There is evidence that rotors could be drivers that maintain atrial fibrillation. Complex fractionated atrial electrograms have been located in rotor tip areas. However, the concept of electrogram fractionation, defined using time intervals, is still controversial as a tool for locating target sites for ablation. We hypothesize that the fractionation phenomenon is better described using non-linear dynamic measures, such as approximate entropy, and that this tool could be used for locating the rotor tip. The aim of this work has been to determine the relationship between approximate entropy and fractionated electrograms, and to develop a new tool for rotor mapping based on fractionation levels. Two episodes of chronic atrial fibrillation were simulated in a 3D human atrial model, in which rotors were observed. Dynamic approximate entropy maps were calculated using unipolar electrogram signals generated over the whole surface of the 3D atrial model. In addition, we optimized the approximate entropy calculation using two real multi-center databases of fractionated electrogram signals, labeled in 4 levels of fractionation. We found that the values of approximate entropy and the levels of fractionation are positively correlated. This allows the dynamic approximate entropy maps to localize the tips from stable and meandering rotors. Furthermore, we assessed the optimized approximate entropy using bipolar electrograms generated over a vicinity enclosing a rotor, achieving rotor detection. Our results suggest that high approximate entropy values are able to detect a high level of fractionation and to locate rotor tips in simulated atrial fibrillation episodes. We suggest that dynamic approximate entropy maps could become a tool for atrial fibrillation rotor mapping.
Conference Contributions (9)
T. Oesterlein, G. Lenis, A. Luik, C. Schmitt, and O. Dössel. Periodic component analysis to eliminate ventricular far field artifacts in unipolar atrial electrograms of patients suffering from atrial flutter. In Biomedizinische Technik / Biomedical Engineering, vol. 59(s1) , pp. 14, 2014
T. Oesterlein, G. Lenis, A. Luik, B. Verma, C. Schmitt, and O. Dössel. Removing ventricular far field artifacts in intracardiac electrograms during stable atrial flutter using the periodic component analysis proof of concept study. In Proceedings 41th International Congress on Electrocardiology, pp. 49--52, 2014
Post-ablation atrial flutter(AF) is a frequently occurring arrhythmia after treatment for persistent atrial fibrillation. However, mapping the flutter circuit using intracardiac electrograms is often challenging due to low signal voltage and scar areas caused by prior substrate modification. In addition, signals are frequently compromised by ventricular far field (VFF) artifacts, which obscure atrial activity (AA). This work introduces a new approach for VFF removal, which is based on the Periodic Component Analysis (􏰋CA). It utilizes the stable temporal relationship between AA and VFF, which poses a problem for other techniques like Principal Component Analysis (PCA) when both components superpose. A benchmark using simulated electrograms demonstrated significantly better correlation for this case when comparing pure AA to the reconstructed data using 􏰋CA instead of PCA (0.98 vs. 0.90, p<0.001). Its benefit for diagnosis is demonstrated on clinical data.
T. Oesterlein, A. Luik, C. Schmitt, and O. Dössel. Neue Möglichkeiten zur Diagnose von Arrhythmien durch Visualisierung der zeitlichen Dynamik von Elektrogrammen. In Deutsche Gesellschaft für Kardiologie 80. Jahrestagung Mannheim, vol. 103(Suppl 1) , pp. V167, 2014
Catheter ablation of atrial fibrillation (AF) is still challenging and the sustaining mechanisms are discussed controversially. Basket mapping has emerged to a promising technique to detect temporary events like focal impulses fast changing fibrillation waves or meandering rotors.The aim of this study was to evaluate the atrial coverage of the basket catheter with respect to the distance of the electrodes to the endocardial surface and inter spline separation.
There is still a need for research to understand the co- herences of the origin of arrhythmias such like rotors and possible ablation strategies. The aim of this work was the analysis of typical signal characteristics near a rotor cen- ter. Rotors were simulated on 2D patch geometry (100 mm x 100 mm) with spatial resolution of 0.1mm. Based on extracellular potentials, different features were evalu- ated: Local activation time, peak to peak amplitude, steep- est negative slope and approximate entropy were com- pared regarding their ability to indicate the rotor tip lo- cation. Furthermore, typical signal patterns of different mapping catheters centered at the rotor tip position were analyzed. The determined maximum distances between the focal point of phase singularities and determined centers by the peak to peak amplitudes were maximal 1.7 mm.
M. Rottmann, T. Oesterlein, and O. Dössel. Local activation time based estimation of the direction of propagation of plane wave and the corresponding conduction velocity in simulated electrograms. In Biomedizinische Technik / Biomedical Engineering, vol. 59(s1) , pp. 152-155, 2014
Direction of propagation (DOP) and conduction velocity (CV) of excitation waves are essential parameters to identify targets for catheter ablation of cardiac arrhythmias. Most approaches to determine the DOP and CV rely on manual anno- tation. Many, time-consuming measurements with mapping catheters are required. Aim of this work was to quantitatively extract the DOP and the CV of wavefronts from intracardiac electrograms with a single shot measurement. We used a simulation database of planar waves computed with a cellular automaton with different CVs between 500 mm/s and 1100 mm/s. By comparing the correct values of CV and DOP with the computed values from the developed algorithm the median CV- error was between 7 mm/s and 50 mm/s and the median DOP- error variated between 1\0 and 4\0.
F. Schenkel, T. Oesterlein, A. Luik, C. Schmitt, and O. Dössel. Detection and classification of atrial excitation patterns in intracardiac electrograms with application on biatrial basket catheter measurements. In Biomedizinische Technik / Biomedical Engineering, vol. 59(s1) , pp. 166-169, 2014
Atrial fibrillation is the most frequent cardiac arrhythmia and often shows a progressive development. An important source of supraventricular extrasystoles triggering paroxysmal atrial fibrillation are the pulmonary veins. Electrograms recorded using an intracardiac catheter can help to improve the classification and quantification of the different atrial excitations. This study presents a framework to recognize and quantify different atrial excitation patterns and to merge them into groups using a clustering method on the basis of the local activation time. The resulting templates can be annotated by physicians and used as a training data set for a classifier to allocate following data. On the basis of the classification result statistics about the origin and occurrence rate of the different excitation patterns could be provided.