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2.
Clin Neurophysiol ; 140: 45-58, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35728405

RESUMO

OBJECTIVE: Parkinson's disease (PD) patients may be categorized into tremor-dominant (TD) and postural-instability and gait disorder (PIGD) motor phenotypes, but the dynamical aspects of subthalamic nucleus local field potentials (STN-LFP) and the neural correlates of this phenotypical classification remain unclear. METHODS: 35 STN-LFP (20 PIGD and 15 TD) were investigated through continuous wavelet transform and machine-learning-based methods. The beta oscillation - the main band associated with motor impairment in PD - dynamics was characterized through beta burst parameters across phenotypes and burst intervals under specific proposed criteria for optimal burst threshold definition. RESULTS: Low-frequency (13-22 Hz) beta burst probability was the best predictor for PD phenotypes (75% accuracy). PIGD patients presented higher average burst duration (p = 0.018), while TD patients exhibited higher burst probability (p = 0.014). Categorization into shorter and longer than 400 ms bursts led to significant interaction between burst length categories and the phenotypes (p < 0.050) as revealed by mixed-effects models. Long burst durations and short bursts probability positively correlated, respectively, with rigidity-bradykinesia (p = 0.029) and tremor (p = 0.038) scores. CONCLUSIONS: Subthalamic low-frequency beta bursts differed between TD and PIGD phenotypes and correlated with motor symptoms. SIGNIFICANCE: These findings improve the PD phenotypes' electrophysiological characterization and may define new criteria for adaptive deep brain stimulation.


Assuntos
Estimulação Encefálica Profunda , Doença de Parkinson , Núcleo Subtalâmico , Marcha , Humanos , Doença de Parkinson/diagnóstico , Doença de Parkinson/terapia , Fenótipo , Tremor/diagnóstico
3.
Europace ; 24(7): 1186-1194, 2022 07 21.
Artigo em Inglês | MEDLINE | ID: mdl-35045172

RESUMO

AIMS: Atrial flutter (AFlut) is a common re-entrant atrial tachycardia driven by self-sustainable mechanisms that cause excitations to propagate along pathways different from sinus rhythm. Intra-cardiac electrophysiological mapping and catheter ablation are often performed without detailed prior knowledge of the mechanism perpetuating AFlut, likely prolonging the procedure time of these invasive interventions. We sought to discriminate the AFlut location [cavotricuspid isthmus-dependent (CTI), peri-mitral, and other left atrium (LA) AFlut classes] with a machine learning-based algorithm using only the non-invasive signals from the 12-lead electrocardiogram (ECG). METHODS AND RESULTS: Hybrid 12-lead ECG dataset of 1769 signals was used (1424 in silico ECGs, and 345 clinical ECGs from 115 patients-three different ECG segments over time were extracted from each patient corresponding to single AFlut cycles). Seventy-seven features were extracted. A decision tree classifier with a hold-out classification approach was trained, validated, and tested on the dataset randomly split after selecting the most informative features. The clinical test set comprised 38 patients (114 clinical ECGs). The classifier yielded 76.3% accuracy on the clinical test set with a sensitivity of 89.7%, 75.0%, and 64.1% and a positive predictive value of 71.4%, 75.0%, and 86.2% for CTI, peri-mitral, and other LA class, respectively. Considering majority vote of the three segments taken from each patient, the CTI class was correctly classified at 92%. CONCLUSION: Our results show that a machine learning classifier relying only on non-invasive signals can potentially identify the location of AFlut mechanisms. This method could aid in planning and tailoring patient-specific AFlut treatments.


Assuntos
Flutter Atrial , Ablação por Cateter , Flutter Atrial/diagnóstico , Flutter Atrial/etiologia , Flutter Atrial/cirurgia , Eletrocardiografia/métodos , Sistema de Condução Cardíaco , Humanos , Aprendizado de Máquina
4.
Neurosurgery ; 89(3): 450-459, 2021 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-34161592

RESUMO

BACKGROUND: Gait and balance disturbance are challenging symptoms in advanced Parkinson's disease (PD). Anatomic and clinical data suggest that the fields of Forel may be a potential surgical target to treat these symptoms. OBJECTIVE: To test whether bilateral stimulation centered at the fields of Forel improves levodopa unresponsive freezing of gait (FOG), balance problems, postural instability, and falls in PD. METHODS: A total of 13 patients with levodopa-unresponsive gait disturbance (Hoehn and Yahr stage ≥3) were included. Patients were evaluated before (on-medication condition) and 1 yr after surgery (on-medication-on-stimulation condition). Motor symptoms and quality of life were assessed with the Unified Parkinson's Disease Rating scale (UPDRS III) and Quality of Life scale (PDQ-39). Clinical and instrumented analyses assessed gait, balance, postural instability, and falls. RESULTS: Surgery improved balance by 43% (95% confidence interval [CI]: 21.2-36.4 to 35.2-47.1; P = .0012), reduced FOG by 35% (95% CI: 15.1-20.3 to 8.1-15.3; P = .0021), and the monthly number of falls by 82.2% (95% CI: 2.2-6.9 to -0.2-1.7; P = .0039). Anticipatory postural adjustments, velocity to turn, and postural sway measurements also improved 1 yr after deep brain stimulation (DBS). UPDRS III motor scores were reduced by 27.2% postoperatively (95% CI: 42.6-54.3 to 30.2-40.5; P < .0001). Quality of life improved 27.5% (95% CI: 34.6-48.8 to 22.4-37.9; P = .0100). CONCLUSION: Our results suggest that DBS of the fields of Forel improved motor symptoms in PD, as well as the FOG, falls, balance, postural instability, and quality of life.


Assuntos
Estimulação Encefálica Profunda , Transtornos Neurológicos da Marcha , Doença de Parkinson , Encéfalo , Marcha , Transtornos Neurológicos da Marcha/tratamento farmacológico , Transtornos Neurológicos da Marcha/etiologia , Humanos , Levodopa/uso terapêutico , Doença de Parkinson/complicações , Doença de Parkinson/tratamento farmacológico , Equilíbrio Postural , Qualidade de Vida
5.
Cardiovasc Digit Health J ; 2(2): 126-136, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33899043

RESUMO

BACKGROUND: Atrial fibrillation (AF) is the most common supraventricular arrhythmia, characterized by disorganized atrial electrical activity, maintained by localized arrhythmogenic atrial drivers. Pulmonary vein isolation (PVI) allows to exclude PV-related drivers. However, PVI is less effective in patients with additional extra-PV arrhythmogenic drivers. OBJECTIVES: To discriminate whether AF drivers are located near the PVs vs extra-PV regions using the noninvasive 12-lead electrocardiogram (ECG) in a computational and clinical framework, and to computationally predict the acute success of PVI in these cohorts of data. METHODS: AF drivers were induced in 2 computerized atrial models and combined with 8 torso models, resulting in 1128 12-lead ECGs (80 ECGs with AF drivers located in the PVs and 1048 in extra-PV areas). A total of 103 features were extracted from the signals. Binary decision tree classifier was trained on the simulated data and evaluated using hold-out cross-validation. The PVs were subsequently isolated in the models to assess PVI success. Finally, the classifier was tested on a clinical dataset (46 patients: 23 PV-dependent AF and 23 with additional extra-PV sources). RESULTS: The classifier yielded 82.6% specificity and 73.9% sensitivity for detecting PV drivers on the clinical data. Consistency analysis on the 46 patients resulted in 93.5% results match. Applying PVI on the simulated AF cases terminated AF in 100% of the cases in the PV class. CONCLUSION: Machine learning-based classification of 12-lead-ECG allows discrimination between patients with PV drivers vs those with extra-PV drivers of AF. The novel algorithm may aid to identify patients with high acute success rates to PVI.

6.
Med Biol Eng Comput ; 59(5): 1133-1150, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33909252

RESUMO

Brain-computer interfaces (BCI) based on steady-state visually evoked potentials (SSVEP) have been increasingly used in different applications, ranging from entertainment to rehabilitation. Filtering techniques are crucial to detect the SSVEP response since they can increase the accuracy of the system. Here, we present an analysis of a space-time filter based on the Minimum Variance Distortionless Response (MVDR). We have compared the performance of a BCI-SSVEP using the MVDR filter to other classical approaches: Common Average Reference (CAR) and Canonical Correlation Analysis (CCA). Moreover, we combined the CAR and MVDR techniques, totalling four filtering scenarios. Feature extraction was performed using Welch periodogram, Fast Fourier transform, and CCA (as extractor) with one and two harmonics. Feature selection was performed by forward wrappers, and a linear classifier was employed for discrimination. The main analyses were carried out over a database of ten volunteers, considering two cases: four and six visual stimuli. The results show that the BCI-SSVEP using the MVDR filter achieves the best performance among the analysed scenarios. Interestingly, the system's accuracy using the MVDR filter is practically constant even when the number of visual stimuli was increased, whereas degradation was observed for the other techniques.


Assuntos
Interfaces Cérebro-Computador , Algoritmos , Eletroencefalografia , Potenciais Evocados , Potenciais Evocados Visuais , Humanos , Estimulação Luminosa
7.
Clin Neurol Neurosurg ; 205: 106626, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33873121

RESUMO

OBJECTIVE: A pragmatic tool for the early and reliable prediction of recovery in patients with acute ischemic stroke is needed. We aimed to test the addition of brain eloquent areas involvement in variables predicting poor outcome, using a simple scoring system. METHODS: Retrospective study of patients with anterior circulation acute ischemic stroke treated with best medical treatment and/or endovascular reperfusion. Primary outcome measure was 3-months poor outcome (mRs 3-6). We developed a prognostic model based on clinical data and a quantitative scoring system of the main eloquent brain areas involved on early follow-up CT, and analyzed its accuracy to predict poor outcome comparatively to three other prognostic models. The final model was used to develop a score for outcome prediction based on the multivariable analysis. RESULTS: A total of 197 patients were included (poor outcome = 62; mean age 67 ± 15.1 years; 44% females). Independent predictors of poor outcome were increasing age (p < 0.001), baseline NIHSS (p = 0.03), and the involvement of two brain areas: posterior limb of internal capsule (p < 0.001) and postero-superior corona radiata (p < 0.001). This model showed to be the most accurate to predict poor outcome (Balance Accuracy = 77.74%; C-Statistic = 0.891). The derived risk score attributing points for each of these variables (EASY score) showed similar performances (Balance Accuracy = 82.11%; C-Statistic = 0.90). CONCLUSION: The EASY score is an easy-to-apply and accurate tool to predict the 3-months functional outcome after ischemic stroke, relying on simple clinical features and the assessment of two key eloquent brain areas on early follow-up CT.

8.
Eur J Neurosci ; 53(8): 2804-2818, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33393163

RESUMO

Parkinson's disease (PD) is clinically heterogeneous across patients and may be classified in three motor phenotypes: tremor dominant (TD), postural instability and gait disorder (PIGD), and undetermined. Despite the significant clinical characterization of motor phenotypes, little is known about how electrophysiological data, particularly subthalamic nucleus local field potentials (STN-LFP), differ between TD and PIGD patients. This is relevant since increased STN-LFP bandpower at α-ß range (8-35 Hz) is considered a potential PD biomarker and, therefore, a critical setpoint to drive adaptive deep brain stimulation. Acknowledging STN-LFP differences between phenotypes, mainly in rest and movement states, would better fit DBS to clinical and motor demands. We studied this issue through spectral analyses on 35 STN-LFP in TD and PIGD patients during rest and movement. We demonstrated that higher ß2 activity (22-35 Hz) was observed in PIGD only during rest. Additionally, bandpower differences between rest and movement occurred at the α-ß range, but with different patterns as per phenotypes: movement-induced desynchronization concerned lower frequencies in TD (10-20 Hz) and higher frequencies in PIGD patients (21-28 Hz). Finally, when supervised learning algorithms were employed aiming to discriminate PD phenotypes based on STN-LFP bandpower features, movement information had improved the classification accuracy, achieving peak performances when TD and PIGD movement-induced desynchronization ranges were considered. These results suggest that STN-LFP ß-band encodes phenotype-movement dependent information in PD patients.


Assuntos
Estimulação Encefálica Profunda , Doença de Parkinson , Núcleo Subtalâmico , Humanos , Movimento , Doença de Parkinson/terapia , Fenótipo , Descanso
9.
IEEE Trans Biomed Eng ; 68(4): 1131-1141, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-32881680

RESUMO

OBJECTIVE: Ablation treatment for persistent atrial fibrillation (persAF) remains challenging due to the absence of a 'ground truth' for atrial substrate characterization and the presence of multiple mechanisms driving the arrhythmia. We implemented an unsupervised classification to identify clusters of atrial electrograms (AEGs) with similar patterns, which were then validated by AEG-derived markers. METHODS: 956 bipolar AEGs were collected from 11 persAF patients. CARTO variables (Biosense Webster; ICL, ACI and SCI) were used to create a 3D space, and subsequently used to perform an unsupervised classification with k-means. The characteristics of the identified groups were investigated using nine AEG-derived markers: sample entropy (SampEn), dominant frequency, organization index (OI), determinism, laminarity, recurrence rate (RR), peak-to-peak (PP) amplitude, cycle length (CL), and wave similarity (WS). RESULTS: Five AEG classes with distinct characteristics were identified (F = 582, P<0.0001). The presence of fractionation increased from class 1 to 5, as reflected by the nine markers. Class 1 (25%) included organized AEGs with high WS, determinism, laminarity, and RR, and low SampEn. Class 5 (20%) comprised fractionated AEGs with in low WS, OI, determinism, laminarity, and RR, and in high SampEn. Classes 2 (12%), 3 (13%) and 4 (30%) suggested different degrees of AEG organization. CONCLUSIONS: Our results expand and reinterpret the criteria used for automated AEG classification. The nine markers highlighted electrophysiological differences among the five classes found by the k-means, which could provide a more complete characterization of persAF substrate during ablation target identification in future clinical studies.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Fibrilação Atrial/diagnóstico , Eletrofisiologia Cardíaca , Técnicas Eletrofisiológicas Cardíacas , Átrios do Coração , Humanos , Recidiva
10.
IEEE Trans Biomed Eng ; 68(3): 914-925, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-32746003

RESUMO

OBJECTIVE: Atrial flutter (AFl) is a common arrhythmia that can be categorized according to different self-sustained electrophysiological mechanisms. The non-invasive discrimination of such mechanisms would greatly benefit ablative methods for AFl therapy as the driving mechanisms would be described prior to the invasive procedure, helping to guide ablation. In the present work, we sought to implement recurrence quantification analysis (RQA) on 12-lead ECG signals from a computational framework to discriminate different electrophysiological mechanisms sustaining AFl. METHODS: 20 different AFl mechanisms were generated in 8 atrial models and were propagated into 8 torso models via forward solution, resulting in 1,256 sets of 12-lead ECG signals. Principal component analysis was applied on the 12-lead ECGs, and six RQA-based features were extracted from the most significant principal component scores in two different approaches: individual component RQA and spatial reduced RQA. RESULTS: In both approaches, RQA-based features were significantly sensitive to the dynamic structures underlying different AFl mechanisms. Hit rate as high as 67.7% was achieved when discriminating the 20 AFl mechanisms. RQA-based features estimated for a clinical sample suggested high agreement with the results found in the computational framework. CONCLUSION: RQA has been shown an effective method to distinguish different AFl electrophysiological mechanisms in a non-invasive computational framework. A clinical 12-lead ECG used as proof of concept showed the value of both the simulations and the methods. SIGNIFICANCE: The non-invasive discrimination of AFl mechanisms helps to delineate the ablation strategy, reducing time and resources required to conduct invasive cardiac mapping and ablation procedures.


Assuntos
Fibrilação Atrial , Flutter Atrial , Ablação por Cateter , Flutter Atrial/diagnóstico , Eletrocardiografia , Átrios do Coração , Humanos , Recidiva
11.
J Neural Eng ; 17(1): 016060, 2020 02 18.
Artigo em Inglês | MEDLINE | ID: mdl-31945751

RESUMO

OBJECTIVE: Adapted from the concept of channel capacity, the information transfer rate (ITR) has been widely used to evaluate the performance of a brain-computer interface (BCI). However, its traditional formula considers the model of a discrete memoryless channel in which the transition matrix presents very particular symmetries. As an alternative to compute the ITR, this work indicates a more general closed-form expression-also based on that channel model, but with less restrictive assumptions-and, with the aid of a selection heuristic based on a wrapper algorithm, extends such formula to detect classes that deteriorate the operation of a BCI system. APPROACH: The benchmark is a steady-state visually evoked potential (SSVEP)-based BCI dataset with 40 frequencies/classes, in which two scenarios are tested: (1) our proposed formula is used and the classes are gradually evaluated in the order of the class labels provided with the dataset; and (2) the same formula is used but with the classes evaluated progressively by a wrapper algorithm. In both scenarios, the canonical correlation analysis (CCA) is the tool to detect SSVEPs. MAIN RESULTS: Before and after class selection using this alternative ITR, the average capacity among all subjects goes from 3.71 [Formula: see text] 1.68 to 4.79 [Formula: see text] 0.70 bits per symbol, with p -value <0.01, and, for a supposedly BCI-illiterate subject, her/his capacity goes from 1.53 to 3.90 bits per symbol. SIGNIFICANCE: Besides indicating a consistent formula to compute ITR, this work provides an efficient method to perform channel assessment in the context of a BCI experiment and argues that such method can be used to study BCI illiteracy.


Assuntos
Interfaces Cérebro-Computador , Eletroencefalografia/métodos , Potenciais Evocados Visuais/fisiologia , Processamento de Sinais Assistido por Computador , Interfaces Cérebro-Computador/psicologia , Bases de Dados Factuais , Humanos , Estimulação Luminosa/métodos
13.
Med Biol Eng Comput ; 57(8): 1709-1725, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31127535

RESUMO

This work presents a classification performance comparison between different frameworks for functional connectivity evaluation and complex network feature extraction aiming to distinguish motor imagery classes in electroencephalography (EEG)-based brain-computer interfaces (BCIs). The analysis was performed in two online datasets: (1) a classical benchmark-the BCI competition IV dataset 2a-allowing a comparison with a representative set of strategies previously employed in this BCI paradigm and (2) a statistically representative dataset for signal processing technique comparisons over 52 subjects. Besides exploring three classical similarity measures-Pearson correlation, Spearman correlation, and mean phase coherence-this work also proposes a recurrence-based alternative for estimating EEG brain functional connectivity, which takes into account the recurrence density between pairwise electrodes over a time window. These strategies were followed by graph feature evaluation considering clustering coefficient, degree, betweenness centrality, and eigenvector centrality. The features were selected by Fisher's discriminating ratio and classification was performed by a least squares classifier in agreement with classical and online BCI processing strategies. The results revealed that the recurrence-based approach for functional connectivity evaluation was significantly better than the other frameworks, which is probably associated with the use of higher order statistics underlying the electrode joint probability estimation and a higher capability of capturing nonlinear inter-relations. There were no significant differences in performance among the evaluated graph features, but the eigenvector centrality was the best feature regarding processing time. Finally, the best ranked graph-based attributes were found in classical EEG motor cortex positions for the subjects with best performances, relating functional organization and motor activity. Graphical Abstract Evaluating functional connectivity based on Space-Time Recurrence Counting for motor imagery classification in brain-computer interfaces. Recurrences are evaluated between electrodes over a time window, and, after a density threshold, the electrodes adjacency matrix is stablish, leading to a graph. Graph-based topological measures are used for motor imagery classification.


Assuntos
Interfaces Cérebro-Computador , Eletroencefalografia/métodos , Imaginação/fisiologia , Encéfalo/fisiologia , Sincronização Cortical , Bases de Dados Factuais , Eletrodos , Eletroencefalografia/instrumentação , , Mãos , Humanos , Atividade Motora/fisiologia , Experimentação Humana não Terapêutica , Processamento de Sinais Assistido por Computador , Língua
14.
Annu Int Conf IEEE Eng Med Biol Soc ; 2019: 2277-2280, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31946354

RESUMO

The outcomes of ablation targeting either reentry activations or fractionated activity during persistent atrial fibrillation (AF) therapy remain suboptimal due to, among others, the intricate underlying AF dynamics. In the present work, we sought to investigate such AF dynamics in a heterogeneous simulation setup using recurrence quantification analysis (RQA). AF was simulated in a spherical model of the left atrium, from which 412 unipolar atrial electrograms (AEGs) were extracted (2 s duration; 5 mm spacing). The phase was calculated using the Hilbert transform, followed by the identification of points of singularity (PS). Three regions were defined according to the occurrence of PSs: 1) no rotors; 2) transient rotors and; 3) long-standing rotors. Bipolar AEGs (1114) were calculated from pairs of unipolar nodes and bandpass filtered (30-300 Hz). The CARTO criterion (Biosense Webster) was used for AEGs classification (normal vs. fractionated). RQA attributes were calculated from the filtered bipolar AEGs: determinism (DET); recurrence rate (RR); laminarity (LAM). Sample entropy (SampEn) and dominant frequency (DF) were also calculated from the AEGs. Regions with longstanding rotors have shown significantly lower RQA attributes and SampEn when compared to the other regions, suggesting a higher irregular behaviour (P≤0.01 for all cases). Normal and fractionated AEGs were found in all regions (respectively; Region 1: 387 vs. 15; Region 2: 221 vs. 13; Region 3: 415 vs. 63). Region 1 vs. Region 3 have shown significant differences in normal AEGs (P≤0.0001 for all RQA attributes and SampEn), and significant differences in fractionated AEGs for LAM, RR and SampEn (P=0.0071, P=0.0221 and P=0.0086, respectively). Our results suggest the co-existence of normal and fractionated AEGs within long-standing rotors. RQA has unveiled distinct dynamic patterns-irrespective of AEGs classification-related to regularity structures and their nonstationary behaviour in a rigorous deterministic context.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Algoritmos , Técnicas Eletrofisiológicas Cardíacas , Átrios do Coração , Humanos , Recidiva
15.
Res. Biomed. Eng. (Online) ; 34(4): 337-349, Oct.-Dec. 2018. tab, graf
Artigo em Inglês | LILACS | ID: biblio-984963

RESUMO

Abstract Introduction The temporal behavior of atrial electrograms (AEGs) collected during persistent atrial fibrillation (persAF) directly affects ablative treatment outcomes. We investigated different durations of AEGs collected during persAF using recurrence quantification analysis (RQA). Methods 797 bipolar AEGs with different durations (from 0.5 s to 8 s) from 18 patients were investigated. Four RQA-based attributes were evaluated based on AEG durations: determinism (DET); recurrence rate (RR); laminarity (LAM); and diagonal lines' entropy (ENTR). The Spearman correlation (ρ) between each duration versus 8 s was calculated. AEG classification was performed following the CARTO criteria (Biosense Webster) and receiving operating characteristic (ROC) curves were created for the RQA variables. Results The RQA variables successfully discriminated the AEGs: the area under the ROC curves were as high as 0.70 for AEGs with 3.5 s or greater. Three types of AEGs were found using these variables: normal, fractionated and temporally unstable. The number of unstable AEGs decreased with longer AEG segments. Different AEG durations significantly affected the RQA variables (P<0.0001), with no statistical difference between the durations 6 s, 7 s and 8 s for DET, LAM and ENTR, and no difference between 7 s and 8 s for RR (P<0.0001). AEGs with 3 s or longer have shown ρ ≥ 80% for all variables. Conclusion The RQA variables have been shown effective in the characterization of AEGs collected during persAF with a shorter duration than current recommendations, which motivates their use for the characterization of atrial substrate during persAF ablation.

16.
Chaos ; 28(8): 085710, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30180613

RESUMO

Atrial fibrillation (AF) is regarded as a complex arrhythmia, with one or more co-existing mechanisms, resulting in an intricate structure of atrial activations. Fractionated atrial electrograms (AEGs) were thought to represent arrhythmogenic tissue and hence have been suggested as targets for radiofrequency ablation. However, current methods for ablation target identification have resulted in suboptimal outcomes for persistent AF (persAF) treatment, possibly due to the complex spatiotemporal dynamics of these mechanisms. In the present work, we sought to characterize the dynamics of atrial tissue activations from AEGs collected during persAF using recurrence plots (RPs) and recurrence quantification analysis (RQA). 797 bipolar AEGs were collected from 18 persAF patients undergoing pulmonary vein isolation (PVI). Automated AEG classification (normal vs. fractionated) was performed using the CARTO criteria (Biosense Webster). For each AEG, RPs were evaluated in a phase space estimated following Takens' theorem. Seven RQA variables were obtained from the RPs: recurrence rate; determinism; average diagonal line length; Shannon entropy of diagonal length distribution; laminarity; trapping time; and Shannon entropy of vertical length distribution. The results show that the RQA variables were significantly affected by PVI, and that the variables were effective in discriminating normal vs. fractionated AEGs. Additionally, diagonal structures associated with deterministic behavior were still present in the RPs from fractionated AEGs, leading to a high residual determinism, which could be related to unstable periodic orbits and suggesting a possible chaotic behavior. Therefore, these results contribute to a nonlinear perspective of the spatiotemporal dynamics of persAF.


Assuntos
Fibrilação Atrial/fisiopatologia , Eletrocardiografia , Processamento Eletrônico de Dados , Modelos Cardiovasculares , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
17.
Cerebrovasc Dis ; 44(3-4): 128-134, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28605741

RESUMO

BACKGROUND AND PURPOSE: The prognostic significance of interictal epileptiform discharges (IED) and periodic patterns (PP) after ischemic stroke has not been assessed. We sought to test whether IED and PP, detected on standard Electroencephalography (EEG) performed during the acute phase of ischemic stroke are associated with a worse functional outcome. METHODS: One-hundred-fifty-seven patients 18 years or older with a diagnosis of acute ischemic stroke presenting within 72 h from stroke onset were prospectively enrolled and followed. Patients with a pre-stroke history of seizures or epilepsy, previous debilitating neurological disease or conditions that precluded the performance of EEG were excluded. Interpretation was performed by a blinded board certified neurophysiologist. IED and PP (grouped as epileptiform activity [EA]) were defined according to proposed guidelines. Univariable and multivariable analyses were used to identify predictors of outcome (modified Rankin Scale dichotomized ≤2 vs. ≥3) at 3 months. RESULTS: In the univariable analysis, admission NIHSS (OR 1.20, 95% CI 1.12-1.28, p = 0.001), age (OR 1.03, 95% CI 1.01-1.05, p = 0.02), and presence of EA (OR 2.94, 95% CI 1.51-5.88, p = 0.001) were significantly associated with the outcome at 3 months. In the multivariable analysis, only admission NIHSS (OR 1.19, 95% CI 1.11-1.28, p < 0.001) and the presence of EA (OR 2.27, 95% CI 1.04-5.00, p = 0.04) were independently associated with the prognosis. SIGNIFICANCE: The importance of EEG in the prognosis of acute ischemic stroke warrants additional research, examining the role of medication therapy on the outcome and the occurrence of seizures for those patients with specific EEG patterns.


Assuntos
Isquemia Encefálica/diagnóstico , Ondas Encefálicas , Encéfalo/fisiopatologia , Eletroencefalografia , Periodicidade , Convulsões/diagnóstico , Acidente Vascular Cerebral/diagnóstico , Idoso , Isquemia Encefálica/complicações , Isquemia Encefálica/fisiopatologia , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Fatores de Risco , Convulsões/etiologia , Convulsões/fisiopatologia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo
18.
Chaos ; 23(2): 023105, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23822470

RESUMO

The present work aims to apply a recently proposed method for estimating Lyapunov exponents to characterize-with the aid of the metric entropy and the fractal dimension-the degree of information and the topological structure associated with multiscroll attractors. In particular, the employed methodology offers the possibility of obtaining the whole Lyapunov spectrum directly from the state equations without employing any linearization procedure or time series-based analysis. As a main result, the predictability and the complexity associated with the phase trajectory were quantified as the number of scrolls are progressively increased for a particular piecewise linear model. In general, it is shown here that the trajectory tends to increase its complexity and unpredictability following an exponential behaviour with the addition of scrolls towards to an upper bound limit, except for some degenerated situations where a non-uniform grid of scrolls is attained. Moreover, the approach employed here also provides an easy way for estimating the finite time Lyapunov exponents of the dynamics and, consequently, the Lagrangian coherent structures for the vector field. These structures are particularly important to understand the stretching/folding behaviour underlying the chaotic multiscroll structure and can provide a better insight of phase space partition and exploration as new scrolls are progressively added to the attractor.

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