A new transform for the analysis of complex fractionated atrial electrograms

BioMedical Engineering OnLine

Edward J Ciaccio²  Angelo B Biviano²  William Whang²  James Coromilas¹  Hasan Garan² 

[1] Department of Medicine, University of Medicine and Dentistry of New Jersey, USA

[2] Department of Medicine, Division of Cardiology, Columbia University, USA

关键词: spectral analysis;    reconstruction;    Fourier transform;    ensemble average;    decomposition;   

Others  :  798307
DOI  :  10.1186/1475-925X-10-35

 received in 2011-01-10, accepted in 2011-05-12,  发布年份 2011

【 摘 要 】

Background

Representation of independent biophysical sources using Fourier analysis can be inefficient because the basis is sinusoidal and general. When complex fractionated atrial electrograms (CFAE) are acquired during atrial fibrillation (AF), the electrogram morphology depends on the mix of distinct nonsinusoidal generators. Identification of these generators using efficient methods of representation and comparison would be useful for targeting catheter ablation sites to prevent arrhythmia reinduction.

Method

A data-driven basis and transform is described which utilizes the ensemble average of signal segments to identify and distinguish CFAE morphologic components and frequencies. Calculation of the dominant frequency (DF) of actual CFAE, and identification of simulated independent generator frequencies and morphologies embedded in CFAE, is done using a total of 216 recordings from 10 paroxysmal and 10 persistent AF patients. The transform is tested versus Fourier analysis to detect spectral components in the presence of phase noise and interference. Correspondence is shown between ensemble basis vectors of highest power and corresponding synthetic drivers embedded in CFAE.

Results

The ensemble basis is orthogonal, and efficient for representation of CFAE components as compared with Fourier analysis (p ≤ 0.002). When three synthetic drivers with additive phase noise and interference were decomposed, the top three peaks in the ensemble power spectrum corresponded to the driver frequencies more closely as compared with top Fourier power spectrum peaks (p ≤ 0.005). The synthesized drivers with phase noise and interference were extractable from their corresponding ensemble basis with a mean error of less than 10%.

Conclusions

The new transform is able to efficiently identify CFAE features using DF calculation and by discerning morphologic differences. Unlike the Fourier transform method, it does not distort CFAE signals prior to analysis, and is relatively robust to jitter in periodic events. Thus the ensemble method can provide a useful alternative for quantitative characterization of CFAE during clinical study.

【 授权许可】

   
2011 Ciaccio et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

Figure 5.

Figure 6.

Figure 7.

Figure 8.

Figure 9.

Figure 10.

Figure 11.

【 参考文献 】

• [1]Ciaccio EJ, Dunn SM, Akay M, Wit AL, Coromilas J, Costeas CA: Localized spatial discrimination of epicardial conduction paths after linear transformation of variant information. Ann Biomed Eng 1994, 22:480-492.
• [2]Nademanee K, McKenzie J, Kosar E, Schwab M, Sunsaneewitayakul B, Vasavakul T, Khunnawat C, Ngarmukos T: A new approach for catheter ablation of atrial fibrillation: Mapping of the electrophysiologic substrate. J Am Coll Cardiol 2004, 43:2044-2053.
• [3]Mandapati R, Skanes A, Chen J, Berenfeld O, Jalife J: Stable microreentrant sources as a mechanism of atrial fibrillation in the isolated sheep heart. Circulation 2000, 101:194-199.
• [4]Oral H, Chugh A, Good E, Sankaran S, Reich SS, Igic P, Elmouchi D, Tschopp D, Crawford T, Dey S, Wimmer A, Lemola K, Jongnarangsin K, Bogun F, Pelosi F Jr, Morady F: A tailored approach to catheter ablation of paroxysmal atrial fibrillation. Circulation 2006, 113:1824-1831.
• [5]Niu G, Scherlag B, Lu Z, Ghias M, Zhang Y, Patterson E, Dasari T, Zacharias S, Lazzara R, Jackman WM, Po SS: An acute experimental model demonstrating two different forms of sustained atrial tachyarrhythmias. Circ Arrhythmia Electrophysiol 2009, 2:384-392.
• [6]Kapa S, Asirvatham SJ: Atrial Fibrillation: Focal or Reentrant or Both? Circulation: Arrhythmia and Electrophysiology 2009, 2:345-348.
• [7]Sanders P, Berenfeld O, Hocini M, Jais P, Vaidyanathan R, Hsu LF, Garrigue S, Takahashi Y, Rotter M, Sacher F, Scavee C, Ploutz-Snyder R, Jalife J, Haïssaguerre M: Spectral analysis identifies sites of high-frequency activity maintaining atrial fibrillation in humans. Circulation 2005, 112:789-797.
• [8]Botteron GW, Smith JM: A technique for measurement of the extent of spatial organization of atrial activation during atrial fibrillation in the intact human heart. IEEE Trans Biomed Eng 1995, 42:579-586.
• [9]Botteron GW, Smith JM: Quantitative assessment of the spatial organization of atrial fibrillation in the intact human heart. Circulation 1996, 93:513-518.
• [10]Ng J, Kadish AH, Goldberger JJ: Effect of electrogram characteristics on the relationship of dominant frequency to atrial activation rate in atrial fibrillation. Heart Rhythm 2006, 3:1295-1305.
• [11]Ng J, Kadish AH, Goldberger JJ: Technical considerations for dominant frequency analysis. J Cardiovasc Electrophysiol 2007, 18:757-764.
• [12]Ng J, Goldberger JJ: Understanding and interpreting dominant frequency analysis of af electrograms. J Cardiovasc Electrophysiol 2007, 18:680-685.
• [13]Fischer G, Stühlinger MC, Nowak CN, Wieser L, Tilg B, Hintringer F: On computing dominant frequency from bipolar intracardiac electrograms. IEEE Trans Biomed Eng 2007, 54:165-169.
• [14]Verma A, Patel D, Famey T, Martin DO, Burkhardt JD, Elayi SC, Lakkireddy D, Wazni O, Cummings J, Schweikert RA, Saliba W, Tchou PJ, Natale A: Efficacy of adjuvant anterior left atrial ablation during intracardiac echocardiography-guided pulmonary vein antrum isolation for atrial fibrillation. J Cardiovasc Electrophysiol 2007, 18:151-156.
• [15]Brooks AG, Stiles MK, Laborderie J, Lau DH, Kuklik P, Shipp NJ, Hsu LF, Sanders P: Outcomes of long-standing persistent atrial fibrillation ablation: A systematic review. Heart Rhythm 2010, 7:835-846.
• [16]Ciaccio EJ: Ablation of longstanding persistent atrial fibrillation. J Atrial Fibrillation 2010, 2:806-809.
• [17]Ciaccio EJ, Biviano AB, Whang W, Wit AL, Garan H, Coromilas J: New methods for estimating local electrical activation rate during atrial fibrillation. Heart Rhythm 2009, 6:21-32.
• [18]Ciaccio EJ, Biviano AB, Whang W, Wit AL, Coromilas J, Garan H: Optimized measurement of activation rate at left atrial sites with complex fractionated electrograms during atrial fibrillation. J Cardiovasc Electrophysiol 2010, 21:133-143.
• [19]Narayan SM, Krummen DE, Kahn AM, Karasik PL, Franz MR: Evaluating fluctuations in human atrial fibrillatory cycle length using monophasic action potentials. PACE 2006, 29:1209-1218.
• [20]Brown JP, Krummen DE, Feld GK, Narayan SM: Using electrocardiographic activation time and diastolic intervals to separate focal from macro-re-entrant atrial tachycardias. J Am Coll Cardiol 2007, 49:1965-1973.
• [21]Narayan SM, Franz MR: Quantifying fractionation and rate in human atrial fibrillation using monophasic action potentials: Implications for substrate mapping. Europace 2007, 9:vi89-vi95.
• [22]Stiles MK, Brooks AG, John B, Shashidhar , Wilson L, Kuklik P, Dimitri H, Lau DH, Roberts-Thomson RL, Mackenzie L, Willoughby S, Young GD, Sanders P: The effect of electrogram duration on quantification of complex fractionated atrial electrograms and dominant frequency. J Cardiovasc Electrophysiol 2008, 19:252-258.
• [23]Biviano AB, Coromilas J, Ciaccio EJ, Whang W, Hickey K, Garan H: Frequency domain and time complex analyses manifest low correlation and temporal variability when calculating activation rates in atrial fibrillation patients. Pacing Clin Electrophysiol 2011, in press.
• [24]MacLeod RS, Johnson CR: Map3d: Interactive scientific visualization for bioengineering data. IEEE Engineering Medicine Biology Society 15th Ann Int Conference 1993, 30-31.
• [25]Stridh M, Sörnmo L, Meurling CJ, Olsson SB: Sequential characterization of atrial tachyarrhythmias based on ECG time-frequency analysis. IEEE Trans Biomed Eng 2004, 51:100-114.
• [26]Ciaccio EJ, Drzewiecki GM: Tonometric arterial pulse sensor with noise cancellation. IEEE Trans Biomed Eng 2008, 55:2388-2396.
• [27]Stridh M, Bollmann A, Olsson B, Sörnmo L: Detection and feature extraction of atrial tachyarrhythmias. A three stage method of time-frequency analysis. IEEE Engineering Medicine Biology Magazine 2006, 25:31-39.
• [28]Sandberg F, Stridh M, Sörnmo L: Frequency tracking of atrial fibrillation using hidden markov models. IEEE Trans Biomed Eng 2008, 55:502-511.
• [29]Ciaccio EJ, Coromilas J, Wit AL, Garan H: Onset dynamics of ventricular tachyarrhythmias as measured by dominant frequency. Heart Rhythm 2011, 8:615-622.
• [30]Corino VDA, Mainardi LT, Stridh M, Sörnmo L: Improved time-frequency analysis of atrial fibrillation signals using spectral modeling. IEEE Trans Biomed Eng 2008, 55:2723-2730.
• [31]Elvan A, Linnenbank AC, van Bemmel MW, Ramdat Misier AR, Delnoy PPHM, Beukema WP, de Bakker JMT: Dominant frequency of atrial fibrillation correlates poorly with atrial fibrillation cycle length. Circ Arrhythm Electrophysiol 2009, 2:634-644.
• [32]Zlochiver S, Yamazaki M, Kalifa J, Berenfeld O: Rotor meandering contributes to irregularity in electrograms during atrial fibrillation. Heart Rhythm 2008, 5:846-854.
• [33]Gray RA, Mornev OA, Jalife J, Aslanidi OV, Pertsov AM: Standing excitation waves in the heart induced by strong alternating electric fields. Phys Rev Lett 2001, 87:168104-1-168104-4.
• [34]Ciaccio EJ, Tennyson CA, Lewis SK, Bhagat G, Green PH: Distinguishing patients with celiac disease by quantitative analysis of videocapsule endoscopy images. Comput Methods Programs Biomed 2010, 100:39-48.
• [35]Ciaccio EJ, Biviano AB, Whang W, Vest JA, Gambhir A, Einstein AJ, Garan H: Differences in repeating patterns of complex fractionated left atrial electrograms in longstanding persistent as compared with paroxysmal atrial fibrillation. Circulation: Arrhythmia and Electrophysiology 2011. [Epub ahead of print]