Evaluation of noninvasive electrophysiological imaging accuracy for focal atrial arrhythmias

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Budanova ◽  
M Chmelevsky ◽  
S Zubarev ◽  
T Treshkur ◽  
D Lebedev
Keyword(s):  
Ventricular Arrhythmias ◽  
High Accuracy ◽  
Atrial Pacing ◽  
Atrial Arrhythmias ◽  
Electrocardiographic Imaging ◽  
Epicardial Surface ◽  
Atrial Contraction ◽  
Premature Atrial Contraction ◽  
Endocardial Surface ◽  
The Right

Abstract Background High accuracy of noninvasive electrocardiographic imaging (ECGI) has recently been shown for topical diagnostics of ventricular arrhythmias. However, the precision of diagnostics of atrial focal arrhythmias requires clarification. To estimate the accuracy of ECGI for premature atrial contraction (PAC) we performed atrial pacing in patients with CRT system and compared early activation zone (EAZ) with pacemaker's tip location. Purpose To determine the accuracy of ECGI for focal atrial arrhythmias using atrial pacing. Methods Twenty-six patients (m/f – 18/9), age (min–max) 52 (26–78) with CRT system and pacemaker's tip location in the right atrium (RA) appendage underwent ECGI (“Amycard 01C”) in combination with CT or MR imaging. Thirty-four atrial pacing (mono- and bipolar) was performed in all patients using standard amplitude 1.5–3.8 mV. Epi-/endocardial polygonal heart models were created and isopotential maps were calculated. The distance between EAZ and the pacemaker's tip were measured for ECG recordings without using the isoline filter on endocardial surface (Fig. 1) as well as for epicardial surface. The time between epicardial and endocardial EAZ breakthrough was calculated also. Results On endocardial surface the EAZ was located in RA appendage, the base of superior cava vena or superior lateral RA wall. The distance (mm) (Me (min; max)) between EAZ and the pacemacer's tip was 28 (6; 68). For epicardial surface in most cases the EAZ was also located in RA appendage, the base of superior cava vena or superior lateral RA wall. In two cases the EAZ was located in inferior septal RA wall, in one case - in superior septal RA wall and in five cases the EAZ was undetectable. The distance between EAZ and the pacemacer's tip was 22 (6; 48). The time (ms) (Mean; Me (min; max)) between EAZ of the endocardial and epicardial surfaces was 16; 7 (0; 68). Conclusion ECGI allows to assess the location of focal atrial arrhythmias on endocardial surface and sometimes on epicardial surface also within the three segments. The results of this study revealed that accuracy of ECGI for atrial arrhythmias is worse than for ventricular arrhythmias. However, it is better on epicardial surface of atrium when EAZ can be determined. Funding Acknowledgement Type of funding source: None

P2567First experience of non-invasive and invasive activation maps merge in carto system for topical diagnosis of focal arrhythmias

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Budanova ◽  
M Chmelevsky ◽  
S Zubarev ◽  
D Potyagaylo ◽  
L Parreira ◽  
...  
Keyword(s):  
Ventricular Arrhythmias ◽  
Operation Time ◽  
Lateral Wall ◽  
Posterior Wall ◽  
Late Enhancement ◽  
Ablation Procedure ◽  
Electrocardiographic Imaging ◽  
Non Invasive ◽  
Topical Diagnosis ◽  
Endocardial Surface

Abstract Background Correct preoperative topical diagnostics of atrial and ventricular arrhythmias allows for operation time reduction by facilitating the ablation target localization, especially in case of several ectopic sources. Purpose To implement a non-invasive electrocardiographic imaging (ECGI) technique in CARTO system for aiming at topical diagnostics of focal arrhythmias improving. Methods Twelve patients (m/f – 10/2, age (min–max) – 50,5 (32–71)) with focal arrhythmias underwent ECGI in combination with CT or MR imaging. Two subjects had atrial premature contractions (PAC), while ten patients suffered from ventricular premature contractions (PVC) with indications for ablation. Before the ablation procedure Carto LAT mapping was performed in all patients. Using ECGI epi-/endocardial polygonal models of the heart were created, isopotential and activation maps were calculated, uploaded into the Carto system and merged with the CARTO FAM models (Figure 1). Results For six patients with PVC and two patients with PAC, earliest activation zones (EAZs) anatomical locations obtained by invasive and non-invasive methods were the same (RVOT septum, RVOT lateral-anterior and RV lateral-basal walls, right aortic cusp, LVOT, coronary sinus (CS), CS ostium, RA posterior wall), and arrhythmias ablation was successful. Two patients featured coherent EAZs (RV lateral-basal wall and RVOT septum) but a negative ablation outcome. In one patient, EAZs were situated in different anatomical regions: CARTO showed the PVC EAZ in RV septum, whereas Amycard system identified endocardial surface of lateral-basal RV wall. In this patient, PVC was ablated partially. For another patient with MRI late enhancement area in LV lateral wall the EAZs were in the same LV segment but with mismatch in epi/endocardial surface. Conclusion Non-invasive and invasive activation maps merge can improve localization of ablation targets in focal arrhythmias, potentially increasing effectiveness of the EP procedure and reducing operation time.

scholarly journals P968 Subcostal M-mode echocardiography of tricuspid annular motion helps recogntion of heart arrhythmias

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
N Drinkovic ◽  
N Drinkovic Jr
Keyword(s):  
Atrial Fibrillation ◽  
Right Atrium ◽  
Ventricular Arrhythmias ◽  
Mechanical Efficiency ◽  
Atrial Pacing ◽  
Supraventricular Arrhythmias ◽  
Characteristic Appearance ◽  
Atrial Contraction ◽  
Heart Arrhythmias ◽  
Av Dissociation

Abstract Recognition of supraventricular arrhythmias and differention between supraventricular and ventricular rhythm abnormalities in ECG can sometimes be difficult due to indiscernible P wave. 1D echocardiography of tricuspid annular motion can quickly and reliably detect atrial contraction (Picture 1, figure 1a.) which has a characteristic appearance for majority of supraventricular arrhythmias. Since subcostal approach is almost always reliable, it allows simple and rapid recognition and differentiation between supraventricular arrhythmias, e.g. atrial fibrillation (Picture 1, figure 1b.) from atrial flutter and nodal rhythm. Detection of atrial contractions enables recognition of AV dissociation in ECG, which helps in differentiation between supraventricular and ventricular arrhythmias. This technique is also useful in checking the function and mechanical efficiency of atrial pacing. Figure 1a. Atrial contraction / sinus rhythm RA = right atrium A = atrial contraction Figure 1b. Atrial fibrillation RA = right atrium a = fibrillary contractions Abstract P968 Figure. Picture 1

scholarly journals Mutual arrangements of coronary blood vessels within the right atrial appendage vestibule.

2021 ◽  
Author(s):  
Jakub Holda ◽  
Katarzyna Słodowska ◽  
Marcin Strona ◽  
Filip Bolechała ◽  
Katarzyna Jasińska ◽  
...  
Keyword(s):  
Blood Vessels ◽  
Complex Analysis ◽  
Coronary Vessels ◽  
Atrial Appendage ◽  
Right Atrial ◽  
Epicardial Surface ◽  
Endocardial Surface ◽  
Coronary Blood Vessels ◽  
Right Atrial Appendage ◽  
The Right

Introduction: The aim of our study was to investigate the presence and mutual relationships of coronary vessels within the right atrial appendage RAA vestibule. Methods and Results: We examined 200 autopsied hearts. The RAA vestibule was cross sectioned along its isthmuses (superior, middle, and inferior). We assessed the presence and mutual relationships between coronary blood vessels. The right coronary artery (RCA) was present in 100% of the superior RAA isthmuses but absent in 2.0% of hearts within the middle isthmus and in 6.5% of hearts within the inferior RAA isthmus. Its diameter was quite uniform along the superior (2.6±0.8mm), middle (2.9±1.1mm) and inferior (2.7±0.9mm) isthmuses (p=0.12). The location of the RCA varied significantly, and it was sometimes accompanied by other accessory coronary vessels. In all the isthmuses, the RCA ran significantly closer to the endocardial surface than to the epicardial surface (p<0.001). At the superior RAA isthmus, the artery was furthest from the right atrial endocardial surface and this distance gradually decreased between the middle RAA isthmus and the inferior RAA isthmus (9.0±4.0 vs. 6.2±3.0 vs. 4.8±2.3mm, respectively; p<0.001). The interposed RCA was found in 7.0% of cases within the superior isthmus, in 2.5% within the middle isthmus and in 1.5% within the inferior isthmus. Conclusions: This study was the most complex analysis of the mutual arrangements and morphometric characteristics of coronary blood vessels within the RAA vestibule. Awareness of additional blood vessels within the vestibule can help clinicians plan and perform safe and efficacious procedures in this region.

scholarly journals Mutual Arrangements of Coronary Blood Vessels within the Right Atrial Appendage Vestibule

2021 ◽  
Vol 10 (16) ◽  
pp. 3588
Author(s):  
Jakub Hołda ◽  
Katarzyna Słodowska ◽  
Marcin Strona ◽  
Karolina Malinowska ◽  
Filip Bolechała ◽  
...  
Keyword(s):  
Blood Vessels ◽  
Complex Analysis ◽  
Coronary Vessels ◽  
Atrial Appendage ◽  
Right Atrial ◽  
Epicardial Surface ◽  
Endocardial Surface ◽  
Coronary Blood Vessels ◽  
Right Atrial Appendage ◽  
The Right

Background: The aim of our study was to investigate the presence and mutual relationships of coronary vessels within the right atrial appendage (RAA) vestibule. Methods: We examined 200 autopsied hearts. The RAA vestibule was cross-sectioned along its isthmuses (superior, middle, and inferior). Results: The right coronary artery (RCA) was present in 100% of the superior RAA isthmuses but absent in 2.0% of hearts within the middle isthmus and in 6.5% of hearts within the inferior RAA isthmus. Its diameter was quite uniform along the superior (2.6 ± 0.8 mm), middle (2.9 ± 1.1 mm), and inferior (2.7 ± 0.9 mm) isthmuses (p = 0.12). The location of the RCA varied significantly, and it was sometimes accompanied by other accessory coronary vessels. In all the isthmuses, the RCA ran significantly closer to the endocardial surface than to the epicardial surface (p < 0.001). At the superior RAA isthmus, the artery was furthest from the right atrial endocardial surface and this distance gradually decreased between the middle RAA isthmus and the inferior RAA. Conclusions: This study was the most complex analysis of the mutual arrangements and morphometric characteristics of coronary blood vessels within the RAA vestibule. Awareness of additional blood vessels within the vestibule can help clinicians plan and perform safe and efficacious procedures in this region.

scholarly journals Autoencoder-Based Extrasystole Detection and Modification of RRI Data for Precise Heart Rate Variability Analysis

Sensors ◽  
2021 ◽  
Vol 21 (9) ◽  
pp. 3235
Author(s):  
Koichi Fujiwara ◽  
Shota Miyatani ◽  
Asuka Goda ◽  
Miho Miyajima ◽  
Tetsuo Sasano ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Mean Squared Error ◽  
False Positive Rate ◽  
Premature Ventricular Contraction ◽  
Heart Rate Variability Analysis ◽  
Unified Framework ◽  
Atrial Contraction ◽  
Premature Atrial Contraction ◽  
Positive Rate

Heart rate variability, which is the fluctuation of the R-R interval (RRI) in electrocardiograms (ECG), has been widely adopted for autonomous evaluation. Since the HRV features that are extracted from RRI data easily fluctuate when arrhythmia occurs, RRI data with arrhythmia need to be modified appropriately before HRV analysis. In this study, we consider two types of extrasystoles—premature ventricular contraction (PVC) and premature atrial contraction (PAC)—which are types of extrasystoles that occur every day, even in healthy persons who have no cardiovascular diseases. A unified framework for ectopic RRI detection and a modification algorithm that utilizes an autoencoder (AE) type of neural network is proposed. The proposed framework consists of extrasystole occurrence detection from the RRI data and modification, whose targets are PVC and PAC. The RRI data are monitored by means of the AE in real time in the detection phase, and a denoising autoencoder (DAE) modifies the ectopic RRI caused by the detected extrasystole. These are referred to as AE-based extrasystole detection (AED) and DAE-based extrasystole modification (DAEM), respectively. The proposed framework was applied to real RRI data with PVC and PAC. The result showed that AED achieved a sensitivity of 93% and a false positive rate of 0.08 times per hour. The root mean squared error of the modified RRI decreased to 31% in PVC and 73% in PAC from the original RRI data by DAEM. In addition, the proposed framework was validated through application to a clinical epileptic seizure problem, which showed that it correctly suppressed the false positives caused by PVC. Thus, the proposed framework can contribute to realizing accurate HRV-based health monitoring and medical sensing systems.

scholarly journals Burden and Long Firing of Premature Atrial Contraction Early After Catheter Ablation Predict Late Recurrence of Atrial Fibrillation

2020 ◽  
Vol 84 (6) ◽  
pp. 894-901 ◽  
Author(s):  
Hiroyuki Inoue ◽  
Nobuaki Tanaka ◽  
Koji Tanaka ◽  
Yuichi Ninomiya ◽  
Yuko Hirao ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Late Recurrence ◽  
Atrial Contraction ◽  
Premature Atrial Contraction

Efferent vagal innervation of canine ventricle

1985 ◽  
Vol 248 (1) ◽  
pp. H89-H97 ◽  
Author(s):  
N. Takahashi ◽  
M. J. Barber ◽  
D. P. Zipes
Keyword(s):  
Coronary Artery ◽  
Vagal Stimulation ◽  
Left Ventricular ◽  
Constant Infusion ◽  
Epicardial Surface ◽  
Before And After ◽  
Vagal Innervation ◽  
The Subject ◽  
Infusion Of Norepinephrine ◽  
The Right

The route efferent vagal fibers travel to reach the left ventricle is not clear and was the subject of this investigation. We measured left ventricular and septal effective refractory period (ERP) changes during vagal stimulation and a constant infusion of norepinephrine, before and after phenol was applied at selected sites of the heart to interrupt efferent vagal fibers that may be traveling in that area. Phenol applied to the atrioventricular (AV) groove between the origin of the right coronary artery anteriorly to the posterior descending branch of the circumflex coronary artery completely eliminated vagal-induced prolongation of ERP in the anterior and posterior left ventricular free wall and reduced, but did not eliminate, ERP prolongation in the septum. A large (3-cm radius) epicardial circle of phenol prevented vagal-induced ERP prolongation within the circle in all dogs, while a small (1-cm radius) epicardial circle of phenol failed to prevent vagal-induced ERP changes within the circle in any dog. An intermediate (2-cm radius) circle eliminated vagal effects on ERP in 13 of 18 dogs. Arcs of phenol, to duplicate the upper portion of the circle, applied sequentially from apex to base eliminated efferent vagal effects only when painted near or at the AV groove. We conclude that the majority of efferent vagal fibers enroute to innervate the anterior and posterior left ventricular epicardium cross the AV groove within 0.25-0.5 mm (depth of phenol destruction) of the epicardial surface.(ABSTRACT TRUNCATED AT 250 WORDS)

scholarly journals Atrial pacing for the management of ventricular arrhythmias in Andersen-Tawil syndrome

2015 ◽  
Vol 1 (5) ◽  
pp. 352-355 ◽  
Author(s):  
Opeyemi Fadahunsi ◽  
Bilal Shaikh ◽  
Andrew Rettew ◽  
Kyle Bennett ◽  
David Scollan
Keyword(s):  
Ventricular Arrhythmias ◽  
Atrial Pacing

scholarly journals Left ventricular noncompaction—a rare cause of triad: heart failure, ventricular arrhythmias, and systemic embolic events: a case report 

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Despina Toader ◽  
Alina Paraschiv ◽  
Petrișor Tudorașcu ◽  
Diana Tudorașcu ◽  
Constantin Bataiosu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Left Ventricle ◽  
Ventricular Arrhythmias ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Left Ventricular Noncompaction ◽  
Ventricular Noncompaction ◽  
The Right

Abstract Background Left ventricular noncompaction is a rare cardiomyopathy characterized by a thin, compacted epicardial layer and a noncompacted endocardial layer, with trabeculations and recesses that communicate with the left ventricular cavity. In the advanced stage of the disease, the classical triad of heart failure, ventricular arrhythmia, and systemic embolization is common. Segments involved are the apex and mid inferior and lateral walls. The right ventricular apex may be affected as well. Case presentation A 29-year-old Caucasian male was hospitalized with dyspnea and fatigue at minimal exertion during the last months before admission. He also described a history of edema of the legs and abdominal pain in the last weeks. Physical examination revealed dyspnea, pulmonary rales, cardiomegaly, hepatomegaly, and splenomegaly. Electrocardiography showed sinus rhythm with nonspecific repolarization changes. Twenty-four-hour Holter monitoring identified ventricular tachycardia episodes with right bundle branch block morphology. Transthoracic echocardiography at admission revealed dilated left ventricle with trabeculations located predominantly at the apex but also in the apical and mid portion of lateral and inferior wall; end-systolic ratio of noncompacted to compacted layers > 2; moderate mitral regurgitation; and reduced left ventricular ejection fraction. Between apical trabeculations, multiple thrombi were found. The right ventricle had normal morphology and function. Speckle-tracking echocardiography also revealed systolic left ventricle dysfunction and solid body rotation. Abdominal echocardiography showed hepatomegaly and splenomegaly. Abdominal computed tomography was suggestive for hepatic and renal infarctions. Laboratory tests revealed high levels of N-terminal pro-brain natriuretic peptide and liver enzymes. Cardiac magnetic resonance evaluation at 1 month after discharge confirmed the diagnosis. The patient received anticoagulants, antiarrhythmics, and heart failure treatment. After 2 months, before device implantation, he presented clinical improvement, and echocardiographic evaluation did not detect thrombi in the left ventricle. Coronary angiography was within normal range. A cardioverter defibrillator was implanted for prevention of sudden cardiac death. Conclusions Left ventricular noncompaction is rare cardiomyopathy, but it should always be considered as a possible diagnosis in a patient hospitalized with heart failure, ventricular arrhythmias, and systemic embolic events. Echocardiography and cardiac magnetic resonance are essential imaging tools for diagnosis and follow-up.

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