Validation and Clinical Application of Time‐Frequency Analysis of Atrial Fibrillation Electrocardiograms

Husser, Daniela; Stridh, Martin; Cannom, David S.; Bhandari, Anil K.; Girsky, Marc J.; Kang, Seung-Min; Sörnmo, Leif; Olsson, S. Bertil; Bollmann, Andreas

doi:10.1111/j.1540-8167.2006.00683.x

Cited by 58 publications

(39 citation statements)

References 35 publications

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“…16 Furthermore, the existence of an AA harmonic structure has been also associated to SR maintenance after internal 17 and external 27 ECV as well as in use of antiarrhythmic drugs. 31,32 Therefore, the agreement between these studies suggests that the harmonic structure of the surface AA signal could be a powerful outcome predictor of any AF treatment. In addition, given that a more organized AF has been associated with stronger harmonics in previous works, 27 it could be considered that patients with more organized fibrillatory activity present a higher probability to respond successfully to any treatment, including ablation.…”

Section: Main Findingsmentioning

confidence: 92%

“…Indeed, only some previous studies have tried to validate the surface DF with invasive recordings from different atrial regions, but reporting inconclusive results. 30,31,47 Anyway, all these works, regardless of the very dissimilar methodology employed, prove that the standard surface ECG can be considered as a promising tool for mean and long-term outcome prognosis of CA as well as for assisting the proper selection of patients undergoing this procedure.…”

Section: Previous Studiesmentioning

confidence: 98%

“…However, this lead is readily available during catheter AF ablation without the need for additional instrumentation and reflects the global activation of the atria. 9,26,30,31,47 In addition, studies relying on only one surface lead can easily be extended to simpler recording systems, like Holter recorders, able to be performed long before the CA procedure. In contrast, other works have reported that improved prediction outcomes can be achieved by combining the information provided by multi-lead surface ECG recording systems.…”

Section: Limitationsmentioning

confidence: 99%

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Electrocardiographic Spectral Features for Long-Term Outcome Prognosis of Atrial Fibrillation Catheter Ablation

2016

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Atrial fibrillation (AF) is the most common arrhythmia in routine clinical practice. Despite many years of research, its mechanisms still are not well understood, thus reducing the effectiveness of AF treatments. Nowadays, pulmonary vein isolation by catheter ablation is the treatment of choice for AF resistant either to pharmacological or electrical cardioversion. However, given that long-term recurrences are common, an appropriate patient selection before the procedure is of paramount relevance in the improvement of AF catheter ablation outcome. The present work studies how several spectral features of the atrial activity (AA) from a single lead of the surface electrocardiogram (ECG) can become potential pre-ablation predictors of long-term (>2 months) sinus rhythm maintenance. Among all the analyzed spectral features, results indicated that the most significant single predictor of paroxysmal AF ablation treatment outcome was related to the amplitude of the first harmonic of the dominant frequency, providing sensitivity (Se), specificity (Sp) and accuracy (Ac) values of 90%, 42.86 and 77.78%, respectively. On the other hand, the AA harmonic structure was the most significant single predictor for persistent AF, with Se, Sp and Ac values of 100%, 54.55 and 77.27%, respectively. A logistic regression analysis, mainly based on spectral amplitudes as well as on the harmonic structure of the AA, provided a higher predictive ability both for paroxysmal AF (Se = 100%, Sp = 57.14% and Ac = 88.89%) and persistent AF (Se = 90.91%, Sp = 72.73 and Ac = 81.82%). In conclusion, the study of key AA spectral features from the surface ECG can provide a significant preoperative prognosis of AF catheter ablation outcome at long-term follow-up.

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Section: Main Findingsmentioning

confidence: 92%

Section: Previous Studiesmentioning

confidence: 98%

Section: Limitationsmentioning

confidence: 99%

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Electrocardiographic Spectral Features for Long-Term Outcome Prognosis of Atrial Fibrillation Catheter Ablation

2016

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“…Moreover, it can be speculated that with the currently available technology, localized intra-atrial phenomena such as micro-re-entry cannot be recorded on the surface. However, since frequency gradients between right and left atrial sites are dependent on the AF type (Lazar et al 2004), overall, there is also a good correlation of fibrillatory rates of left atrial sites and V1 (figure 5; Husser et al 2007b). Nevertheless, non-standard surface ECG lead positions such as at the posterior chest wall for better characterization of left atrial/pulmonary vein activity or identification of spatial variation have been validated in a preliminary study (Petrutiu et al 2006), and their feasibility for time-frequency analysis has been suggested (Husser et al 2007c).…”

Section: Clinical Applications (A ) Methods Validation and Reproducibimentioning

confidence: 93%

Analysis of atrial fibrillation: from electrocardiogram signal processing to clinical management

Sörnmo¹,

Stridh²,

Husser

et al. 2008

Phil. Trans. R. Soc. A.

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The analysis of atrial fibrillation in non-invasive ECG recordings has received considerable attention in recent years, spurring the development of signal processing techniques for more advanced characterization of the atrial waveforms than previously available. The present paper gives an overview of different approaches to the extraction of atrial activity in the ECG and to the characterization of the resulting atrial signal with respect to its spectral properties. So far, the repetition rate of the atrial waves is the most studied parameter and its significance in clinical management is briefly considered, including the identification of pathomechanisms and prediction of therapy efficacy.

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“…Previous works have shown that structural changes into surface f waves reflect the intraatrial activity organization variation [28,29]. Thus, it has been observed that ECGs acquired during intraatrial organized rhythms present f waves with well-defined and repetitive morphology and ECGs recorded during highly disorganized AA with fragmented activations contain surface f waves with very dissimilar morphologies [30].…”

Section: Surface Organization Assessmentmentioning

confidence: 99%

The Contribution of Nonlinear Methods in the Understanding of Atrial Fibrillation

Alcaraz¹,

Rieta²

2013

Atrial Fibrillation - Mechanisms and Treatment

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Additionally, the f wave analysis from surface ECG recordings is complicated by the simultaneous presence of VA, which is of much higher amplitude. Thereby, the dissociation of atrial and ventricular components is mandatory [12]. Nowadays, several methods to extract the AA signal from surface ECG recordings exist. The most powerful techniques are those that exploit the spatial diversity of the multilead ECG, such as the method that solves the blind source separation problem [3] or the spatiotemporal QRST cancellation strategy [13]. However, the performance of these techniques is seriously reduced when recordings are obtained from Holter systems for paroxysmal AF analysis. The reason is that, generally, Holter systems use no more than two or three leads, which are not enough to exploit the ECG spatial information. For single-lead applications, the most widely used alternative to extract the AA is the averaged beat subtraction (ABS). This method relies on the assumption that the average beat can represent, approximately, each individual beat [12]. Recently, a variety of extensions for this method have been proposed [12,14]. Intraatrial EGMNowadays, a variety of intraatrial recording modalities exists, such as bipolar and unipolar recordings from endocardial and epicardial electrodes, optical mapping and noncontact Atrial Fibrillation -Mechanisms and Treatment 182 mapping [15]. Although recordings from each one of these modalities have their own characteristics, unipolar recordings are generally characterized by a substantial far-field contamination, such as VA, whereas bipolar recordings contains local atrial activations of the place in which the electrodes are located. Nonetheless, these recordings are also affected by ventricular interference, especially in recording sites closer to the ventricles, even if its effect is less evident than on unipolar EGMs and surface ECG recordings. Thereby, for the VA cancellation both from unipolar and bipolar recordings, an averaged ventricular interference complex, as in ABS, is usually computed and subtracted from each atrial signal [16,17]. Only remark that the ventricular activations are habitually detected from a surface ECG recording simultaneously acquired for more accuracy.On the other hand, given that atrial dynamics can be analyzed both from simple EGMs and local atrial period (LAP) series, i.e., the sequence of temporal distances between two consecutive local atrial activations, the appropriate identification of these points is a important task in this context. For this purpose, EGMs are habitually high-pass filtering (40-250 Hz) to remove baseline shifts and high-frequency noise [18]. The filtered signal is then rectified, introducing low-frequency components related to the amplitude of the high-frequency oscillations of the original signal. The modulus of the filtered signal is further low-pass filtered (cut-off at 20 Hz) to extract a waveform proportional to the amplitude of the components of occurring at 40-250 Hz. The atrial activations are then detected by thr...

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Validation and Clinical Application of Time‐Frequency Analysis of Atrial Fibrillation Electrocardiograms

Abstract: Fibrillatory waves of surface ECG lead V1 closely reflect right atrial, and, to a lesser degree, left atrial activity. Time-frequency analysis allows noninvasive monitoring of antiarrhythmic drug effects on fibrillatory rate and waveform.

Cited by 58 publications

References 35 publications

Electrocardiographic Spectral Features for Long-Term Outcome Prognosis of Atrial Fibrillation Catheter Ablation

Electrocardiographic Spectral Features for Long-Term Outcome Prognosis of Atrial Fibrillation Catheter Ablation

Analysis of atrial fibrillation: from electrocardiogram signal processing to clinical management

The Contribution of Nonlinear Methods in the Understanding of Atrial Fibrillation

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