Top stories on catheter ablation of atrial fibrillation in patients with congenital heart defects

Biomechanical EngineeringSignal Processing System

Joint cardiac tissue conductivity and activation time estimation using confirmatory factor analysis

Mathematical models of the electrophysiology of cardiac tissue play an important role when studying heart rhythm disorders like atrial fibrillation. Model parameters such as conductivity, activation time, and anisotropy ratio are useful parameters to determine the arrhythmogenic substrate that causes abnormalities in the atrial tissue. Existing methods often estimate the model parameters separately and assume some of the parameters to be known as a priori knowledge. In this work, we propose an efficient method to jointly estimate the parameters of interest from the cross power spectral density matrix (CPSDM) model of the electrograms. By applying confirmatory factor analysis (CFA) to the CPSDMs of multi-electrode electrograms, we can make use of the spatial information of the data and analyze the relationship between the desired resolution and the required amount of data. With the reasonable assumptions that the conductivity parameters and the anisotropy parameters are constant across different frequencies and heart beats, we estimate these parameters using multiple frequencies and multiple heart beats simultaneously to easier satisfy the identifiability conditions in the CFA problem. Results on the simulated data show that using multiple heart beats decreases the estimation errors of the conductivity and the estimated activation time parameters. The experimental results on clinical data show that using multiple heart beats for parameter estimation can reduce the reconstruction errors of the clinical electrograms, which further demonstrates the robustness of the proposed method.Circuits and System

Cardiac tissue conductivity estimation using confirmatory factor analysis

Impaired electrical conduction has been shown to play an important role in the development of heart rhythm disorders. Being able to determine the conductivity is important to localize the arrhythmogenic substrate that causes abnormalities in atrial tissue. In this work, we present an algorithm to estimate the conductivity from epicardial electrograms (EGMs) using a high-resolution electrode array. With these arrays, it is possible to measure the propagation of the extracellular potential of the cardiac tissue at multiple positions simultaneously. Given this data, it is in principle possible to estimate the tissue conductivity. However, this is an ill-posed problem due to the large number of unknown parameters in the electrophysiological data model. In this paper, we make use of an effective method called confirmatory factor analysis (CFA), which we apply to the cross correlation matrix of the data to estimate the tissue conductivity. CFA comes with identifiability conditions that need to be satisfied to solve the problem, which is, in this case, estimation of the tissue conductivity. These identifiability conditions can be used to find the relationship between the desired resolution and the required amount of data. Numerical experiments on the simulated data demonstrate that the proposed method can localize the conduction blocks in the tissue and can also estimate the smoother variation in the conductivities. The conductivity values estimated from the clinical data are in line with the values reported in literature and the EGMs reconstructed based on the estimated parameters match well with the clinical EGMs.Circuits and System

Estimation of Cardiac Fibre Direction Based on Activation Maps

Estimating tissue conductivity parameters from electrograms (EGMs) could be an important tool for diagnosing and treating heart rhythm disorders such as atrial fibrillation (AF). One of these parameters is the fibre direction, often assumed to be known in conductivity estimation methods. In this paper, a novel method to estimate the fibre direction from EGMs is presented. This method is based on local conduction slowness vectors of a propagating activation wave. These conduction slowness vectors follow an elliptical pattern that depends on the underlying conductivity parameters. The fibre direction and conductivity anisotropy ratio can therefore be estimated by fitting an ellipse to the conduction slowness vectors. Applying the presented method on simulated data shows that it can estimate the fibre direction more accurately than existing methods, and that its performance depends mostly on the range of wavefront directions present in the measurement area. The main advantage of the presented method is that it still functions relatively well in the presence of conduction blocks, as long as the surrounding tissue is approximately homogeneous.Green Open Access added to TU Delft Institutional Repository 'You share, we take care!' - Taverne project https://www.openaccess.nl/en/you-share-we-take-care Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work public.Signal Processing System

Local Activation Time Estimation in Atrial Electrograms Using Cross-Correlation over Higher-Order Neighbors

Atrial electrograms are often used to gain understanding on the development of atrial fibrillation (AF). Using such electrograms, cardiologists can reconstruct how the depolarization wave-front propagates across the atrium. Knowing the exact moment at which the depolarization wavefront in the tissue reaches each electrode is an important aspect of such reconstruction. A common way to determine the LAT is based on the steepest deflection (SD) of the individual electrograms. However, the SD annotates each electrogram individually and is expected to be more prone to errors compared to approaches that would employ the data from the surrounding electrodes to estimate the LAT. As electrograms from neighboring electrodes tend to have rather similar morphology up to a delay, we propose in this paper to use the cross-correlation to find the pair-wise relative delays between electrograms. Instead of only using the direct neighbors we consider the array as a graph and involve higher order neighbors as well. Using a least-squares method, the absolute LATs can then be estimated from the calculated pair-wise relative delays. Simulated and clinically recorded electrograms are used to evaluate the proposed approach. From the simulated data it follows that the proposed approach outperforms the SD approach.Circuits and System

Graph-time spectral analysis for atrial fibrillation

Atrial fibrillation is a clinical arrhythmia with multifactorial mechanisms still unresolved. Time-frequency analysis of epicardial electrograms has been investigated to study atrial fibrillation. However, deeper understanding can be achieved by incorporating the spatial dimension. Unfortunately, the physical models describing the spatial relations of atrial fibrillation signals are complex and non-linear; hence, conventional signal processing techniques to study electrograms in the joint space, time, and frequency domain are less suitable. In this study, we wish to put forward a radically different approach to analyze atrial fibrillation with a higher-level model. This approach relies on graph signal processing to represent the spatial relations between epicardial electrograms. To capture the frequency content along both the time and graph domain, we propose the joint graph and short-time Fourier transform. The latter allows us to analyze the spatial variability of the electrogram temporal frequencies. With this technique, we found the spatial variation of the atrial electrograms decreases during atrial fibrillation since the high temporal frequencies of the atrial waves reduce. The proposed analysis further confirms that the ventricular activity is smoother over the atrial area compared with the atrial activity. Besides using the proposed graph-time analysis to conduct a first study on atrial fibrillation, we demonstrate its potential by applying it to the cancellation of ventricular activity from the atrial electrograms. Experimental results on simulated and real data further corroborate our findings in this atrial fibrillation study.Circuits and SystemsMultimedia ComputingBiomechanical Engineerin

An accurate and efficient method to train classifiers for atrial fibrillation detection in ECGs: Learning by asking better questions

Background: An increasing number of wearables are capable of measuring electrocardiograms (ECGs), which may help in early detection of atrial fibrillation (AF). Therefore, many studies focus on automated detection of AF in ECGs. A major obstacle is the required amount of manually labelled data. This study aimed to provide an efficient and reliable method to train a classifier for AF detection using large datasets of real-life ECGs. Method: Human-controlled semi-supervised learning was applied, consisting of two phases: the pre-training phase and the semi-automated training phase. During pre-training, an initial classifier was trained, which was used to predict the classes of new ECG segments in the semi-automated training phase. Based on the degree of certainty, segments were added to the training dataset automatically or after human validation. Thereafter, the classifier was retrained and this procedure was repeated. To test the model performance, a real-life telemetry dataset containing 3,846,564 30-s ECG segments of hospitalized patients (n = 476) and the CinC Challenge 2017 database were used. Results: After pre-training, the average F1-score on a hidden testing dataset was 89.0%. Furthermore, after the pre-training phase 68.0% of all segments in the hidden test set could be classified with an estimated probability of successful classification of 99%, providing an F1-score of 97.9% for these segments. During the semi-automated training phase, this F1-score showed little variation (97.3%–97.9% in the hidden test set), whilst the number of segments which could be automatically classified increased from 68.0% to 75.8% due to the enhanced training dataset. At the same time, the overall F1-score increased from 89.0% to 91.4%. Conclusions: Human-validated semi-supervised learning makes training a classifier more time efficient without compromising on accuracy, hence this method might be valuable in the automated detection of AF in real-life ECGs.Circuits and System

Digital biomarkers and algorithms for detection of atrial fibrillation using surface electrocardiograms: A systematic review: Digital Biomarkers for AF in Surface ECGs

Aims: Automated detection of atrial fibrillation (AF) in continuous rhythm registrations is essential in order to prevent complications and optimize treatment of AF. Many algorithms have been developed to detect AF in surface electrocardiograms (ECGs) during the past few years. The aim of this systematic review is to gain more insight into these available classification methods by discussing previously used digital biomarkers and algorithms and make recommendations for future research. Methods: On the 14th of September 2020, the PubMed database was searched for articles focusing on algorithms for AF detection in ECGs using the MeSH terms Atrial Fibrillation, Electrocardiography and Algorithms. Articles which solely focused on differentiation of types of rhythm disorders or prediction of AF termination were excluded. Results: The search resulted in 451 articles, of which 130 remained after full-text screening. Not only did the amount of research on methods for AF detection increase over the past years, but a trend towards more complex classification methods is observed. Furthermore, three different types of features can be distinguished: atrial features, ventricular features, and signal features. Although AF is an atrial disease, only 22% of the described methods use atrial features. Conclusion: More and more studies focus on improving accuracy of classification methods for AF in ECGs. As a result, algorithms become increasingly complex and less well interpretable. Only a few studies focus on detecting atrial activity in the ECG. Developing innovative methods focusing on detection of atrial activity might provide accurate classifiers without compromising on transparency.Biomechanical EngineeringCircuits and System

Analyzing the effect of electrode size on electrogram and activation map properties

Background: Atrial electrograms recorded from the epicardium provide an important tool for studying the initiation, perpetuation, and treatment of AF. However, the properties of these electrograms depend largely on the properties of the electrode arrays that are used for recording these signals. Method: In this study, we use the electrode's transfer function to model and analyze the effect of electrode size on the properties of measured electrograms. To do so, we use both simulated as well as clinical data. To simulate electrogram arrays we use a two-dimensional (2D) electrogram model as well as an action propagation model. For clinical data, however, we first estimate the trans-membrane current for a higher resolution 2D modeled cell grid and later use these values to interpolate and model electrograms with different electrode sizes. Results: We simulate electrogram arrays for 2D tissues with 3 different levels of heterogeneity in the conduction and stimulation pattern to model the inhomogeneous wave propagation observed during atrial fibrillation. Four measures are used to characterize the properties of the simulated electrogram arrays of different electrode sizes. The results show that increasing the electrode size increases the error in LAT estimation and decreases the length of conduction block lines. Moreover, visual inspection also shows that the activation maps generated by larger electrodes are more homogeneous with a lower number of observed wavelets. The increase in electrode size also increases the low voltage areas in the tissue while decreasing the slopes and the number of detected deflections. The effect is more pronounced for a tissue with a higher level of heterogeneity in the conduction pattern. Similar conclusions hold for the measurements performed on clinical data. Conclusion: The electrode size affects the properties of recorded electrogram arrays which can respectively complicate our understanding of atrial fibrillation. This needs to be considered while performing any analysis on the electrograms or comparing the results of different electrogram arrays.Circuits and System

Ventricular Activity Signal Removal in Atrial Electrograms of Atrial Fibrillation

Diagnosis and treatment of atrial fibrillation can benefit from various signal processing approaches employed on atrial electrograms. However, the performance and interpretation of these approaches get highly degraded by far-field ventricular activities (VAs) that distort the morphology of the pure atrial activities (AAs). In this study, we aim to remove VAs from the recorded unipolar electrogram while preserving the AA components. To do so, we have developed a framework which first removes the VA-containing segments and interpolates the remaining samples. This will also partly remove the atrial components that overlap with VA signals, e.g., during atrial fibrillation. To reconstruct the AA components, we estimate them from the removed VA-containing segments based on a low-rank and sparse matrix decomposition and add them back to the electrograms. The presented framework is of rather low complexity, preserves AA components, and requires only a single EGM recording. Instrumental comparison to template matching and subtraction and independent component analysis shows that the proposed approach leads to smoother results with better similarity to the true atrial signal.Circuits and System