Abstract:

The electrocardiogram (ECG) is a standard cost-efficient and non-invasive tool for the early detection of various cardiac diseases. Quantifying different timing and amplitude features of and in between the single ECG waveforms can reveal important information about the underlying (dys-)function of the heart. Determining these features requires the detection of fiducial points that mark the on- and offset as well as the peak of each ECG waveform (P wave, QRS complex, T wave). Manually setting these points is time-consuming and requires a physician’s expert knowledge. Therefore, the highly modular ECGdeli toolbox for MATLAB was developed, which is capable of filtering clinically recorded 12-lead ECG signals and detecting the fiducial points, also called delineation. It is one of the few open toolboxes offering ECG delineation for P waves, T Waves and QRS complexes. The algorithms provided were evaluated with the QT database, an ECG database comprising 105 signals with fiducial points annotated by clinicians. The median difference between the fiducial points set by the boundary detection algorithm and the clinical annotations serving as a ground truth is less than 4 samples (16 ms) for the P wave and the QRS complex markers.

Abstract:

The most common arrhythmia worldwide is atrial fibrillation (AF), recognized as a substantialpublic health burden due to its rising incidence. Patients affected by AF face elevated risksfor stroke, myocardial infarction, and mortality. Moreover, current treatment approachesoften prove ineffective, resulting in a high recurrence rate. Hence, there is an urgent need forfurther investigation into the mechanisms underlying AF to advance treatment strategies.The objective of this study was to assess the impact of the morphology of the conductionvelocity (CV) restitution curve on reentry events. We evaluated this influence using metricssuch as the vulnerability window, the average reentry duration, and the dominant frequency.By conducting this vulnerability assessment, the aim was to establish correlations betweenthe morphology of the CV restitution curve and these key features.We investigated the impact of using the pacing cycle length (PCL) and the diastolic interval(DI) on the restitution curve through simulations in the monodomain model. Additionally, theinfluence of the maximum longitudinal CV on the CV restitution curve was analyzed. ClinicalCV restitution curves of 13 patients with persistent AF, measured at various atrial locations,were employed in simulations on a 2D tissue slab utilizing the diffusion reaction eikonalalternant model (DREAM) to simulate electrical wave propagation with a personalizedionic model (Courtemanche) for the action potential (AP). The vulnerability assessmentwas done using an S1-S2 protocol. The experiments encompassed diverse morphologies ofrestitution curves and varying maximal longitudinal CV values. Moreover, experiments withheterogeneous meshes using two different restitution curve morphologies were conducted.No notable influence of the maximal longitudinal CV on the morphology of the CV restitutioncurve was identified. Moreover, the ionic model was successfully personalized using afunction that interpolated conductance values between healthy and AF tissue. Additionally, acorrelation between the steepness of the CV restitution curve and the vulnerability window,average reentry duration, and dominant frequency was established.Nevertheless, this work has limitations regarding the data acquisition and the model usedfor the electrophysiological simulations although it was shown that a shallow CV restitutioncurve is more vulnerable to AF and maintains it longer. Summarizing, the CV restitutioncurve proved to be a crucial factor for reentry events, promising to improve vulnerabilityassessment and treatment outcomes of AF.