Far-field effect in unipolar electrograms recorded from epicardial and endocardial surface: Quantification of epi-endo dissociation during atrial Fibrillation in Humans

Author(s):  
Piotr Podziemski ◽  
Stef Zeemering ◽  
Elham Bidar ◽  
Pawel Kuklik ◽  
Arne van Hunnik ◽  
...  
2015 ◽  
Vol 1 (1) ◽  
pp. 38-41 ◽  
Author(s):  
Laura Anna Unger ◽  
Markus Rottmann ◽  
Gunnar Seemann ◽  
Olaf Dössel

AbstractThis work aimed at the detection of rotor centers within the atrial cavity during atrial fibrillation on the basis of phase singularities. A voxel based method was established which employs the Hilbert transform and the phase of unipolar electrograms. The method provides a 3D overview of phase singularities at the endocardial surface and within the blood volume. Mapping those phase singularities from the inside of the atria at the endocardium yielded rotor center trajectories. We discuss the results for an unstable and a more stable rotor. The side length of the areas covered by the trajectories varied from 1.5 mm to 10 mm. These results are important for cardiologists who target rotors with RF ablation in order to cure atrial fibrillation.


2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Prasanth Ganesan ◽  
Elizabeth M. Cherry ◽  
Arkady M. Pertsov ◽  
Behnaz Ghoraani

Atrial fibrillation (AF) is the most common arrhythmia in USA with more than 2.3 million people affected annually. Catheter ablation procedure is a method for treatment of AF, which involves 3D electroanatomic mapping of the patient's left atrium (LA) by maneuvering a conventional multipolar diagnostic catheter (MPDC) along the LA endocardial surface after which pulmonary vein (PV) isolation is performed, thus eliminating the AF triggers originating from the PVs. However, it remains unclear how to effectively utilize the information provided by the MPDC to locate the AF-sustaining sites, known as sustained rotor-like activities (RotAs). In this study, we use computer modeling to investigate the variations in the characteristics of the MPDC electrograms, namely, total conduction delay (TCD) and average cycle length (CL), as the MPDC moves towards a RotA source. Subsequently, a study with a human subject was performed in order to verify the predictions of the simulation study. The conclusions from this study may be used to iteratively direct an MPDC towards RotA sources thus allowing the RotAs to be localized for customized and improved AF ablation.


Circulation ◽  
2009 ◽  
Vol 120 (6) ◽  
pp. 467-476 ◽  
Author(s):  
Flavio H. Fenton ◽  
Stefan Luther ◽  
Elizabeth M. Cherry ◽  
Niels F. Otani ◽  
Valentin Krinsky ◽  
...  

2021 ◽  
Vol 12 ◽  
Author(s):  
Shun Liao ◽  
Don Ragot ◽  
Sachin Nayyar ◽  
Adrian Suszko ◽  
Zhaolei Zhang ◽  
...  

Focal sources are potential targets for atrial fibrillation (AF) catheter ablation, but they can be time-consuming and challenging to identify when unipolar electrograms (EGM) are numerous and complex. Our aim was to apply deep learning (DL) to raw unipolar EGMs in order to automate putative focal sources detection. We included 78 patients from the Focal Source and Trigger (FaST) randomized controlled trial that evaluated the efficacy of adjunctive FaST ablation compared to pulmonary vein isolation alone in reducing AF recurrence. FaST sites were identified based on manual classification of sustained periodic unipolar QS EGMs over 5-s. All periodic unipolar EGMs were divided into training (n = 10,004) and testing cohorts (n = 3,180). DL was developed using residual convolutional neural network to discriminate between FaST and non-FaST. A gradient-based method was applied to interpret the DL model. DL classified FaST with a receiver operator characteristic area under curve of 0.904 ± 0.010 (cross-validation) and 0.923 ± 0.003 (testing). At a prespecified sensitivity of 90%, the specificity and accuracy were 81.9 and 82.5%, respectively, in detecting FaST. DL had similar performance (sensitivity 78%, specificity 89%) to that of FaST re-classification by cardiologists (sensitivity 78%, specificity 79%). The gradient-based interpretation demonstrated accurate tracking of unipolar QS complexes by select DL convolutional layers. In conclusion, our novel DL model trained on raw unipolar EGMs allowed automated and accurate classification of FaST sites. Performance was similar to FaST re-classification by cardiologists. Future application of DL to classify FaST may improve the efficiency of real-time focal source detection for targeted AF ablation therapy.


2021 ◽  
Author(s):  
Thomas Gusmeo ◽  
William Cavazza ◽  
Victor Alania ◽  
Onise Enukidze ◽  
Massimiliano Zattin ◽  
...  

<p>Young back-arc rift basins, because of the not yet dissipated extensional thermal signature, can be easily inverted following changes in the geodynamic regime and/or far-field stress transmission. Structural inversion of such basins mainly develops through reactivation of normal faults, particularly if the latter are favourably oriented with respect to the direction of stress transfer. The Adjara-Trialeti fold-and-thrust belt of SW Georgia is an example of this mechanism, resulting from the structural inversion of a continental back-arc rift basin developed on the upper plate of the northern Neotethys slab in Paleogene times, behind the Pontides-Lesser Caucasus magmatic arc. New low-temperature thermochronological data [apatite fission-track (AFT) and (U-Th)/He (AHe) analyses] were obtained from a number of samples, collected across the Adjara-Trialeti belt from the former sedimentary fill of the basin and from syn-rift plutons. AFT central ages range between 46 and 15 Ma, while AHe ages cluster mainly between 10 and 3 Ma. Thermal modelling, integrating AFT and AHe data with independent geological constraints (e.g. depositional/intrusion age, other geochronological data, thermal maturity indicators and stratigraphic relationships), clearly indicates that the Adjara-Trialeti back-arc basin was inverted starting from the late Middle Miocene, at 14-10 Ma. This result is corroborated by many independent geological evidences, found for example in the adjacent Rioni, Kartli and Kura foreland basins and in the eastern Black Sea offshore, which all suggest a Middle-Late Miocene phase of deformation linked with the Adjara-Trialeti FTB building. Adjara-Trialeti structural inversion can be associated with the widespread Middle-to-Late Miocene phase of shortening and exhumation that is recognised from the eastern Pontides to the Lesser Caucasus, the Talysh and the Alborz ranges. This tectonic phase can in turn be interpreted as a far-field effect of the Arabia-Eurasia collision, developed along the Bitlis suture hundreds of kilometres to the south.</p>


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