A Singular-value-based Map to Highlight Abnormal Regions Associated with Atrial Fibrillation Using High-resolution Electrograms and Multi-lead ECG.

OBJECTIVE: The severity of atrial fibrillation (AF) can be assessed from intra-operative epicardial measurements (high-resolution electrograms), using metrics such as conduction block (CB) and continuous conduction delay and block (cCDCB). These features capture differences in conduction velocity and wavefront propagation, but ignore complementary properties such as the morphology of the action potentials. In this work, we focus on such complementary properties, and derive features to detect variations in the atrial potential waveforms. METHODS: We show that the spatial variation of atrial potential morphology during a single beat may be described by changes in the singular values of the epicardial measurement matrix. The method is non-parametric and requires little preprocessing. A corresponding singular value map points at areas subject to fractionation and block. Further, we developed an experiment where we simultaneously measure electrograms (EGMs) and a multi-lead ECG. RESULTS: The captured data showed that the normalized singular values of the heartbeats during AF are higher than during SR, and that this difference is more pronounced for the (non-invasive) ECG data than for the EGM data, if the electrodes are positioned at favorable locations. CONCLUSION: Overall, the singular value-based features are a useful indicator to detect and evaluate AF. SIGNIFICANCE: The proposed method might be beneficial for identifying electropathological regions in the tissue without estimating the local activation time.

Classification of De novo post-operative and persistent atrial fibrillation using multi-channel ECG recordings.

Atrial fibrillation (AF) is the most sustained arrhythmia in the heart and also the most common complication developed after cardiac surgery. Due to its progressive nature, timely detection of AF is important. Currently, physicians use a surface electrocardiogram (ECG) for AF diagnosis. However, when the patient develops AF, its various development stages are not distinguishable for cardiologists based on visual inspection of the surface ECG signals. Therefore, severity detection of AF could start from differentiating between short-lasting AF and long-lasting AF. Here, de novo post-operative AF (POAF) is a good model for short-lasting AF while long-lasting AF can be represented by persistent AF. Therefore, we address in this paper a binary severity detection of AF for two specific types of AF. We focus on the differentiation of these two types as de novo POAF is the first time that a patient develops AF. Hence, comparing its development to a more severe stage of AF (e.g., persistent AF) could be beneficial in unveiling the electrical changes in the atrium. To the best of our knowledge, this is the first paper that aims to differentiate these different AF stages. We propose a method that consists of three sets of discriminative features based on fundamentally different aspects of the multi-channel ECG data, namely based on the analysis of RR intervals, a greyscale image representation of the vectorcardiogram, and the frequency domain representation of the ECG. Due to the nature of AF, these features are able to capture both morphological and rhythmic changes in the ECGs. Our classification system consists of a random forest classifier, after a feature selection stage using the ReliefF method. The detection efficiency is tested on 151 patients using 5-fold cross-validation. We achieved 89.07% accuracy in the classification of de novo POAF and persistent AF. The results show that the features are discriminative to reveal the severity of AF. Moreover, inspection of the most important features sheds light on the different characteristics of de novo post-operative and persistent AF.

Critical appraisal of technologies to assess electrical activity during atrial fibrillation: a position paper from the European Heart Rhythm Association and European Society of Cardiology Working Group on eCardiology in collaboration with the Heart Rhythm Society, Asia Pacific Heart Rhythm Society, Latin American Heart Rhythm Society and Computing in Cardiology.

We aim to provide a critical appraisal of basic concepts underlying signal recording and processing technologies applied for (i) atrial fibrillation (AF) mapping to unravel AF mechanisms and/or identifying target sites for AF therapy and (ii) AF detection, to optimize usage of technologies, stimulate research aimed at closing knowledge gaps, and developing ideal AF recording and processing technologies. Recording and processing techniques for assessment of electrical activity during AF essential for diagnosis and guiding ablative therapy including body surface electrocardiograms (ECG) and endo- or epicardial electrograms (EGM) are evaluated. Discussion of (i) differences in uni-, bi-, and multi-polar (omnipolar/Laplacian) recording modes, (ii) impact of recording technologies on EGM morphology, (iii) global or local mapping using various types of EGM involving signal processing techniques including isochronal-, voltage- fractionation-, dipole density-, and rotor mapping, enabling derivation of parameters like atrial rate, entropy, conduction velocity/direction, (iv) value of epicardial and optical mapping, (v) AF detection by cardiac implantable electronic devices containing various detection algorithms applicable to stored EGMs, (vi) contribution of machine learning (ML) to further improvement of signals processing technologies. Recording and processing of EGM (or ECG) are the cornerstones of (body surface) mapping of AF. Currently available AF recording and processing technologies are mainly restricted to specific applications or have technological limitations. Improvements in AF mapping by obtaining highest fidelity source signals (e.g. catheter-electrode combinations) for signal processing (e.g. filtering, digitization, and noise elimination) is of utmost importance. Novel acquisition instruments (multi-polar catheters combined with improved physical modelling and ML techniques) will enable enhanced and automated interpretation of EGM recordings in the near future.

Enabling Robust Radar-Based Localization and Vital Signs Monitoring in Multipath Propagation Environments.

OBJECTIVE: Over the last two decades, radar-based contactless monitoring of vital signs (heartbeat and respiration rate) has raised increasing interest as an emerging and added value to health care. However, until now, the flaws caused by indoor multipath propagation formed a fundamental hurdle for the adoption of such technology in practical healthcare applications where reliability and robustness are crucial. Multipath reflections, originated from one person, combine with the direct signals and multipaths of other people and stationary objects, thus jeopardizing individual vital signs extraction and localization. This work focuses on tackling indoor multipath propagation. METHODS: We describe a methodology, based on accurate models of the indoor multipaths and of the radar signals, that enables separating the undesired multipaths from desired signals of multiple individuals, removing a key obstacle to real-world contactless vital signs monitoring and localization. RESULTS: We also demonstrated it by accurately measure individual heart rates, respiration rates, and absolute distances (range information) of paired volunteers in a challenging real-world office setting. CONCLUSION: The approach, validated using a frequency-modulated continuous wave (FMCW) radar, was shown to function in an indoor environment where radar signals are severely affected by multipath reflections. SIGNIFICANCE: Practical applications arise for health care, assisted living, geriatric and quarantine medicine, rescue and security purposes.

Improved local activation time annotation of fractionated atrial electrograms for atrial mapping.

BACKGROUND: Local activation time (LAT) annotation in unipolar electrograms is complicated by interference from nonlocal atrial activities of neighboring tissue. This happens due to the spatial blurring that is inherent to electrogram recordings. In this study, we aim to exploit multi-electrode electrogram recordings to amplify the local activity in each electrogram and subsequently improve the annotation of LATs. METHODS: An electrogram array can be modeled as a spatial convolution of per cell transmembrane currents with an appropriate distance kernel, which depends on the cells' distances to the electrodes. By deconvolving the effect of the distance kernel from the electrogram array, we undo the blurring and estimate the underlying transmembrane currents as our desired local activities. However, deconvolution problems are typically highly ill-posed and result in unstable solutions. To overcome this issue, we propose to use a regularization term that exploits the sparsity of the first-order time derivative of the transmembrane currents. RESULTS: We perform experiments on simulated two-dimensional tissues, as well as clinically recorded electrograms during paroxysmal atrial fibrillation. The results show that the proposed approach for deconvolution can improve the annotation of the true LAT in the electrograms. We also discuss, in summary, the required electrode array specifications for an appropriate recording and subsequent deconvolution. CONCLUSION: By ignoring small but local deflections, algorithms based on steepest descent are prone to generate smoother activation maps. However, by exploiting multi-electrode recordings, we can efficiently amplify small but local deflections and reveal new details in the activation maps that were previously missed.

A compact matrix model for atrial electrograms for tissue conductivity estimation.

Finding the hidden parameters of the cardiac electrophysiological model would help to gain more insight on the mechanisms underlying atrial fibrillation, and subsequently, facilitate the diagnosis and treatment of the disease in later stages. In this work, we aim to estimate tissue conductivity from recorded electrograms as an indication of tissue (mal)functioning. To do so, we first develop a simple but effective forward model to replace the computationally intensive reaction-diffusion equations governing the electrical propagation in tissue. Using the simplified model, we present a compact matrix model for electrograms based on conductivity. Subsequently, we exploit the simplicity of the compact model to solve the ill-posed inverse problem of estimating tissue conductivity. The algorithm is demonstrated on simulated data as well as on clinically recorded data. The results show that the model allows to efficiently estimate the conductivity map. In addition, based on the estimated conductivity, realistic electrograms can be regenerated demonstrating the validity of the model.

Local Activation Time Estimation in Fractionated Electrograms of Cardiac Mappings.

In this study, we propose a novel approach for estimation of local activation times (LATs) in fractionated electrograms. Using an electrophysiological tissue model, we first formulate the electrogram array as a convolution of transmembrane currents with a distance kernel. These currents are more local activities and less affected by the heterogeneity in the tissue compared to electrograms. We then deconvolve the distance kernel with the electrograms to reconstruct the transmembrane current. To stabilize the solution of this ill-posed deconvolution, we use spatio-temporal total variation as a regularization. This helps to preserve sharp spatial and temporal deflections in the currents that are of higher importance in LAT estimation. Finally, the maximum negative slope of the reconstructed transmembrane currents are used to estimate the LATs. Instrumental comparison to two reference approaches shows that the proposed approach performs better in estimating the LATs in fractionated electrograms.