Determination of Synchronization of Electrical Activity in the Heart by Shannon Entropy Measure
In this paper we propose a new index of synchronization for the study of heart’s electrical activity during atrial fibrillation (AF). The index relies on the measure of the time delays between correspondent activations in two atrial electrograms and on the characterization of their dispersion by a measure of Shannon Entropy. The algorithm was validated on simulated signals mimicking different degree of synchronization. Results showed the index was able to discriminate among different levels of organization, provided that it works on series of at least 50 activations (time resolution of almost 10 sec during AF). Moreover, we applied the algorithm to real bipolar electrograms, obtained from a…
Quantification of synchronization during atrial fibrillation by Shannon entropy: Validation in patients and computer model of atrial arrhythmias
Atrial fibrillation (AF), a cardiac arrhythmia classically described as completely desynchronized, is now known to show a certain amount of synchronized electrical activity. In the present work a new method for quantifying the level of synchronization of the electrical activity recorded in pairs of atrial sites during atrial fibrillation is presented. A synchronization index (Sy) was defined by quantifying the degree of complexity of the distribution of the time delays between sites by Shannon entropy estimation. The capability of Sy to discriminate different AF types in patients was assessed on a database of 60 pairs of endocardial recordings from a multipolar basket catheter. The analysis…
Wave similarity mapping shows the spatiotemporal distribution of fibrillatory wave complexity in the human right atrium during paroxysmal and chronic atrial fibrillation.
Introduction: The complexity of waveforms during atrial fibrillation may reflect critical activation patterns for the arrhythmia perpetuation. In this study, we introduce a novel concept of map, based on the analysis of the wave morphology, which gives a direct evidence in the human right atrium on the spatiotemporal distribution of fibrillatory wave complexity in paroxysmal (PAF) and chronic (CAF) atrial fibrillation. Methods and Results: Electrograms were recorded from a 64-electrode catheter in the right atrium of 15 patients during PAF (n = 8) and CAF (n = 7). Wave similarity maps were constructed by calculating the degree of morphological similarity of activation waves (S) at each atri…
A method for quantifying atrial fibrillation organization based on wave-morphology similarity
A new method for quantifying the organization of single bipolar electrograms recorded in the human atria during atrial fibrillation (AF) is presented. The algorithm relies on the comparison between pairs of local activation waves (LAWs) to estimate their morphological similarity, and returns a regularity index (/spl rho/) which measures the extent of repetitiveness over time of the detected activations. The database consisted of endocardial data from a multipolar basket catheter during AF and intraatrial recordings during atrial flutter. The index showed maximum regularity (/spl rho/=1) for all atrial flutter episodes and decreased significantly when increasing AF complexity as defined by W…
Propagation pattern analysis during atrial fibrillation based on the adaptive group LASSO.
The present study introduces sparse modeling for the estimation of propagation patterns in intracardiac atrial fibrillation (AF) signals. The estimation is based on the partial directed coherence (PDC) function, derived from fitting a multivariate autoregressive model to the observed signals. A sparse optimization method is proposed for estimation of the model parameters, namely, the adaptive group least absolute selection and shrinkage operator (aLASSO). In simulations aLASSO was found superior to the commonly used least-squares (LS) estimation with respect to estimation performance. The normalized error between the true and estimated model parameters dropped from 0.200.04 for LS estimatio…
A Novel Approach to Propagation Pattern Analysis in Intracardiac Atrial Fibrillation Signals
The purpose of this study is to investigate propagation patterns in intracardiac signals recorded during atrial fibrillation (AF) using an approach based on partial directed coherence (PDC), which evaluates directional coupling between multiple signals in the frequency domain. The PDC is evaluated at the dominant frequency of AF signals and tested for significance using a surrogate data procedure specifically designed to assess causality. For significantly coupled sites, the approach allows also to estimate the delay in propagation. The methods potential is illustrated with two simulation scenarios based on a detailed ionic model of the human atrial myocyte as well as with real data recordi…
A stochastic approach for automatic registration and fusion of left atrial electroanatomic maps with 3D CT anatomical images.
The integration of electroanatomic maps with highly resolved computed tomography cardiac images plays an important role in the successful planning of the ablation procedure of arrhythmias. In this paper, we present and validate a fully-automated strategy for the registration and fusion of sparse, atrial endocardial electroanatomic maps (CARTO maps) with detailed left atrial (LA) anatomical reconstructions segmented from a pre-procedural MDCT scan. Registration is accomplished by a parameterized geometric transformation of the CARTO points and by a stochastic search of the best parameter set which minimizes the misalignment between transformed CARTO points and the LA surface. The subsequent …
An Automatic System for the Analysis and Classification of Human Atrial Fibrillation Patterns from Intracardiac Electrograms
This paper presents an automatic system for the analysis and classification of atrial fibrillation (AF) patterns from bipolar intracardiac signals. The system is made up of: 1) a feature- extraction module that defines and extracts a set of measures potentially useful for characterizing AF types on the basis of their degree of organization; 2) a feature-selection module (based on the Jeffries-Matusita distance and a branch and bound search algorithm) identifying the best subset of features for discriminating different AF types; and 3) a support vector machine technique-based classification module that automatically discriminates the AF types according to the Wells' criteria. The automatic s…
Exploring directionality in spontaneous heart period and systolic pressure variability interactions in humans: implications in the evaluation of baroreflex gain
Although in physiological conditions RR interval and systolic arterial pressure (SAP) are likely to interact in a closed loop, the traditional cross-spectral analysis cannot distinguish feedback (FB) from feedforward (FF) influences. In this study, a causal approach was applied for calculating the coherence from SAP to RR ( Ks-r) and from RR to SAP ( Kr-s) and the gain and phase of the baroreflex transfer function. The method was applied, compared with the noncausal one, to RR and SAP series taken from 15 healthy young subjects in the supine position and after passive head-up tilt. For the low frequency (0.04–0.15 Hz) spectral component, the enhanced FF coupling ( Kr-s = 0.59 ± 0.21, signi…
Deterioration of organization in the first minutes of atrial fibrillation: A beat-to-beat analysis of cycle length and wave similarity
Deterioration of AF Organization. Introduction: It has been recently suggested that many episodes of atrial fibrillation (AF) may be partially organized at the onset and thus more suitable for antitachycardia pacing therapy. Nevertheless, the time course of organization in the first minutes of AF has not been quantified yet. Methods and Results: Twenty episodes of paroxysmal AF were studied. Electrograms were recorded from the right atrium (RA), distal (CSd), and proximal coronary sinus (CSp). The time course of AF cycle length (AFCL) and the regularity of wave morphology (similarity index S) were beat-to-beat measured at each recording site during the first 7 minutes of AF. AFCL and S show…
Causal linear parametric model for baroreflex gain assessment in patients with recent myocardial infarction
Spectral and cross-spectral analysis of R-R interval and systolic arterial pressure (SAP) spontaneous fluctuations have been proposed for noninvasive evaluation of baroreflex sensitivity (BRS). However, results are not in good agreement with clinical measurements. In this study, a bivariate parametric autoregressive model with exogenous input (ARXAR model), able to divide the R-R variability into SAP-related and -unrelated parts, was used to quantify the gain (αARXAR) of the baroreflex regulatory mechanism. For performance assessing, two traditional noninvasive methods based on frequency domain analysis [spectral, baroreflex gain by autogressive model (αAR); cross-spectral, baroreflex gain…
Evidence of unbalanced regulatory mechanism of heart rate and systolic pressure after acute myocardial infarction
The interactions between systolic arterial pressure (SAP) and R-R interval (RR) fluctuations after acute myocardial infarction (AMI) were investigated by measures of synchronization separating the feedback from the feedforward control and capturing both linear and nonlinear contributions. The causal synchronization, evaluating the ability of RR to predict SAP (χs/t) or vice versa (χt/s), and the global synchronization (χ) were estimated at rest and after head-up tilt in 35 post-AMI patients, 20 young and 12 old. Significance and nonlinearity of the coupling were assessed by surrogate data analysis. Tilting increased the number of young subjects in which RR-SAP link was significant (from 17…
Propagation pattern analysis during atrial fibrillation based on sparse modeling.
In this study, sparse modeling is introduced for the estimation of propagation patterns in intracardiac atrial fibrillation (AF) signals. The estimation is based on the partial directed coherence function, derived from fitting a multivariate autoregressive model to the observed signal using least-squares (LS) estimation. The propagation pattern analysis incorporates prior information on sparse coupling as well as the distance between the recording sites. Two optimization methods are employed for estimation of the model parameters, namely, the adaptive group least absolute selection and shrinkage operator (aLASSO), and a novel method named the distance-adaptive group LASSO (dLASSO). Using si…
Organization measures of atrial activity during fibrillation
The present chapter summarizes the state-of-art of how to quantify the degree of atrial organization during AF through a review of the main signal processing techniques employed for the analysis of atrial electrical activity. As the concept of atrial organization may assume different meanings in the context of AF, particular attention is paid to stress those peculiar characters of organization probed and captured by each method.
A Multi-Variate Predictability Framework to Assess Invasive Cardiac Activity and Interactions during Atrial Fibrillation
Objective: This study introduces a predictability framework based on the concept of Granger causality (GC), in order to analyze the activity and interactions between different intracardiac sites during atrial fibrillation (AF). Methods: GC-based interactions were studied using a three-electrode analysis scheme with multi-variate autoregressive models of the involved preprocessed intracardiac signals. The method was evaluated in different scenarios covering simulations of complex atrial activity as well as endocardial signals acquired from patients. Results: The results illustrate the ability of the method to determine atrial rhythm complexity and to track and map propagation during AF. Conc…
Isolation of the left atrial surface from cardiac multi-detector CT images based on marker controlled watershed segmentation
The delineation of left atrium (LA) and pulmonary veins (PVs) anatomy from high resolution images holds importance for atrial fibrillation (AF) investigation and treatment. In this study, a semiautomatic segmentation procedure for LA and PVs inner surface from contrast enhanced CT data was developed. The procedure consists of a three dimensional marker controlled watershed segmentation applied to the external morphological gradient, followed by variable threshold surface extraction from the original intensity image. A preliminary anisotropic non-linear filtering was implemented to improve the S/N ratio of CT images. The performance of segmentation was evaluated on cardiac CT scans of 12 AF …
Small-sample characterization of stochastic approximation staircases in forced-choice adaptive threshold estimation
Despite the widespread use of up—down staircases in adaptive threshold estimation, their efficiency and usability in forced-choice experiments has been recently debated. In this study, simulation techniques were used to determine the small-sample convergence properties of stochastic approximation (SA) staircases as a function of several experimental parameters. We found that satisfying some general requirements (use of the accelerated SA algorithm, clear suprathreshold initial stimulus intensity, large initial step size) the convergence was accurate independently of the spread of the underlying psychometric function. SA staircases were also reliable for targeting percent-correct levels far …
Quantitative assessment of regularity and synchronization of intracardiac recordings during human atrial fibrillation
This study proposes the morphology-based evaluation of the regularity (R) and the synchronization (S) of intra-atrial electrograms acquired during atrial fibrillation (AF). R is defined as the degree of repetitiveness over time of the shapes of the activation waves detected in single atrial recordings. S accounts for the simultaneous presence of morphologically similar activation waves in two atrial electrograms, and for the dispersion of the propagation delays between the two sites. Both R and S resulted unitary for normal sinus rhythm and decreased significantly moving from atrial flutter (R=0.93, S=0.88) to AF of increasing complexity class (type I AF: R=0.75, S=0.66; type II AF: R=0.32,…
Morphology-based measurement of activation time in human atrial fibrillation
The measurement of the activation time is crucial to allow the correct automatic analysis and classification of intracardiac electrograms recorded in the human atria during atrial fibrillation (AF). This study proposes a method which accounts for the morphology of bipolar signals. After ventricular artifact removal and activation wave recognition, the fiducial point of the activation wave was set at its local barycentre (LB). The method was tested on a set of 30 AF bipolar recordings of increasing complexity class; its performance was compared with that of the traditional methods of maximum peak (MP) or maximum slope (MS) estimation, taking the manual measurements performed by an expert car…
Registration and fusion of segmented left atrium CT images with CARTO electrical maps for the ablative treatment of atrial fibrillation
This study aims to extract the interior surface of the left atrium (LA) and pulmonary veins (PVs) from threedimensional tomographic data and to integrate it with LA CARTO electrical maps. The separation of LA and PVs from other overlapping structures of the heart was performed processing 3D CT data by marker-controlled watershed segmentation and surface extraction. CARTO maps were then registered on the L A internal surface by a stochastic optimization algorithm based on simulated annealing. The residual registration error resulted inferior to 3 mm. The integration between electrophysiological and high resolved anatomic information of LA results feasible and may constitute a significant sup…
Noninvasive assessment of baroreflex sensitivity in post-MI patients by an open loop parametric model of RR-systolic pressure interactions
Noninvasive evaluation of baroreflex sensitivity is considered an important goal for diagnosis and prognosis in post-MI patients. Methodological approach and physiological measure conditions may be the main causes for the differences found with respect to the standard Phenylephrine test. In this study, three linear parametric models, describing variability and mutual interactions of RR interval and systolic arterial pressure (SAP), were compared in relation to their ability to quantify baroreflex gain, using the Phenylephrine test index (Phe/sub BRS/) as reference. By monovariate autoregressive (AR) model, bivariate AR model and open loop ARXAR model, specific gain indexes (/spl alpha//sub …
Letter by Masè et al Regarding Article, "Granger Causality-Based Analysis for Classification of Fibrillation Mechanisms and Localization of Rotational Drivers".
Quantitative assessment of synchronization during atrial fibrillation by Shannon Entropy characterization of propagation delays
This study introduced a new method for the quantification of the synchronization (S) and the causal verse of activation (S12) in couples of atrial electrograms recorded during atrial fibrillation (AF). The synchronization indexes S and S12 relied on the measure of the propagation delays between coupled activation times in two atrial signals and on the characterization of their dispersion by Shannon-Entropy (SE). S and S12 were validated both on simulated activation time series and endocavitary signals in patients. In simulation, S and S12 were equal to 1 for propagation of one single wavefront in a fully excitable tissue, while they decreased for reentries in partially excitable tissue (S =…