Determine atrial fibrillation burden with a photoplethysmographic mobile sensor: the atrial fibrillation burden trial: detection and quantification of episodes of atrial fibrillation using a cloud analytics service connected to a wearable with photoplethysmographic sensor.

Aims: Recent studies suggest that atrial fibrillation (AF) burden (time AF is present) is an independent risk factor for stroke. The aim of this trial was to study the feasibility and accuracy to identify AF episodes and quantify AF burden in patients with a known history of paroxysmal AF with a photoplethysmography (PPG)-based wearable. Methods and results: In this prospective, single-centre trial, the PPG-based estimation of AF burden was compared with measurements of a conventional 48 h Holter electrocardiogram (ECG), which served as the gold standard. An automated algorithm performed PPG analysis, while a cardiologist, blinded for the PPG data, analysed the ECG data. Detected episodes of AF measured by both methods were aligned timewise.Out of 100 patients recruited, 8 had to be excluded due to technical issues. Data from 92 patients were analysed [55.4% male; age 73.3 years (standard deviation, SD: 10.4)]. Twenty-five patients presented AF during the study period. The intraclass correlation coefficient of total AF burden minutes detected by the two measurement methods was 0.88. The percentage of correctly identified AF burden over all patients was 85.1% and the respective parameter for non-AF time was 99.9%. Conclusion: Our results demonstrate that a PPG-based wearable in combination with an analytical algorithm appears to be suitable for a semiquantitative estimation of AF burden in patients with a known history of paroxysmal AF. Trial Registration number: NCT04563572.

Tracking the Reorganization of Module Structure in Time-Varying Weighted Brain Functional Connectivity Networks.

Identification of module structure in brain functional networks is a promising way to obtain novel insights into neural information processing, as modules correspond to delineated brain regions in which interactions are strongly increased. Tracking of network modules in time-varying brain functional networks is not yet commonly considered in neuroscience despite its potential for gaining an understanding of the time evolution of functional interaction patterns and associated changing degrees of functional segregation and integration. We introduce a general computational framework for extracting consensus partitions from defined time windows in sequences of weighted directed edge-complete networks and show how the temporal reorganization of the module structure can be tracked and visualized. Part of the framework is a new approach for computing edge weight thresholds for individual networks based on multiobjective optimization of module structure quality criteria as well as an approach for matching modules across time steps. By testing our framework using synthetic network sequences and applying it to brain functional networks computed from electroencephalographic recordings of healthy subjects that were exposed to a major balance perturbation, we demonstrate the framework's potential for gaining meaningful insights into dynamic brain function in the form of evolving network modules. The precise chronology of the neural processing inferred with our framework and its interpretation helps to improve the currently incomplete understanding of the cortical contribution for the compensation of such balance perturbations.

Nonlinear Directed Interactions Between HRV and EEG Activity in Children With TLE.

OBJECTIVE: Epileptic seizure activity influences the autonomic nervous system (ANS) in different ways. Heart rate variability (HRV) is used as indicator for alterations of the ANS. It was shown that linear, nondirected interactions between HRV and EEG activity before, during, and after epileptic seizure occur. Accordingly, investigations of directed nonlinear interactions are logical steps to provide, e.g., deeper insight into the development of seizure onsets. METHODS: Convergent cross mapping (CCM) investigates nonlinear, directed interactions between time series by using nonlinear state space reconstruction. CCM is applied to simulated and clinically relevant data, i.e., interactions between HRV and specific EEG components of children with temporal lobe epilepsy (TLE). In addition, time-variant multivariate Autoregressive model (AR)-based estimation of partial directed coherence (PDC) was performed for the same data. RESULTS: Influence of estimation parameters and time-varying behavior of CCM estimation could be demonstrated by means of simulated data. AR-based estimation of PDC failed for the investigation of our clinical data. Time-varying interval-based application of CCM on these data revealed directed interactions between HRV and delta-related EEG activity. Interactions between HRV and alpha-related EEG activity were visible but less pronounced. EEG components mainly drive HRV. The interaction pattern and directionality clearly changed with onset of seizure. Statistical relevant interactions were quantified by bootstrapping and surrogate data approach. CONCLUSION AND SIGNIFICANCE: In contrast to AR-based estimation of PDC CCM was able to reveal time-courses and frequency-selective views of nonlinear interactions for the further understanding of complex interactions between the epileptic network and the ANS in children with TLE.

Time-variant, frequency-selective, linear and nonlinear analysis of heart rate variability in children with temporal lobe epilepsy.

The major aim of our study is to demonstrate that a concerted combination of time-variant, frequency-selective, linear and nonlinear analysis approaches can be beneficially used for the analysis of heart rate variability (HRV) in epileptic patients to reveal premonitory information regarding an imminent seizure and to provide more information on the mechanisms leading to changes of the autonomic nervous system. The quest is to demonstrate that the combined approach gains new insights into specific short-term patterns in HRV during preictal, ictal, and postictal periods in epileptic children. The continuous Morlet-wavelet transform was used to explore the time-frequency characteristics of the HRV using spectrogram, phase-locking, band-power and quadratic phase coupling analyses. These results are completed by time-variant characteristics derived from a signal-adaptive approach. Advanced empirical mode decomposition was utilized to separate out certain HRV components, in particular blood-pressure-related Mayer waves (≈0.1 Hz) and respiratory sinus arrhythmia (≈0.3 Hz). Their time-variant nonlinear predictability was analyzed using local estimations of the largest Lyapunov exponent (point prediction error). Approximately 80-100 s before the seizure onset timing and coordination of both HRV components can be observed. A higher degree of synchronization is found and with it a higher predictability of the HRV. All investigated linear and nonlinear analyses contribute with a specific importance to these results.

Synchronization analysis between heart rate variability and EEG activity before, during, and after epileptic seizure.

Abstract An innovative concept for synchronization analysis between heart rate (HR) components and rhythms in EEG envelopes is represented; it applies time-variant analyses to heart rate variability (HRV) and EEG, and it was tested in children with temporal lobe epilepsy (TLE). After a removal of ocular and movement-related artifacts, EEG band activity was computed by means of the frequency-selective Hilbert transform providing envelopes of frequency bands. Synchronization between HRV and EEG envelopes was quantified by Morlet wavelet coherence. A surrogate data approach was adapted to test for statistical significance of time-variant coherences. Using this processing scheme, significant coherence values between a HRV low-frequency sub-band (0.08-0.12 Hz) and the EEG δ envelope (1.5-4 Hz) occurring both in the preictal and early postictal periods of a seizure can be shown. Investigations were performed for all electrodes at 20-s intervals and for selected electrode pairs (T3÷C3, T4÷C4) in a time-variant mode. Synchronization was more pronounced in the group of right hemispheric TLE patients than in the left hemispheric group. Such a group-specific augmentation of synchronization confirms the hypothesis of a right hemispheric lateralization of sympathetic cardiac control of the low-frequency HRV components.

Monitoring the fetal heart rate variations by means of time-variant multivariate analysis.

The analysis of the fetal heart rate (fHR) is important in detecting the fetal distress related with hypoxic episodes, noticed sometimes during the uterine activity, which can severely affect the fetus. Occasional synchrony between the fHR and the maternal heart rate (mHR) was reported and the mHR shows some variations during pregnancy and labor, especially when the contractions are very strong. The current study proposes a new strategy to investigate the relations between the fHR, the mHR and the uterine activity, by applying the time-variant Partial Directed Coherence (tvPDC).