Overcoming Uncertainties in Electrogram-Based Atrial Fibrillation Mapping: A Review.

In clinical rhythmology, intracardiac bipolar electrograms (EGMs) play a critical role in investigating the triggers and substrates inducing and perpetuating atrial fibrillation (AF). However, the interpretation of bipolar EGMs is ambiguous due to several aspects of electrodes, mapping algorithms and wave propagation dynamics, so it requires several variables to describe the effects of these uncertainties on EGM analysis. In this narrative review, we critically evaluate the potential impact of such uncertainties on the design of cardiac mapping tools on AF-related substrate characterization. Literature suggest uncertainties are due to several variables, including the wave propagation vector, the wave's incidence angle, inter-electrode spacing, electrode size and shape, and tissue contact. The preprocessing of the EGM signals and mapping density will impact the electro-anatomical representation and the features extracted from the local electrical activities. The superposition of multiple waves further complicates EGM interpretation. The inclusion of these uncertainties is a nontrivial problem but their consideration will yield a better interpretation of the intra-atrial dynamics in local activation patterns. From a translational perspective, this review provides a concise but complete overview of the critical variables for developing more precise cardiac mapping tools.

Can Inter-Subject Associativity Predict Data-Driven BCI Performance?

Intra- and inter-subject variability causes covariate shifts in training and testing feature spaces, resulting in low sensorimotor (SMR) brain-computer interface (BCI) performance for practical implementation. Studies involving data-driven transfer learning strategies demonstrated improving BCI performance by covariate shift adaptation. In this study, we aim to illustrate if inter-subject associativity (e.g., subjects having similar SMR brain dynamics) can predict data-driven inter-subject BCI performance. We implemented a BCI classification pipeline with a common spatial pattern, principal component analysis and linear discriminant analysis for performance evaluation. Both intra- and inter-subject BCI were evaluated in 5-Fold Validation settings. We further proposed a Bhattacharyya distance-based covariate shift score (CSS) for assessing the difference between training and testing feature domains. We performed Pearson correlation analysis to draw the relation-ship between BCI performance and CSS. Intra-subject BCI performances were significantly and negatively correlated with CSS (r = -0.94, p < 0.05). For the inter-subject experiment, BCI performances were also highly and negatively associated with CSS (r = -0.61, p < 0.05). However, this data-driven BCI evaluation framework does not necessarily manifest inter-subject associativity in BCI performance, requiring further investigations for a conclusion.Clinical relevance- If it predicts BCI performance successfully, inter-subject associativity could reduce time-consuming and annoying subject-specific calibration for the users.

Progress in Brain Computer Interface: Challenges and Opportunities.

Brain computer interfaces (BCI) provide a direct communication link between the brain and a computer or other external devices. They offer an extended degree of freedom either by strengthening or by substituting human peripheral working capacity and have potential applications in various fields such as rehabilitation, affective computing, robotics, gaming, and neuroscience. Significant research efforts on a global scale have delivered common platforms for technology standardization and help tackle highly complex and non-linear brain dynamics and related feature extraction and classification challenges. Time-variant psycho-neurophysiological fluctuations and their impact on brain signals impose another challenge for BCI researchers to transform the technology from laboratory experiments to plug-and-play daily life. This review summarizes state-of-the-art progress in the BCI field over the last decades and highlights critical challenges.

Wavelet Entropy-Based Inter-subject Associative Cortical Source Localization for Sensorimotor BCI.

We propose event-related cortical sources estimation from subject-independent electroencephalography (EEG) recordings for motor imagery brain computer interface (BCI). By using wavelet-based maximum entropy on the mean (wMEM), task-specific EEG channels are selected to predict right hand and right foot sensorimotor tasks, employing common spatial pattern (CSP) and regularized common spatial pattern (RCSP). EEG from five healthy individuals (Dataset IVa, BCI Competition III) were evaluated by a cross-subject paradigm. Prediction performance was evaluated via a two-layer feed-forward neural network, where the classifier was trained and tested by data from two subjects independently. On average, the overall mean prediction accuracies obtained using all 118 channels are (55.98±6.53) and (71.20±5.32) in cases of CSP and RCSP, respectively, which are slightly lower than the accuracies obtained using only the selected channels, i.e., (58.95±6.90) and (71.41±6.65), respectively. The highest mean prediction accuracy achieved for a specific subject pair by using selected EEG channels was on average (90.36±5.59) and outperformed that achieved by using all available channels (86.07 ± 10.71). Spatially projected cortical sources approximated using wMEM may be useful for capturing inter-subject associative sensorimotor brain dynamics and pave the way toward an enhanced subject-independent BCI.

Intra- and Inter-subject Variability in EEG-Based Sensorimotor Brain Computer Interface: A Review.

Brain computer interfaces (BCI) for the rehabilitation of motor impairments exploit sensorimotor rhythms (SMR) in the electroencephalogram (EEG). However, the neurophysiological processes underpinning the SMR often vary over time and across subjects. Inherent intra- and inter-subject variability causes covariate shift in data distributions that impede the transferability of model parameters amongst sessions/subjects. Transfer learning includes machine learning-based methods to compensate for inter-subject and inter-session (intra-subject) variability manifested in EEG-derived feature distributions as a covariate shift for BCI. Besides transfer learning approaches, recent studies have explored psychological and neurophysiological predictors as well as inter-subject associativity assessment, which may augment transfer learning in EEG-based BCI. Here, we highlight the importance of measuring inter-session/subject performance predictors for generalized BCI frameworks for both normal and motor-impaired people, reducing the necessity for tedious and annoying calibration sessions and BCI training.

Beamforming-inspired Spatial Filtering Technique for Intracardiac Electrograms.

Bipolar electrograms (EGM) are widely used to assess intracardiac electrical activity and to find the atrial fibrillation-related sources. However, the interpretation of bipolar EGM is not straightforward. Variables including bipolar lead (vector) orientation relative to the wave propagation dynamics significantly impact the EGM and EGM-derived measures, which are clinically used to select target sources for catheter ablation. In this study, left atrial unipolar EGM were recorded using a 4 × 4 grid of 16 unipolar electrodes. A set (node) of 4 unipolar EGM were used to construct possible 6 bipolar EGM to evaluate the measurement uncertainty within a particular node. A novel beamforming-inspired spatial filtering (BiSF) method is proposed to reduce the potential measurement uncertainty inevitable in bipolar EGM. A set of three bipolar lead orientations that were constructed using a common unipolar electrode towards three different directions at 45°s, were added to form beamforming EGM. Finally, two beamforming EGM were intertwined to acquire BiSF EGM for a node. Results show greater signal power gain (at least around 10dB) for all BiSF EGM with better or similar signal-to-noise ratio as compared to their respective bipolar counterparts. In conclusion, reduced uncertainty in BiSF EGM improve the interpretation of EGM and EGM-derived measures used in clinical practice after further validation on a larger dataset.

Evidence of Variabilities in EEG Dynamics During Motor Imagery-Based Multiclass Brain-Computer Interface.

Inter-subject and inter-session variabilities pose a significant challenge in electroencephalogram (EEG)-based brain-computer interface (BCI) systems. Furthermore, high dimensional EEG montages introduce huge computational burden due to excessive number of channels involved. Two experimental, i.e., inter-session and inter-subject, variabilities of EEG dynamics during motor imagery (MI) tasks are investigated in this paper. In particular, the effect on the performance of the BCIs due to day-to-day variability in EEG dynamics during the alterations in cognitive stages is explored. In addition, the inter-subject BCIs feasibility between cortically synchronized and desynchronized subject pairs on pairwise performance associativity is further examined. Moreover, the consequences of integrating spatial brain dynamics of varying the number of channels - from specific regions of the brain - are also discussed in case of both the contexts. The proposed approach is validated on real BCI data set containing EEG data from four classes of MI tasks, i.e., left/right hand, both feet, and tongue, subjected prior to a preprocessing of three different spatial filtering techniques. Experimental results have shown that a maximum classification accuracy of around 58% was achieved for the inter-subject experimental case, whereas a 31% deviation was noticed in the classification accuracies across two sessions during the inter-session experimental case. In conclusion, BCIs, without the subject-and session-specific calibration and with lesser number of channels employed, play a vital role while promoting a generic and efficient framework for plug and play use.

Suicidal Ideation Is Associated with Altered Variability of Fingertip Photo-Plethysmogram Signal in Depressed Patients.

Physiological and psychological underpinnings of suicidal behavior remain ill-defined and lessen timely diagnostic identification of this subgroup of patients. Arterial stiffness is associated with autonomic dysregulation and may be linked to major depressive disorder (MDD). The aim of this study was to investigate the association between arterial stiffness by photo-plethysmogram (PPG) in MDD with and without suicidal ideation (SI) by applying multiscale tone entropy (T-E) variability analysis. Sixty-one 10-min PPG recordings were analyzed from 29 control, 16 MDD patients with (MDDSI+) and 16 patients without SI (MDDSI-). MDD was based on a psychiatric evaluation and the Mini-International Neuropsychiatric Interview (MINI). Severity of depression was assessed using the Hamilton Depression Rating Scale (HAM-D). PPG features included peak (systole), trough (diastole), pulse wave amplitude (PWA), pulse transit time (PTT) and pulse wave velocity (PWV). Tone (Diastole) at all lags and Tone (PWA) at lags 8, 9, and 10 were found to be significantly different between the MDDSI+ and MDDSI- group. However, Tone (PWA) at all lags and Tone (PTT) at scales 3-10 were also significantly different between the MDDSI+ and CONT group. In contrast, Entropy (Systole), Entropy (Diastole) and Tone (Diastole) were significantly different between MDDSI- and CONT groups. The suicidal score was also positively correlated (r = 0.39 ~ 0.47; p < 0.05) with systolic and diastolic entropy values at lags 2-10. Multivariate logistic regression analysis and leave-one-out cross-validation were performed to study the effectiveness of multi-lag T-E features in predicting SI risk. The accuracy of predicting SI was 93.33% in classifying MDDSI+ and MDDSI- with diastolic T-E and lag between 2 and 10. After including anthropometric variables (Age, body mass index, and Waist Circumference), that accuracy increased to 96.67% for MDDSI+/- classification. Our findings suggest that tone-entropy based PPG variability can be used as an additional accurate diagnostic tool for patients with depression to identify SI.

Enhanced inter-subject brain computer interface with associative sensorimotor oscillations.

Electroencephalography (EEG) captures electrophysiological signatures of cortical events from the scalp with high-dimensional electrode montages. Usually, excessive sources produce outliers and potentially affect the actual event related sources. Besides, EEG manifests inherent inter-subject variability of the brain dynamics, at the resting state and/or under the performance of task(s), caused probably due to the instantaneous fluctuation of psychophysiological states. A wavelet coherence (WC) analysis for optimally selecting associative inter-subject channels is proposed here and is being used to boost performances of motor imagery (MI)-based inter-subject brain computer interface (BCI). The underlying hypothesis is that optimally associative inter-subject channels can reduce the effects of outliers and, thus, eliminate dissimilar cortical patterns. The proposed approach has been tested on the dataset IVa from BCI competition III, including EEG data acquired from five healthy subjects who were given visual cues to perform 280 trials of MI for the right hand and right foot. Experimental results have shown increased classification accuracy (81.79%) using the WC-based selected 16 channels compared to the one (56.79%) achieved using all the available 118 channels. The associative channels lie mostly around the sensorimotor regions of the brain, reinforced by the previous literature, describing spatial brain dynamics during sensorimotor oscillations. Apparently, the proposed approach paves the way for optimised EEG channel selection that could boost further the efficiency and real-time performance of BCI systems.