characterization and treatment guidance.
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Affiliation(s)
- João Salinet
- Biomedical Engineering, Centre for Engineering, Modelling and Applied Social Sciences (CECS), Federal University of ABC, São Bernardo do Campo, Brazil
| | - Rubén Molero
- ITACA Institute, Universitat Politècnica de València, València, Spain
| | - Fernando S. Schlindwein
- School of Engineering, University of Leicester, United Kingdom and National Institute for Health Research, Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Joël Karel
- Department of Data Science and Knowledge Engineering, Maastricht University, Maastricht, Netherlands
| | - Miguel Rodrigo
- Electronic Engineering Department, Universitat de València, València, Spain
| | - José Luis Rojo-Álvarez
- Department of Signal Theory and Communications and Telematic Systems and Computation, University Rey Juan Carlos, Madrid, Spain
| | - Omer Berenfeld
- Center for Arrhythmia Research, University of Michigan, Ann Arbor, MI, United States
| | - Andreu M. Climent
- ITACA Institute, Universitat Politècnica de València, València, Spain
| | - Brian Zenger
- Biomedical Engineering Department, Scientific Computing and Imaging Institute (SCI), and Cardiovascular Research and Training Institute (CVRTI), The University of Utah, Salt Lake City, UT, United States
| | - Frederique Vanheusden
- Department of Engineering, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - Jimena Gabriela Siles Paredes
- Biomedical Engineering, Centre for Engineering, Modelling and Applied Social Sciences (CECS), Federal University of ABC, São Bernardo do Campo, Brazil
| | - Rob MacLeod
- Biomedical Engineering Department, Scientific Computing and Imaging Institute (SCI), and Cardiovascular Research and Training Institute (CVRTI), The University of Utah, Salt Lake City, UT, United States
| | - Felipe Atienza
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, and Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - María S. Guillem
- ITACA Institute, Universitat Politècnica de València, València, Spain
| | - Matthijs Cluitmans
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Pietro Bonizzi
- Department of Data Science and Knowledge Engineering, Maastricht University, Maastricht, Netherlands
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Meo M, Denis A, Sacher F, Duchâteau J, Cheniti G, Puyo S, Bear L, Jaïs P, Hocini M, Haïssaguerre M, Bernus O, Dubois R. Insights Into the Spatiotemporal Patterns of Complexity of Ventricular Fibrillation by Multilead Analysis of Body Surface Potential Maps. Front Physiol 2020; 11:554838. [PMID: 33071814 PMCID: PMC7538856 DOI: 10.3389/fphys.2020.554838] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 08/12/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Ventricular fibrillation (VF) is the main cause of sudden cardiac death, but its mechanisms are still unclear. We propose a noninvasive approach to describe the progression of VF complexity from body surface potential maps (BSPMs). METHODS We mapped 252 VF episodes (16 ± 10 s) with a 252-electrode vest in 110 patients (89 male, 47 ± 18 years): 50 terminated spontaneously, otherwise by electrical cardioversion (DCC). Changes in complexity were assessed between the onset ("VF start") and the end ("VF end") of VF by the nondipolar component index (N D I B S P M ), measuring the fraction of energy nonpreserved by an equivalent 3D dipole from BSPMs. Higher NDI reflected lower VF organization. We also examined other standard body surface markers of VF dynamics, including fibrillatory wave amplitude (A BSPM ), surface cycle length (BsCL BSPM ) and Shannon entropy (S h E n B S P M ). Differences between patients with and without structural heart diseases (SHD, 32 vs. NSHD, 78) were also tested at those stages. Electrocardiographic features were validated with simultaneous endocardium cycle length (CL) in a subset of 30 patients. RESULTS All BSPM markers measure an increase in electrical complexity during VF (p < 0.0001), and more significantly in NSHD patients. Complexity is significantly higher at the end of sustained VF episodes requiring DCC. Intraepisode intracardiac CL shortening (VF start 197 ± 24 vs. VF end 169 ± 20 ms; p < 0.0001) correlates with an increase in NDI, and decline in surface CL, f-wave amplitude, and entropy (p < 0.0001). In SHD patients VF is initially more complex than in NSHD patients (N D I B S P M , p = 0.0007; S h E n B S P M , p < 0.0001), with moderately slower (BsCL BSPM , p = 0.06), low-amplitude f-waves (A BSPM , p < 0.0001). In this population, lower NDI (p = 0.004) and slower surface CL (p = 0.008) at early stage of VF predict self-termination. In the NSHD group, a more abrupt increase in VF complexity is quantified by all BSPM parameters during sustained VF (p < 0.0001), whereas arrhythmia evolution is stable during self-terminating episodes, hinting at additional mechanisms driving VF dynamics. CONCLUSION Multilead BSPM analysis underlines distinct degrees of VF complexity based on substrate characteristics.
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Affiliation(s)
- Marianna Meo
- Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Bordeaux, France
- Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, University of Bordeaux, Bordeaux, France
- Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Institut National de la Santé et de la Recherche Médicale, Bordeaux, France
| | - Arnaud Denis
- Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Bordeaux, France
- Electrophysiology and Ablation Unit, Bordeaux University Hospital, Bordeaux, France
| | - Frédéric Sacher
- Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Bordeaux, France
- Electrophysiology and Ablation Unit, Bordeaux University Hospital, Bordeaux, France
| | - Josselin Duchâteau
- Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Bordeaux, France
- Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, University of Bordeaux, Bordeaux, France
- Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Institut National de la Santé et de la Recherche Médicale, Bordeaux, France
- Electrophysiology and Ablation Unit, Bordeaux University Hospital, Bordeaux, France
| | - Ghassen Cheniti
- Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Bordeaux, France
- Electrophysiology and Ablation Unit, Bordeaux University Hospital, Bordeaux, France
| | - Stéphane Puyo
- Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Bordeaux, France
- Electrophysiology and Ablation Unit, Bordeaux University Hospital, Bordeaux, France
| | - Laura Bear
- Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Bordeaux, France
- Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, University of Bordeaux, Bordeaux, France
- Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Institut National de la Santé et de la Recherche Médicale, Bordeaux, France
| | - Pierre Jaïs
- Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Bordeaux, France
- Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, University of Bordeaux, Bordeaux, France
- Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Institut National de la Santé et de la Recherche Médicale, Bordeaux, France
- Electrophysiology and Ablation Unit, Bordeaux University Hospital, Bordeaux, France
| | - Mélèze Hocini
- Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Bordeaux, France
- Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, University of Bordeaux, Bordeaux, France
- Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Institut National de la Santé et de la Recherche Médicale, Bordeaux, France
- Electrophysiology and Ablation Unit, Bordeaux University Hospital, Bordeaux, France
| | - Michel Haïssaguerre
- Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Bordeaux, France
- Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, University of Bordeaux, Bordeaux, France
- Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Institut National de la Santé et de la Recherche Médicale, Bordeaux, France
- Electrophysiology and Ablation Unit, Bordeaux University Hospital, Bordeaux, France
| | - Olivier Bernus
- Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Bordeaux, France
- Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, University of Bordeaux, Bordeaux, France
- Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Institut National de la Santé et de la Recherche Médicale, Bordeaux, France
| | - Rémi Dubois
- Institute of Electrophysiology and Heart Modeling (IHU Liryc), Foundation Bordeaux University, Bordeaux, France
- Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, University of Bordeaux, Bordeaux, France
- Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Institut National de la Santé et de la Recherche Médicale, Bordeaux, France
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Maury P, Duchateau J, Rollin A, Hocini M, Voglimacci-Stephanopoli Q, Monteil B, Sacher F, Jaïs P, Bernus O, Mondoly P, Delmas C, Haïssaguerre M, Dubois R. Long-Lasting Ventricular Fibrillation in Humans ECG Characteristics and Effect of Radiofrequency Ablation. Circ Arrhythm Electrophysiol 2020; 13:e008639. [PMID: 32911973 DOI: 10.1161/circep.120.008639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Studies of ventricular fibrillation (VF) in humans are limited because of the short available duration. We sought to study surface ECG waveforms and effect of ablation in long-lasting VF in patients with left assist devices. METHODS Continuous 12-lead ECG of 5 episodes of long-lasting VF occurring in 3 patients with left ventricular assist device were analyzed. Spectral analysis (dominant frequency) and quantification of waveform amplitude, regularity (Unbiased Regularity Index), and complexity (Nondipolar Index) were performed over a median of 24 minutes of VF. Radiofrequency ablation was performed during VF in 2 patients. RESULTS There was a significant increase in dominant frequency between VF onset and termination but none of the other parameters significantly changed. Some VF parameters varied from patient to patient and from lead to lead. Dominant frequency decreased after radiofrequency ablation in both cases and VF terminated spontaneously shortly after ablation in one case. The previously incessant VFs in these 2 patients did not recur afterward. CONCLUSIONS VF rate increases over time in patients with left ventricular assist devices and is lowered by ablation. Long-lasting VF may be modified or even terminated by ablation.
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Affiliation(s)
- Philippe Maury
- Department of Cardiology, University Hospital Rangueil, Toulouse, France (P.M., A.R., Q.V.-S., B.M., P.M., C.D.).,Unité Inserm U 1048, Toulouse, France (P.M.)
| | - Josselin Duchateau
- Bordeaux University Hospital, France (J.D., M. Hocini, F.S., P.J., M. Haïssaguerre).,LIRYC Institute/INSERM 1045, Bordeaux University, France (J.D., M. Hocini, F.S., P.J., O.B., M. Haïssaguerre, R.D.)
| | - Anne Rollin
- Department of Cardiology, University Hospital Rangueil, Toulouse, France (P.M., A.R., Q.V.-S., B.M., P.M., C.D.)
| | - Meleze Hocini
- Bordeaux University Hospital, France (J.D., M. Hocini, F.S., P.J., M. Haïssaguerre).,LIRYC Institute/INSERM 1045, Bordeaux University, France (J.D., M. Hocini, F.S., P.J., O.B., M. Haïssaguerre, R.D.)
| | | | - Benjamin Monteil
- Department of Cardiology, University Hospital Rangueil, Toulouse, France (P.M., A.R., Q.V.-S., B.M., P.M., C.D.)
| | - Frederic Sacher
- Bordeaux University Hospital, France (J.D., M. Hocini, F.S., P.J., M. Haïssaguerre).,LIRYC Institute/INSERM 1045, Bordeaux University, France (J.D., M. Hocini, F.S., P.J., O.B., M. Haïssaguerre, R.D.)
| | - Pierre Jaïs
- Bordeaux University Hospital, France (J.D., M. Hocini, F.S., P.J., M. Haïssaguerre).,LIRYC Institute/INSERM 1045, Bordeaux University, France (J.D., M. Hocini, F.S., P.J., O.B., M. Haïssaguerre, R.D.)
| | - Olivier Bernus
- LIRYC Institute/INSERM 1045, Bordeaux University, France (J.D., M. Hocini, F.S., P.J., O.B., M. Haïssaguerre, R.D.)
| | - Pierre Mondoly
- Department of Cardiology, University Hospital Rangueil, Toulouse, France (P.M., A.R., Q.V.-S., B.M., P.M., C.D.)
| | - Clément Delmas
- Department of Cardiology, University Hospital Rangueil, Toulouse, France (P.M., A.R., Q.V.-S., B.M., P.M., C.D.)
| | - Michel Haïssaguerre
- Bordeaux University Hospital, France (J.D., M. Hocini, F.S., P.J., M. Haïssaguerre).,LIRYC Institute/INSERM 1045, Bordeaux University, France (J.D., M. Hocini, F.S., P.J., O.B., M. Haïssaguerre, R.D.)
| | - Rémi Dubois
- LIRYC Institute/INSERM 1045, Bordeaux University, France (J.D., M. Hocini, F.S., P.J., O.B., M. Haïssaguerre, R.D.)
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9
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Del-Canto I, Gómez-Cid L, Hernández-Romero I, Guillem MS, Fernández-Santos ME, Atienza F, Such L, Fernández-Avilés F, Chorro FJ, Climent AM. Ranolazine-Mediated Attenuation of Mechanoelectric Feedback in Atrial Myocyte Monolayers. Front Physiol 2020; 11:922. [PMID: 32848863 PMCID: PMC7417656 DOI: 10.3389/fphys.2020.00922] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/09/2020] [Indexed: 12/20/2022] Open
Abstract
Background Mechanical stretch increases Na+ inflow into myocytes, related to mechanisms including stretch-activated channels or Na+/H+ exchanger activation, involving Ca2+ increase that leads to changes in electrophysiological properties favoring arrhythmia induction. Ranolazine is an antianginal drug with confirmed beneficial effects against cardiac arrhythmias associated with the augmentation of INaL current and Ca2+ overload. Objective This study investigates the effects of mechanical stretch on activation patterns in atrial cell monolayers and its pharmacological response to ranolazine. Methods Confluent HL-1 cells were cultured in silicone membrane plates and were stretched to 110% of original length. The characteristics of in vitro fibrillation (dominant frequency, regularity index, density of phase singularities, rotor meandering, and rotor curvature) were analyzed using optical mapping in order to study the mechanoelectric response to stretch under control conditions and ranolazine action. Results HL-1 cell stretch increased fibrillatory dominant frequency (3.65 ± 0.69 vs. 4.35 ± 0.74 Hz, p < 0.01) and activation complexity (1.97 ± 0.45 vs. 2.66 ± 0.58 PS/cm2, p < 0.01) under control conditions. These effects were related to stretch-induced changes affecting the reentrant patterns, comprising a decrease in rotor meandering (0.72 ± 0.12 vs. 0.62 ± 0.12 cm/s, p < 0.001) and an increase in wavefront curvature (4.90 ± 0.42 vs. 5.68 ± 0.40 rad/cm, p < 0.001). Ranolazine reduced stretch-induced effects, attenuating the activation rate increment (12.8% vs. 19.7%, p < 0.01) and maintaining activation complexity—both parameters being lower during stretch than under control conditions. Moreover, under baseline conditions, ranolazine slowed and regularized the activation patterns (3.04 ± 0.61 vs. 3.65 ± 0.69 Hz, p < 0.01). Conclusion Ranolazine attenuates the modifications of activation patterns induced by mechanical stretch in atrial myocyte monolayers.
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Affiliation(s)
- Irene Del-Canto
- INCLIVA Health Research Institute, Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, Valencia, Spain.,Department of Electronic Engineering, Universitat Politècnica de València, Valencia, Spain
| | - Lidia Gómez-Cid
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, Madrid, Spain
| | | | - María S Guillem
- ITACA Institute, Universitat Politècnica de València, Valencia, Spain
| | - María Eugenia Fernández-Santos
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, Madrid, Spain
| | - Felipe Atienza
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, Madrid, Spain
| | - Luis Such
- INCLIVA Health Research Institute, Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, Valencia, Spain.,Department of Physiology, Universitat de València Estudi General, Valencia, Spain
| | - Francisco Fernández-Avilés
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, Madrid, Spain
| | - Francisco J Chorro
- INCLIVA Health Research Institute, Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, Valencia, Spain.,Department of Cardiology, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain
| | - Andreu M Climent
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, Madrid, Spain.,ITACA Institute, Universitat Politècnica de València, Valencia, Spain
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10
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The impact of the dominant frequency of body surface electrocardiography in patients with persistent atrial fibrillation. Heart Vessels 2020; 35:967-976. [PMID: 32016538 DOI: 10.1007/s00380-020-01563-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 01/24/2020] [Indexed: 10/25/2022]
Abstract
The dominant frequency (DF) of atrial fibrillation (AF) reflects atrial electrical activity. However, the relationship between DF measured using surface electrocardiography (ECG) and AF ablation success remains unclear. This study aimed to clarify whether the DF of surface ECG in patients with persistent AF could predict arrhythmia recurrence after catheter ablation. We investigated 125 patients with persistent AF who underwent catheter ablation between January 2009 and December 2016. Thirty-four patients (27%) had arrhythmia recurrence after catheter ablation. These patients showed a significantly high DF value in leads aVL (7.2 ± 0.7 Hz vs 6.6 ± 0.9 Hz, p < 0.001) and V1 (7.4 ± 0.8 Hz vs 6.7 ± 0.7 Hz, p < 0.001). We set the cutoff value of DF as 6.9 Hz in lead aVL (sensitivity, 80%; specificity, 63%) and as 7.1 Hz in lead V1 (sensitivity, 72%; specificity, 67%). Patients with DF < 6.9 Hz in lead aVL showed a significantly higher recurrence-free rate than those with DF ≥ 6.9 Hz (88% vs 45%; p < 0.001). Patients with DF of < 7.1 Hz in lead V1 showed a significantly higher recurrence-free rate than those with DF of ≥ 7.1 (87% vs 47%; p < 0.001). Patients with a high DF in leads aVL and V1 showed a lower success rate of persistent AF ablation. The DF measured from surface ECG can be a useful marker to predict ablation success.
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11
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Ganesan P, Cherry EM, Huang DT, Pertsov AM, Ghoraani B. Locating Atrial Fibrillation Rotor and Focal Sources Using Iterative Navigation of Multipole Diagnostic Catheters. Cardiovasc Eng Technol 2019; 10:354-366. [PMID: 30989616 PMCID: PMC6527788 DOI: 10.1007/s13239-019-00414-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 04/08/2019] [Indexed: 01/14/2023]
Abstract
Purpose Multi-polar diagnostic catheters are used to construct the 3D electro-anatomic mapping of the atrium during atrial fibrillation (AF) ablation procedures; however, it remains unclear how to use the electrograms recorded by these catheters to locate AF-driving sites known as focal and rotor source types. The purpose of this study is to present the first algorithm to iteratively navigate a circular multi-polar catheter to locate AF focal and rotor sources without the need to map the entire atria. Methods Starting from an initial location, the algorithm, which was blinded to the location and type of the AF source, iteratively advanced a Lasso catheter based on its electrogram characteristics. The algorithm stopped the catheter when it located of an AF source and identified the type. The efficiency of the algorithm is validated using a set of simulated focal and rotor-driven arrhythmias in fibrotic human 2D and 3D atrial tissue. Results Our study shows the feasibility of locating AF sources with a success rate of greater than 95.25% within average 7.56 ± 2.28 placements independently of the initial position of the catheter and the source type. Conclusions The algorithm could play a critical role in clinical electrophysiology laboratories for mapping patient-specific ablation of AF sources located outside the pulmonary veins and improving the procedure success. Electronic supplementary material The online version of this article (10.1007/s13239-019-00414-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Prasanth Ganesan
- Department of Computer and Electrical Engineering, Florida Atlantic University, Boca Raton, FL, USA
| | - Elizabeth M Cherry
- School of Mathematical Sciences, Rochester Institute of Technology, Rochester, NY, USA
| | - David T Huang
- Department of Cardiology, University of Rochester Medical Center, Rochester, NY, USA
| | - Arkady M Pertsov
- Department of Pharmacology, SUNY Upstate Medical Center, Syracuse, NY, USA
| | - Behnaz Ghoraani
- Department of Computer and Electrical Engineering, Florida Atlantic University, Boca Raton, FL, USA. .,, 777 Glades Road, EE (Bldg. 96) Room 319, Boca Raton, FL, 33431, USA.
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12
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Ganesan P, Salmin A, Cherry EM, Huang DT, Pertsov AM, Ghoraani B. Iterative navigation of multipole diagnostic catheters to locate repeating-pattern atrial fibrillation drivers. J Cardiovasc Electrophysiol 2019; 30:758-768. [PMID: 30725499 PMCID: PMC6554033 DOI: 10.1111/jce.13872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/16/2019] [Accepted: 01/31/2019] [Indexed: 01/01/2023]
Abstract
Introduction Targeting repeating‐pattern atrial fibrillation (AF) sources (reentry or focal drivers) can help in patient‐specific ablation therapy for AF; however, the development of reliable and accurate tools for locating such sources remains a major challenge. We describe iterative catheter navigation (ICAN) algorithm to locate AF drivers using a conventional circular Lasso catheter. Methods and Results At each step, the algorithm analyzes 10 bipolar electrograms recoded at a given catheter location and the history of previous catheter movements to determine if the source is inside the catheter loop. If not, it calculates new coordinates and selects a new position for the catheter. The process continues until a source is located. The algorithm was evaluated in a computer model of atrial tissue with various degrees of fibrosis under a broad range of arrhythmia scenarios. The latter included slow and fast reentry, macroreentry, figure‐of‐eight reentry, and fibrillatory conduction. Depending on the initial distance of the catheter from the source and scenario, it took about 3 to 16 steps to localize an AF source. In 94% of cases, the identified location was within 4 mm from the source, independently of the initial position of the catheter. The algorithm worked equally well in the presence of patchy fibrosis, low‐voltage areas, fragmented electrograms, and dominant‐frequency gradients. Conclusions AF repeating‐pattern sources can be localized using circular catheters without the need to map the entire tissue. The proposed algorithm has the potential to become a useful tool for patient‐specific ablation of AF sources located outside the pulmonary veins.
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Affiliation(s)
- Prasanth Ganesan
- Computer and Electrical Engineering and Computer Science, Florida Atlantic University, Boca Raton, Florida
| | - Anthony Salmin
- School of Mathematical Sciences, Rochester Institute of Technology, Rochester, New York
| | - Elizabeth M Cherry
- School of Mathematical Sciences, Rochester Institute of Technology, Rochester, New York
| | - David T Huang
- Department of Cardiology, University of Rochester Medical Center, Rochester, New York
| | - Arkady M Pertsov
- Department of Pharmacology, SUNY Upstate Medical Center, Syracuse, New York
| | - Behnaz Ghoraani
- Computer and Electrical Engineering and Computer Science, Florida Atlantic University, Boca Raton, Florida
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