Detection and removal of ventricular ectopic beats in atrial fibrillation recordings via principal component analysis

Bertomeu-González

Fácila

et al. 2022

JPM

Since the discovery of pulmonary veins (PVs) as foci of atrial fibrillation (AF), the commonest cardiac arrhythmia, investigation revolves around PVs catheter ablation (CA) results. Notwithstanding, CA process itself is rather neglected. We aim to decompose crucial CA steps: coronary sinus (CS) catheterization and the impact of left and right PVs isolation (LPVI, RPVI), separately. We recruited 40 paroxysmal AF patients undergoing first-time CA and obtained five-minute lead II and bipolar CS recordings during sinus rhythm (SR) before CA (B), after LPVI (L) and after RPVI (R). Among others, duration, amplitude and atrial-rate variability (ARV) were calculated for P-waves and CS local activation waves (LAWs). LAWs features were compared among CS channels for reliability analysis. P-waves and LAWs features were compared after each ablation step (B, L, R). CS channels: amplitude and area were different between distal/medial (p≤0.0014) and distal/mid-proximal channels (p≤0.0025). Medial and distal showed the most and least coherent values, respectively. Correlation was higher in proximal (≥93%) than distal (≤91%) areas. P-waves: duration was significantly shortened after LPVI (after L: p=0.0012, −13.30%). LAWs: insignificant variations. ARV modification was more prominent in LAWs (L: >+73.12%, p≤0.0480, R: <−33.94%, p≤0.0642). Medial/mid-proximal channels are recommended during SR. CS LAWs are not significantly affected by CA but they describe more precisely CA-induced ARV modifications. LPVI provokes the highest impact in paroxysmal AF CA, significantly modifying P-wave duration.

Section: Methodsmentioning

confidence: 99%

The Dissimilar Impact in Atrial Substrate Modificationof Left and Right Pulmonary Veins Isolation after Catheter Ablation of Paroxysmal Atrial Fibrillation

Bertomeu-González

Fácila

et al. 2022

JPM

“…Ectopic beats were present in some of the recordings, with a maximum prevalence of

of total beats. Ectopic beat removal contained the ectopic detection, cancellation, and replacement by linear interpolation [ 53 , 54 ]. After ectopics removal, P-waves were detected and delineated [ 55 , 56 ].…”

Section: Methodsmentioning

confidence: 99%

The Relevance of Heart Rate Fluctuation When Evaluating Atrial Substrate Electrical Features in Catheter Ablation of Paroxysmal Atrial Fibrillation

Moreno‐Arribas

Gracia-Baena

et al. 2022

JCDD

Coronary sinus (CS) catheterization is critical during catheter ablation (CA) of atrial fibrillation (AF). However, the association of CS electrical activity with atrial substrate modification has been barely investigated and mostly limited to analyses during AF. In sinus rhythm (SR), atrial substrate modification is principally assessed at a global level through P-wave analysis. Cross-correlating CS electrograms (EGMs) and P-waves’ features could potentiate the understanding of AF mechanisms. Five-minute surface lead II and bipolar CS recordings before, during, and after CA were acquired from 40 paroxysmal AF patients. Features related to duration, amplitude, and heart-rate variability of atrial activations were evaluated. Heart-rate adjustment (HRA) was applied. Correlations between each P-wave and CS local activation wave (LAW) feature were computed with cross-quadratic sample entropy (CQSE), Pearson correlation (PC), and linear regression (LR) with 10-fold cross-validation. The effect of CA between different ablation steps was compared with PC. Linear correlations: poor to mediocre before HRA for analysis at each P-wave/LAW (PC: max. +18.36%, p=0.0017, LR: max. +5.33%, p=0.0002) and comparison between two ablation steps (max. +54.07%, p=0.0205). HRA significantly enhanced these relationships, especially in duration (P-wave/LAW: +43.82% to +69.91%, p<0.0001 for PC and +18.97% to +47.25%, p<0.0001 for LR, CA effect: +53.90% to +85.72%, p<0.0210). CQSE reported negligent correlations (0.6 –1.2). Direct analysis of CS features is unreliable to evaluate atrial substrate modification due to CA. HRA substantially solves this problem, potentiating correlation with P-wave features. Hence, its application is highly recommended.

“…A wavelet-based method was adopted in order to remove powerline interference, followed by muscle noise and baseline wander removal via bidirectional low-pass and high-pass filters, respectively [13], [14]. Finally, ectopic beats cancellation was performed by linear interpolation [15]. P-and R-wave detection as well as P-wave delineation followed the preprocessing [16], [17].…”

Section: Methodsmentioning

confidence: 99%

Alternative Time-Domain P-wave Analysis for Precise Information on Substrate Alteration After Pulmonary Vein Isolation for Atrial Fibrillation

2021 International Conference on E-Health and Bioengineering (EHB)

Bertomeu‐González

Hornero

et al. 2021

While P-wave duration (PWD) is primarily employed to observe the atrial substrate alterations after pulmonary vein isolation (PVI) on atrial fibrillation (AF) patients, the acquired information corresponds to the entire atria. Left (LA) and right atrium (RA), though, may be differently affected by PVI, implying the need for different after-PVI handling. In order to clarify this assumption, five-minute lead II recordings from 29 paroxysmal AF patients undergoing first-ever PVI were recruited before and after PVI. PWD was analyzed integrally and in parts, with the first part (P W D1) from the onset to the peak corresponding to RA and the second part (P W D2) to LA depolarization. Time from P-wave onset or offset to the R peak were also calculated (Pon − R and Pof f − R, respectively). Normalization (N) to mitigate heartrate effect was applied. Results before and after PVI were compared with Mann-Whitney U-test (MWU). Median values and variations due to PVI were calculated for all features and compared between PWD and the remaining features via Pearson correlation. After PVI, PWD (−9.84%, p = 0.0085, N : − 17.96%, p = 0.0442) and P W D2 (−22.03%, p = 0.0250, N :− 27.77%, p = 0.0268) were significantly decreased. P W D1 did not shorten significantly (up to −8.96%, p > 0.05 at either cases). P W D − P W D1 (ρ > 74.5%, p < 0.0001) showed higher correlation than P W D − P W D2 (ρ > 41.9%, p < 0.0001) in before and after PVI analysis but not for PVIrelated variation (ρP W D−P W D 1 = 54.0%, p = 0.0114 and ρP W D−P W D 2 = 61.4%, p = 0.0031). While RA depolarization time is more in line with PWD analysis, the effect of PVI in PWD is more coherent with LA's findings. Additionally, PWD shortening is only observed in the LA. Therefore, LA is crucial for the assessment of the atrial substrate alteration after PVI and its analysis should be considered by future studies.