1
|
Riccio J, Alcaine A, Rocher S, Martinez-Mateu L, Laranjo S, Saiz J, Laguna P, Martínez JP. Characterization of Atrial Propagation Patterns and Fibrotic Substrate With a Modified Omnipolar Electrogram Strategy in Multi-Electrode Arrays. Front Physiol 2021; 12:674223. [PMID: 34539424 PMCID: PMC8446360 DOI: 10.3389/fphys.2021.674223] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 07/13/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction: The omnipolar electrogram method was recently proposed to try to generate orientation-independent electrograms. It estimates the electric field from the bipolar electrograms of a clique, under the assumption of locally plane and homogeneous propagation. The local electric field evolution over time describes a loop trajectory from which omnipolar signals in the propagation direction, substrate and propagation features, are derived. In this work, we propose substrate and conduction velocity mapping modalities based on a modified version of the omnipolar electrogram method, which aims to reduce orientation-dependent residual components in the standard approach. Methods: A simulated electrical propagation in 2D, with a tissue including a circular patch of diffuse fibrosis, was used for validation. Unipolar electrograms were calculated in a multi-electrode array, also deriving bipolar electrograms along the two main directions of the grid. Simulated bipolar electrograms were also contaminated with real noise, to assess the robustness of the mapping strategies against noise. The performance of the maps in identifying fibrosis and in reproducing unipolar reference voltage maps was evaluated. Bipolar voltage maps were also considered for performance comparison. Results: Results show that the modified omnipolar mapping strategies are more accurate and robust against noise than bipolar and standard omnipolar maps in fibrosis detection (accuracies higher than 85 vs. 80% and 70%, respectively). They present better correlation with unipolar reference voltage maps than bipolar and original omnipolar maps (Pearson's correlations higher than 0.75 vs. 0.60 and 0.70, respectively). Conclusion: The modified omnipolar method improves fibrosis detection, characterization of substrate and propagation, also reducing the residual sensitivity to directionality over the standard approach and improving robustness against noise. Nevertheless, studies with real electrograms will elucidate its impact in catheter ablation interventions.
Collapse
Affiliation(s)
- Jennifer Riccio
- Biomedical Signal Interpretation and Computational Simulation Group, Aragón Institute of Engineering Research, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain
| | - Alejandro Alcaine
- Biomedical Signal Interpretation and Computational Simulation Group, Aragón Institute of Engineering Research, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain.,Facultad de Ciencias de la Salud, Universidad San Jorge, Zaragoza, Spain.,Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Zaragoza, Spain
| | - Sara Rocher
- Centro de Investigación e Innovación en Ingeniería, Universitat Politècnica de València, Valencia, Spain
| | - Laura Martinez-Mateu
- Departamento de Teoría de la Señal y Comunicaciones y Sistemas Telemáticos y Computación, Universidad Rey Juan Carlos, Madrid, Spain
| | - Sergio Laranjo
- Department of Pediatric Cardiology, Hospital Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Javier Saiz
- Centro de Investigación e Innovación en Ingeniería, Universitat Politècnica de València, Valencia, Spain
| | - Pablo Laguna
- Biomedical Signal Interpretation and Computational Simulation Group, Aragón Institute of Engineering Research, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain.,Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Zaragoza, Spain
| | - Juan Pablo Martínez
- Biomedical Signal Interpretation and Computational Simulation Group, Aragón Institute of Engineering Research, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain.,Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, Zaragoza, Spain
| |
Collapse
|
2
|
Jimenez-Perez G, Alcaine A, Camara O. Delineation of the electrocardiogram with a mixed-quality-annotations dataset using convolutional neural networks. Sci Rep 2021; 11:863. [PMID: 33441632 PMCID: PMC7806759 DOI: 10.1038/s41598-020-79512-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 12/08/2020] [Indexed: 11/16/2022] Open
Abstract
Detection and delineation are key steps for retrieving and structuring information of the electrocardiogram (ECG), being thus crucial for numerous tasks in clinical practice. Digital signal processing (DSP) algorithms are often considered state-of-the-art for this purpose but require laborious rule readaptation for adapting to unseen morphologies. This work explores the adaptation of the the U-Net, a deep learning (DL) network employed for image segmentation, to electrocardiographic data. The model was trained using PhysioNet's QT database, a small dataset of 105 2-lead ambulatory recordings, while being independently tested for many architectural variations, comprising changes in the model's capacity (depth, width) and inference strategy (single- and multi-lead) in a fivefold cross-validation manner. This work features several regularization techniques to alleviate data scarcity, such as semi-supervised pre-training with low-quality data labels, performing ECG-based data augmentation and applying in-built model regularizers. The best performing configuration reached precisions of 90.12%, 99.14% and 98.25% and recalls of 98.73%, 99.94% and 99.88% for the P, QRS and T waves, respectively, on par with DSP-based approaches. Despite being a data-hungry technique trained on a small dataset, a U-Net based approach demonstrates to be a viable alternative for this task.
Collapse
Affiliation(s)
- Guillermo Jimenez-Perez
- PhySense research group, BCN-MedTech, Department of Information and Communication Technologies, Barcelona, 08018, Spain.
| | - Alejandro Alcaine
- Facultad de Ciencias de la Salud, Universidad San Jorge, Zaragoza, 05830, Spain
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) group, Aragón Institute of Engineering Research, Zaragoza, 50018, Spain
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, 28029, Spain
| | - Oscar Camara
- PhySense research group, BCN-MedTech, Department of Information and Communication Technologies, Barcelona, 08018, Spain
| |
Collapse
|
3
|
Doste R, Sebastian R, Gomez JF, Soto-Iglesias D, Alcaine A, Mont L, Berruezo A, Penela D, Camara O. In silico pace-mapping: prediction of left vs. right outflow tract origin in idiopathic ventricular arrhythmias with patient-specific electrophysiological simulations. Europace 2020; 22:1419-1430. [PMID: 32607538 DOI: 10.1093/europace/euaa102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/09/2020] [Indexed: 11/12/2022] Open
Abstract
AIMS A pre-operative non-invasive identification of the site of origin (SOO) of outflow tract ventricular arrhythmias (OTVAs) is important to properly plan radiofrequency ablation procedures. Although some algorithms based on electrocardiograms (ECGs) have been developed to predict left vs. right ventricular origins, their accuracy is still limited, especially in complex anatomies. The aim of this work is to use patient-specific electrophysiological simulations of the heart to predict the SOO in OTVA patients. METHODS AND RESULTS An in silico pace-mapping procedure was designed and used on 11 heart geometries, generating for each case simulated ECGs from 12 clinically plausible SOO. Subsequently, the simulated ECGs were compared with patient ECG data obtained during the clinical tachycardia using the 12-lead correlation coefficient (12-lead ρ). Left ventricle (LV) vs. right ventricle (RV) SOO was estimated by computing the LV/RV ratio for each patient, obtained by dividing the average 12-lead ρ value of the LV- and RV-SOO simulated ECGs, respectively. Simulated ECGs that had virtual sites close to the ablation points that stopped the arrhythmia presented higher correlation coefficients. The LV/RV ratio correctly predicted LV vs. RV SOO in 10/11 cases; 1.07 vs. 0.93 P < 0.05 for 12-lead ρ. CONCLUSION The obtained results demonstrate the potential of the developed in silico pace-mapping technique to complement standard ECG for the pre-operative planning of complex ventricular arrhythmias.
Collapse
Affiliation(s)
- Ruben Doste
- Department of Information and Communication Technologies, Physense, Universitat Pompeu Fabra, Barcelona, Spain
| | - Rafael Sebastian
- Department of Computer Science, Computational Multiscale Simulation Lab (CoMMLab), Universitat de Valencia, Valencia, Spain
| | | | | | - Alejandro Alcaine
- Department of Information and Communication Technologies, Physense, Universitat Pompeu Fabra, Barcelona, Spain
| | - Lluis Mont
- Department of Cardiology, Unitat de Fibril lacio Auricular (UFA), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | | | - Diego Penela
- Heart Institute, Teknon Medical Center, Barcelona, Spain
| | - Oscar Camara
- Department of Information and Communication Technologies, Physense, Universitat Pompeu Fabra, Barcelona, Spain
| |
Collapse
|
4
|
Doste R, Soto-Iglesias D, Bernardino G, Alcaine A, Sebastian R, Giffard-Roisin S, Sermesant M, Berruezo A, Sanchez-Quintana D, Camara O. A rule-based method to model myocardial fiber orientation in cardiac biventricular geometries with outflow tracts. Int J Numer Method Biomed Eng 2019; 35:e3185. [PMID: 30721579 DOI: 10.1002/cnm.3185] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 10/23/2018] [Accepted: 01/05/2019] [Indexed: 06/09/2023]
Abstract
Rule-based methods are often used for assigning fiber orientation to cardiac anatomical models. However, existing methods have been developed using data mostly from the left ventricle. As a consequence, fiber information obtained from rule-based methods often does not match histological data in other areas of the heart such as the right ventricle, having a negative impact in cardiac simulations beyond the left ventricle. In this work, we present a rule-based method where fiber orientation is separately modeled in each ventricle following observations from histology. This allows to create detailed fiber orientation in specific regions such as the endocardium of the right ventricle, the interventricular septum, and the outflow tracts. We also carried out electrophysiological simulations involving these structures and with different fiber configurations. In particular, we built a modeling pipeline for creating patient-specific volumetric meshes of biventricular geometries, including the outflow tracts, and subsequently simulate the electrical wavefront propagation in outflow tract ventricular arrhythmias with different origins for the ectopic focus. The resulting simulations with the proposed rule-based method showed a very good agreement with clinical parameters such as the 10 ms isochrone ratio in a cohort of nine patients suffering from this type of arrhythmia. The developed modeling pipeline confirms its potential for an in silico identification of the site of origin in outflow tract ventricular arrhythmias before clinical intervention.
Collapse
Affiliation(s)
- Ruben Doste
- Physense, ETIC, Universitat Pompeu Fabra, Barcelona, Spain
| | | | | | | | - Rafael Sebastian
- Computational Multiscale Simulation Lab (CoMMLab), Department of Computer Science, Universitat de Valencia, Valencia, Spain
| | | | | | - Antonio Berruezo
- Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Damian Sanchez-Quintana
- Department of Anatomy and Cell Biology, Faculty of Medicine, University of Extremadura, Badajoz, Spain
| | - Oscar Camara
- Physense, ETIC, Universitat Pompeu Fabra, Barcelona, Spain
| |
Collapse
|
5
|
Alcaine A, Soto-Iglesias D, Acosta J, Korshunov V, Penela D, Andreu D, Fernandez-Armenta J, Laguna P, Martinez JP, Camara O, Berruezo A. P780Clinical evaluation of an automatic activation mapping algorithm for identifying the site of origin of idiopathic ventricular arrhythmias. Europace 2018. [DOI: 10.1093/europace/euy015.384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Alcaine
- University of Zaragoza, BSICoS Group, Aragon Institute of Engineering Research, IIS Aragón, Zaragoza, Spain
| | - D Soto-Iglesias
- Hospital Clínic, Arrhythmia Section, Cardiology Department, Thorax Institute, Barcelona, Spain
| | - J Acosta
- Hospital Clínic, Arrhythmia Section, Cardiology Department, Thorax Institute, Barcelona, Spain
| | - V Korshunov
- Hospital Clínic, Arrhythmia Section, Cardiology Department, Thorax Institute, Barcelona, Spain
| | - D Penela
- Hospital Clínic, Arrhythmia Section, Cardiology Department, Thorax Institute, Barcelona, Spain
| | - D Andreu
- Hospital Clínic, Arrhythmia Section, Cardiology Department, Thorax Institute, Barcelona, Spain
| | - J Fernandez-Armenta
- Hospital Clínic, Arrhythmia Section, Cardiology Department, Thorax Institute, Barcelona, Spain
| | - P Laguna
- University of Zaragoza, BSICoS Group, Aragon Institute of Engineering Research, IIS Aragón, Zaragoza, Spain
| | - J P Martinez
- University of Zaragoza, BSICoS Group, Aragon Institute of Engineering Research, IIS Aragón, Zaragoza, Spain
| | - O Camara
- University Pompeu Fabra, PhySense Group, Departament of Information and Communication Technologies, Barcelona, Spain
| | - A Berruezo
- Hospital Clínic, Arrhythmia Section, Cardiology Department, Thorax Institute, Barcelona, Spain
| |
Collapse
|
6
|
Doste R, Soto-Iglesias D, Alcaine A, Giffard-Roisin S, Sermesant M, Berruezo A, Camara O. P457Prediction of the site of origin in outflow tract ventricular arrhythmias with electrophysiological simulations. Europace 2018. [DOI: 10.1093/europace/euy015.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- R Doste
- University Pompeu Fabra, Physense, Barcelona, Spain
| | | | - A Alcaine
- University Pompeu Fabra, Physense, Barcelona, Spain
| | | | - M Sermesant
- Inria, Asclepios Resarch Group, Sophia-Antipolis, France
| | - A Berruezo
- Hospital Clinic de Barcelona, Arrhythmia Section, Barcelona, Spain
| | - O Camara
- University Pompeu Fabra, Physense, Barcelona, Spain
| |
Collapse
|
7
|
Alcaine A, Soto-Iglesias D, Acosta J, Penela D, Andreu D, Fernandez-Armenta J, Laguna P, Camara O, Martinez JP, Berruezo A. P778Slow conducting channel identification from electroanatomical maps using an automatic algorithm in patients with scar-related ventricular arrhythmias. Europace 2018. [DOI: 10.1093/europace/euy015.382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Alcaine
- University Pompeu Fabra, PhySense Group, Departament of Information and Communication Technologies, Barcelona, Spain
| | - D Soto-Iglesias
- Hospital Clínic, Arrhythmia Section, Cardiology Department, Thorax Institute, Barcelona, Spain
| | - J Acosta
- Hospital Clínic, Arrhythmia Section, Cardiology Department, Thorax Institute, Barcelona, Spain
| | - D Penela
- Hospital Clínic, Arrhythmia Section, Cardiology Department, Thorax Institute, Barcelona, Spain
| | - D Andreu
- Hospital Clínic, Arrhythmia Section, Cardiology Department, Thorax Institute, Barcelona, Spain
| | - J Fernandez-Armenta
- Hospital Clínic, Arrhythmia Section, Cardiology Department, Thorax Institute, Barcelona, Spain
| | - P Laguna
- University of Zaragoza, BSICoS Group, Aragon Institute of Engineering Research, IIS Aragón, Zaragoza, Spain
| | - O Camara
- University Pompeu Fabra, PhySense Group, Departament of Information and Communication Technologies, Barcelona, Spain
| | - J P Martinez
- University of Zaragoza, BSICoS Group, Aragon Institute of Engineering Research, IIS Aragón, Zaragoza, Spain
| | - A Berruezo
- Hospital Clínic, Arrhythmia Section, Cardiology Department, Thorax Institute, Barcelona, Spain
| |
Collapse
|
8
|
Acosta J, Soto-Iglesias D, Fernández-Armenta J, Frutos-López M, Jáuregui B, Arana-Rueda E, Fernández M, Penela D, Alcaine A, Cano L, Pedrote A, Berruezo A. Clinical validation of automatic local activation time annotation during focal premature ventricular complex ablation procedures. Europace 2017; 20:f171-f178. [DOI: 10.1093/europace/eux306] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 09/04/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Juan Acosta
- Arrhythmia Section, Department of Cardiology, Virgen del Rocío University Hospital, Avda Manuel Siurot s/n, Seville, Spain
| | - David Soto-Iglesias
- Arrhythmia Section, Department of Cardiology, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d’Investigació Agustí Pi i Sunyer), C/Villarroel 170, Barcelona, Catalonia, Spain
| | - Juan Fernández-Armenta
- Arrhythmia Section, Department of Cardiology, Puerta del Mar University Hospital, C/ Ana de Viya 21. Cádiz, Spain
| | - Manuel Frutos-López
- Arrhythmia Section, Department of Cardiology, Virgen del Rocío University Hospital, Avda Manuel Siurot s/n, Seville, Spain
| | - Beatriz Jáuregui
- Arrhythmia Section, Department of Cardiology, Virgen del Rocío University Hospital, Avda Manuel Siurot s/n, Seville, Spain
| | - Eduardo Arana-Rueda
- Arrhythmia Section, Department of Cardiology, Virgen del Rocío University Hospital, Avda Manuel Siurot s/n, Seville, Spain
| | - Marcos Fernández
- Arrhythmia Section, Department of Cardiology, Puerta del Mar University Hospital, C/ Ana de Viya 21. Cádiz, Spain
| | - Diego Penela
- Arrhythmia Section, Department of Cardiology, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d’Investigació Agustí Pi i Sunyer), C/Villarroel 170, Barcelona, Catalonia, Spain
| | - Alejandro Alcaine
- PhySense Group, Department de Tecnologies de la Informació i les Comunicacions (DTIC), Universitat Pompeu Fabra, Carrer Roc Boronat 138, Tànger Building, Office 55.107, Barcelona, Spain
| | - Lucas Cano
- Arrhythmia Section, Department of Cardiology, Puerta del Mar University Hospital, C/ Ana de Viya 21. Cádiz, Spain
| | - Alonso Pedrote
- Arrhythmia Section, Department of Cardiology, Virgen del Rocío University Hospital, Avda Manuel Siurot s/n, Seville, Spain
| | - Antonio Berruezo
- Arrhythmia Section, Department of Cardiology, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d’Investigació Agustí Pi i Sunyer), C/Villarroel 170, Barcelona, Catalonia, Spain
| |
Collapse
|
9
|
Alcaine A, Soto-Iglesias D, Acosta J, Korshunov V, Penela D, Martínez M, Linhart M, Andreu D, Fernández-Armenta J, Laguna P, Martínez JP, Camara O, Berruezo A. Automatic activation mapping and origin identification of idiopathic outflow tract ventricular arrhythmias. J Electrocardiol 2017; 51:239-246. [PMID: 29242053 DOI: 10.1016/j.jelectrocard.2017.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Indexed: 11/17/2022]
Abstract
PURPOSE Activation mapping is used to guide ablation of idiopathic outflow tract ventricular arrhythmias (OTVAs). Isochronal activation maps help to predict the site of origin (SOO): left vs right outflow tract (OT). We evaluate an algorithm for automatic activation mapping based on the onset of the bipolar electrogram (EGM) signal for predicting the SOO and the effective ablation site in OTVAs. METHODS Eighteen patients undergoing ablation due to idiopathic OTVAs were studied (12 with left ventricle OT origin). Right ventricle activation maps were obtained offline with an automatic algorithm and compared with manual annotation maps obtained during the intervention. Local activation time (LAT) accuracy was assessed, as well as the performance of the 10ms earliest activation site (EAS) isochronal area in predicting the SOO. RESULTS High correlation was observed between manual and automatic LATs (Spearman's: 0.86 and Lin's: 0.85, both p<0.01). The EAS isochronal area were closely located in both map modalities (5.55 ± 3.56mm) and at a similar distance from the effective ablation site (0.15±2.08mm difference, p=0.859). The 10ms isochronal area longitudinal/perpendicular diameter ratio measured from automatic maps showed slightly superior SOO identification (67% sensitivity, 100% specificity) compared with manual maps (67% sensitivity, 83% specificity). CONCLUSIONS Automatic activation mapping based on the bipolar EGM onset allows fast, accurate and observer-independent identification of the SOO and characterization of the spreading of the activation wavefront in OTVAs.
Collapse
Affiliation(s)
- Alejandro Alcaine
- BSICoS Group, Aragón Institute of Engineering Research (I3A), IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain; CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - David Soto-Iglesias
- Arrhythmia Section, Cardiology Dept., Thorax Institute, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Juan Acosta
- IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Viatcheslav Korshunov
- Arrhythmia Section, Cardiology Dept., Thorax Institute, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Diego Penela
- IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Mikel Martínez
- Arrhythmia Section, Cardiology Dept., Thorax Institute, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Markus Linhart
- Arrhythmia Section, Cardiology Dept., Thorax Institute, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - David Andreu
- IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | | | - Pablo Laguna
- BSICoS Group, Aragón Institute of Engineering Research (I3A), IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain; CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - Juan Pablo Martínez
- BSICoS Group, Aragón Institute of Engineering Research (I3A), IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain; CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - Oscar Camara
- Physense Group, Dept. of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Antonio Berruezo
- Arrhythmia Section, Cardiology Dept., Thorax Institute, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; IDIBAPS (Institut d'Investigació Agustí Pi i Sunyer), Barcelona, Spain.
| |
Collapse
|
10
|
Alcaine A, Mase M, Cristoforetti A, Ravelli F, Nollo G, Laguna P, Martinez JP, Faes L. A Multi-Variate Predictability Framework to Assess Invasive Cardiac Activity and Interactions During Atrial Fibrillation. IEEE Trans Biomed Eng 2017; 64:1157-1168. [DOI: 10.1109/tbme.2016.2592953] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
11
|
Alcaine A, Soto-Iglesias D, Calvo M, Guiu E, Andreu D, Fernandez-Armenta J, Berruezo A, Laguna P, Camara O, Martinez JP. A Wavelet-Based Electrogram Onset Delineator for Automatic Ventricular Activation Mapping. IEEE Trans Biomed Eng 2014; 61:2830-9. [DOI: 10.1109/tbme.2014.2330847] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
12
|
Lázaro J, Alcaine A, Romero D, Gil E, Laguna P, Pueyo E, Bailón R. Electrocardiogram Derived Respiratory Rate from QRS Slopes and R-Wave Angle. Ann Biomed Eng 2014; 42:2072-83. [DOI: 10.1007/s10439-014-1073-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 07/16/2014] [Indexed: 12/01/2022]
|
13
|
Arruti N, Rebollo A, Mezquita G, Alcaine A, Andonegui J. [Use of ocular drugs in pregnancy]. An Sist Sanit Navar 2014; 36:479-87. [PMID: 24406361 DOI: 10.4321/s1137-66272013000300013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The information available on the safety of medicines in pregnant women is limited and must be suitably channeled. Medication that is applied topically or as eye drops can present relevant systemic absorption and cross the placenta barrier or enter maternal milk. We have reviewed ophthalmic medicines according to the fetal risk categories proposed by the classification of the Food and Drug Administration (FDA). We evaluate the medicines of choice in the most frequent ophthalmic pathologies, as well as the medicines that must be avoided.
Collapse
Affiliation(s)
- N Arruti
- Servicio de Oftalmología A, Complejo Hospitalario de Navarra, Pamplona 31008, Spain.
| | | | | | | | | |
Collapse
|
14
|
Lazaro JL, Alcaine A, Gil E, Laguna P, Bailón R. Electrocardiogram derived respiration from QRS slopes. Annu Int Conf IEEE Eng Med Biol Soc 2013; 2013:3913-3916. [PMID: 24110587 DOI: 10.1109/embc.2013.6610400] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A method for estimation of respiratory rate from electrocardiogram (ECG) signals, based on variations in slopes of QRS complexes, is presented. 12 standard leads, 3 leads from vectorcardiogram (VCG), and 2 additional non-standard leads derived from VCG loops were analysed. A total of 34 slope series were studied, 2 for each analysed lead: slopes between the peak of Q and R waves, and between the peak of R and S waves. Information of QRS slopes series was combined in order to increase the robustness of estimation. Evaluation is performed over a database containing ECG and respiratory signals simultaneously recorded in 17 subjects spontaneously breathing during a tilt table test. Respiratory rate estimation is performed with information of 4 different combinations of QRS slope series. The best results in respiratory rate estimation error terms are 0.72 ± 4.34%(0.46 ± 7.59 mHz). These results outperform those obtained with other known methods, motivating the use of QRS slopes to obtain reliable respiratory rate estimates.
Collapse
|
15
|
Hernando D, Alcaine A, Laguna P, Pueyo E, Bailon R. Very low frequency modulation in QRS slopes and its relation with respiration and heart rate variability during hemodialysis. Annu Int Conf IEEE Eng Med Biol Soc 2013; 2013:5365-5368. [PMID: 24110948 DOI: 10.1109/embc.2013.6610761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In this work, we study the very low frequency (VLF) modulation (range 0.01-0.03 Hz) in QRS slopes, heart rate variability (HRV) and ECG-derived respiration in hemodialysis patients. First, the relation between QRS slopes and HRV in the VLF band is measured using ordinary coherence. Then, partial coherence is used to measure the former relationship once the effect related to respiration is removed. Ordinary coherence values above a statistical threshold revealed linear relationship between VLF modulation in QRS slopes and HRV in about 10% of analyzed segments, with mean ± SD values of 0.79 ± 0.07 for upward slope and 0.77 ± 0.06 for downward slope. For these segments, partial coherence values drop below the threshold for 64% of the cases for upward slope and 76% for downward slope, suggesting that the origin of the VLF modulation in QRS slopes is mainly driven by respiration or linearly related to it. In the rest of the cases, partial coherence values dropped with respect to ordinary coherence from 0.89 to 0.77 for upward slope and from 0.86 to 0.75 for downward slope, suggesting that other ANS effects non-linearly related to respiration also contribute to the VLF modulation in QRS slopes.
Collapse
|
16
|
Campo JM, Pascual JL, Martínez Arrieta F, Diego M, Alcaine A, Hebrero J, Milazzo A. [Diagnostic aspects of insulinoma. Apropos of 2 cases]. Rev Esp Enferm Apar Dig 1981; 60:481-90. [PMID: 6276946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|