Annoni, Elizabeth M.

AbstractBackgroundCatheter ablation is associated with limited success rates in patients with persistent atrial fibrillation (AF). Currently, existing mapping systems fail to identify critical target sites for ablation. Recently, we proposed and validated several techniques (multiscale frequency [MSF], Shannon entropy [SE], kurtosis [Kt], and multiscale entropy [MSE]) to identify pivot point of rotors using ex‐vivo optical mapping animal experiments. However, the performance of these techniques is unclear for the clinically recorded intracardiac electrograms (EGMs), due to the different nature of the signals.ObjectiveThis study aims to evaluate the performance of MSF, MSE, SE, and Kt techniques to identify the pivot point of the rotor using unipolar and bipolar EGMs obtained from numerical simulations.MethodsStationary and meandering rotors were simulated in a 2D human atria. The performances of new approaches were quantified by comparing the “true” core of the rotor with the core identified by the techniques. Also, the performances of all techniques were evaluated in the presence of noise, scar, and for the case of the multielectrode multispline and grid catheters.ResultsOur results demonstrate that all the approaches are able to accurately identify the pivot point of both stationary and meandering rotors from both unipolar and bipolar EGMs. The presence of noise and scar tissue did not significantly affect the performance of the techniques. Finally, the core of the rotors was correctly identified for the case of multielectrode multispline and grid catheter simulations.ConclusionThe core of rotors can be successfully identified from EGMs using novel techniques; thus, providing motivation for future clinical implementations.

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia affecting approximately 3 million Americans, and is a prognostic marker for stroke, heart failure and even death [1]. 12-lead electrocardiogram (ECG) is used to monitor normal sinus rhythm (NSR) and also detect AF. Although the persistent form of AF can be detected relatively easy, detecting paroxysmal AF is often a challenge since requiring continuous monitoring, which becomes expensive and cumbersome to collect lot of ECG data [1]. Several researchers have attempted to develop new methods to discriminate NSR and AF which are based on R-R interval analysis, linear methods, filtering, spectral analysis, statistical approaches such as entropy etc. which faces limitation of successfully detecting AF of all types with high sensitivity and specificity using short time ECG data [1–3]. The major issues with these approaches is that they often distort the ECG by several pre-processing steps with filters, do not provide reliable discrimination using short ECG time series data and many of them lack real-time capability that makes it difficult to trust the data for diagnosis and treatment. Both clinical and scientific communities recognize these difficulties and the necessity to develop novel methods that can enable accurate monitoring and detection of AF [2]. In addition, robust detection and classification algorithms are essential for delivering appropriate therapy for implantable cardioverter defibrillators (ICD) to provide lifesaving timely action. In this work, the authors propose and demonstrate the application of a multiscale frequency (MSF) approach [4] for accurate detection and discrimination between AF and NSR ECG traces taken from publically available Physionet database. The MSF approach takes into account the contribution from various frequencies in ECG and thus yield valuable information regarding the chaotic nature of AF. Therefore, we demonstrate that MSF can capture the complexity of AF which is associated with higher MSF value compared with NSR thus enabling robust discrimination e AF manifests itself with numerous chaotic frequencies within the body surface ECG,. We validate the feasibility of this technique to discriminate NSR from AF.