Atrial fibrosis identification with unipolar electrogram eigenvalue distribution analysis in multi-electrode arrays

Autor: Riccio, Jennifer, Alcaine, Alejandro, Rocher, Sara, Martinez-Mateu, Laura, Laguna, Pablo, Martinez, Juan Pablo, Saiz, Javier, Guillem, Maria S, Invers‑Rubio, Eric
Rok vydání: 2022
Předmět:
Zdroj: Medical & Biological Engineering & Computing. 60:3091-3112
ISSN: 1741-0444
0140-0118
DOI: 10.1007/s11517-022-02648-3
Popis: Atrial fibrosis plays a key role in the initiation and progression of atrial fibrillation (AF). Atrial fibrosis is typically identified by a peak-to-peak amplitude of bipolar electrograms (b-EGMs) lower than 0.5 mV, which may be considered as ablation targets. Nevertheless, this approach disregards signal spatiotemporal information and b-EGM sensitivity to catheter orientation. To overcome these limitations, we propose the dominant-to-remaining eigenvalue dominance ratio (EIGDR) of unipolar electrograms (u-EGMs) within neighbor electrode cliques as a waveform dispersion measure, hypothesizing that it is correlated with the presence of fibrosis. A simulated 2D tissue with a fibrosis patch was used for validation. We computed EIGDR maps from both original and time-aligned u-EGMs, denoted as$$\mathcal {R}$$Rand$$\mathcal{R}^{\mathcal{A}}$$RA, respectively, also mapping the gain in eigenvalue concentration obtained by the alignment,$$\Delta \mathcal{R}^{\mathcal{A}}$$ΔRA. The performance of each map in detecting fibrosis was evaluated in scenarios including noise and variable electrode-tissue distance. Best results were achieved by$$\mathcal{R}^{\mathcal{A}}$$RA, reaching 94% detection accuracy, versus the 86% of b-EGMs voltage maps. The proposed strategy was also tested in real u-EGMs from fibrotic and non-fibrotic areas over 3D electroanatomical maps, supporting the ability of the EIGDRs as fibrosis markers, encouraging further studies to confirm their translation to clinical settings.Graphical AbstractUpper panels: map of$$\mathcal {R}^{\mathcal {A}}$$RAfrom 3×3 cliques for Ψ= 0∘and bipolar voltage mapVb-m, performed assuming a variable electrode-to-tissue distance and noisy u-EGMs (noise levelσv= 46.4μV). Lower panels: detected fibrotic areas (brown), using the thresholds that maximize detection accuracy of each map
Databáze: OpenAIRE
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