Left atrial voltage maps are routinely acquired during electroanatomic mapping in patients undergoing catheter ablation for atrial fibrillation. For patients, who have prior catheter ablation when they are in sinus rhythm, the voltage map can be used to identify low voltage areas using a threshold of 0.2 - 0.45 mV. However, such a voltage threshold for maps acquired during atrial fibrillation has not been well established. A prerequisite for defining a voltage threshold is to maximize the topologically matched low voltage areas between the electroanatomic mapping acquired during atrial fibrillation and sinus rhythm. This paper demonstrates a new technique to improve the sensitivity and specificity of the matched low voltage areas. This is achieved by computing omni-directional bipolar voltages and applying Gaussian Process Regression based interpolation to derive the atrial fibrillation map. The proposed method is evaluated on a test cohort of 7 male patients, and a total of 46,589 data points were included in analysis. The low voltage areas in the posterior left atrium and pulmonary vein junction are determined using the standard method and the proposed method. Overall, the proposed method showed patient-specific sensitivity and specificity in matching low voltage areas of 75.70% and 65.55% for a geometric mean of 70.69%. On average, there was an improvement of 3.00% in the geometric mean, 7.88% improvement in sensitivity, 0.30% improvement in specificity compared to the standard method. The results show that the proposed method is an improvement in matching low voltage areas. This may help develop the voltage threshold to better identify low voltage areas in the left atrium for patients in atrial fibrillation.
Atrial fibrillation is a heart rhythm disorder that affects tens of millions people worldwide. The most effective treatment is catheter ablation. This involves irreversible heating of abnormal cardiac tissue facilitated by electroanatomical mapping. However, it is difficult to consistently identify the triggers and sources that may initiate or perpetuate atrial fibrillation due to its chaotic behavior. We developed a patient-specific computational heart model that can accurately reproduce the activation patterns to help in localizing these triggers and sources. Our model has high spatial resol…
Combination of frequency-and time-domain characteristics of the fibrillatory waves for enhanced prediction of persistent atrial fibrillation recurrence after catheter ablation
The complexity of the patterns associated with Atrial Fibrillation (AF) and the high level of noise affecting these patterns have significantly limited the current signal processing and shallow machine learning approaches to get accurate AF detection results. Deep neural networks have shown to be very powerful to learn the non-linear patterns in the data. While a deep learning approach attempts to learn complex pattern related to the presence of AF in the ECG, they can benefit from knowing which parts of the signal is more important to focus during learning. In this paper, we introduce a two-c…
We develop an algorithm that accurately detects Atrial Fibrillation (AF) episodes from photoplethysmograms (PPG) recorded in ambulatory free-living conditions. We collect and annotate a dataset containing more than 4000 hours of PPG recorded from a wrist-worn device. Using a 50-layer convolutional neural network, we achieve a test AUC of 95% and show robustness to motion artifacts inherent to PPG signals. Continuous and accurate detection of AF from PPG has the potential to transform consumer wearable devices into clinically useful medical monitoring tools.
Atrial fibrillation (AF) consequences on the heart valve dynamics are usually studied along with a valvular disfunction or disease, since in medical monitoring the two pathologies are often concomitant. Aim of the present work is to study, through a stochastic lumped-parameter approach, the basic fluid dynamics variations of heart valves, when only paroxysmal AF is present with respect to the normal sinus rhythm (NSR) in absence of any valvular pathology. Among the most common parameters interpreting the valvular function, the most useful turns out to be the regurgitant volume. During AF both …
We propose a stochastic individual-based model of the progression of atrial fibrillation (AF). The model operates at patient level over a lifetime and is based on elements of the physiology and biophysics of AF, making contact with existing mechanistic models. The outputs of the model are times when the patient is in normal rhythm and AF, and we carry out a population-level analysis of the statistics of disease progression. While the model is stylised at present and not directly predictive, future improvements are proposed to tighten the gap between existing mechanistic models of AF, and epide…
Cardiac diseases are the principal cause of human morbidity and mortality in the western world. The electric potential of the heart is a highly complex signal emerging as a result of nontrivial flow conduction, hierarchical structuring and multiple regulation mechanisms. Its proper accurate analysis becomes of crucial importance in order to detect and treat arrhythmias or other abnormal dynamics that could lead to life-threatening conditions. To achieve this, advanced nonlinear processing methods are needed: one example here is the case of recent advances in the Microcanonical Multiscale Forma…
SHDB-AF: a Japanese Holter ECG database of atrial fibrillation
Teikyo University School of Medicine（帝京大学医学部）；Saitama Medical University International Medical Center（埼玉医科大学国际医疗中心）；Technion-IIT（以色列理工学院）；Centre hospitalier Universitaire de Nancy（南锡大学医院）；INSERM（法国国家健康与医学研究院）；Universite de Lorraine（洛林大学）
We analyze left atrium haemodynamics, highlighting differences among healthy individuals and patients affected by atrial fibrillation. The computational study is based on patient-specific geometries of the left atria to simulate blood flow dynamics. We devise a novel procedure aimed at recovering the boundary conditions for the 3D haemodynamics simulations, particularly useful in absence of specific ones provided by clinical measurements. With this aim, we introduce a parametric definition of the atria displacement, and we employ a closed-loop lumped parameter model of the whole cardiocirculat…
Integrating spatial information about atrial physiology and anatomy in a single patient from multimodal datasets, as well as generalizing these data across patients, requires a common coordinate system. In the atria, this is challenging due to the complexity and variability of the anatomy. We aimed to develop and validate a universal atrial coordinate system for the following applications: combination and assessment of multimodal data; comparison of spatial data across patients; 2D visualization; and construction of patient specific geometries to test mechanistic hypotheses. Left and right atr…
The mechanism of atrial fibrillation (AF) is poorly understood, resulting in disappointing success rates of ablative treatment. Different mechanisms defined largely by different atrial activation patterns have been proposed and, arguably, this dispute has slowed the progress of AF research. Recent clinical evidence suggests a unifying mechanism based on sustained re-entrant circuits in the complex atrial architecture. Here, we present a simple computational model showing spontaneous emergence of AF that strongly supports, and gives a theoretical explanation for, the clinically observed diversi…
Atrial fibrillation (AF) is the most common abnormal heart rhythm and the single biggest cause of stroke. Ablation, destroying regions of the atria, is applied largely empirically and can be curative but with a disappointing clinical success rate. We design a simple model of activation wavefront propagation on a structure mimicking the branching network architecture of heart muscle and show how AF emerges spontaneously as age-related parameters change. We identify regions responsible for the initiation and maintenance of AF, the ablation of which terminates AF. The simplicity of the model allo…
Atrial fibrillation (AF) is the most common arrhythmia affecting millions of people in the Western countries and, due to the widespread impact on the population and its medical relevance, is largely investigated in both clinical and bioengineering sciences. However, some important feedback mechanisms are still not clearly established. The present study aims at understanding the global response of the cardiovascular system during paroxysmal AF through a lumped-parameter approach, which is here performed paying particular attention to the stochastic modeling of the irregular heartbeats and the r…
Atrial fibrillation (AF) is associated with an increased risk of dementia and cognitive decline, independent of strokes. Several mechanisms have been proposed to explain this association, but altered cerebral blood flow dynamics during AF has been poorly investigated: in particular, it is unknown how AF influences hemodynamic parameters of the distal cerebral circulation, at the arteriolar and capillary level. Two coupled lumped-parameter models (systemic and cerebrovascular circulations, respectively) were here used to simulate sinus rhythm (SR) and AF. For each simulation 5000 cardiac cycles…
We study the interplay between traveling action potentials and spatial inhomogeneities in the FitzHugh-Nagumo model to investigate possible mechanisms for the occurrence of fibrillatory states in the atria of the heart. Different dynamical patterns such as ectopic foci, localized and meandering spiral waves are found depending on the characteristics of the inhomogeneities. Their appearance in dependence of the size and strength of the inhomogeneities is quantified by phase diagrams. Furthermore it is shown that regularly paced waves in a region R, that is connected by a small bridge connection…
Atrial fibrillation (AF) is the most common form of arrhythmia with accelerated and irregular heart rate (HR), leading to both heart failure and stroke and being responsible for an increase in cardiovascular morbidity and mortality. In spite of its importance, the direct effects of AF on the arterial hemodynamic patterns are not completely known to date. Based on a multiscale modelling approach, the proposed work investigates the effects of AF on the local arterial fluid dynamics. AF and normal sinus rhythm (NSR) conditions are simulated extracting 2000 $\mathrm{RR}$ heartbeats and comparing t…
Although atrial fibrillation (AF), a common arrhythmia, frequently presents in patients with underlying valvular disease, its hemodynamic contributions are not fully understood. The present work aimed to computationally study how physical conditions imposed by pathologic valvular anatomy act on AF hemodynamics. We simulated AF with different severity grades of left-sided valvular diseases and compared the cardiovascular effects that they exert during AF, compared to lone AF. The fluid dynamics model used here has been recently validated for lone AF and relies on a lumped parameterization of th…
Atrial fibrillation (AF) increases the risk of stroke by a factor of four to five and is the most common abnormal heart rhythm. The progression of AF with age, from short self-terminating episodes to persistence, varies between individuals and is poorly understood. An inability to understand and predict variation in AF progression has resulted in less patient-specific therapy. Likewise, it has been a challenge to relate the microstructural features of heart muscle tissue (myocardial architecture) with the emergent temporal clinical patterns of AF. We use a simple model of activation wavefront …
Aims. Clinical data indicating a heart rate (HR) target during rate control therapy for permanent atrial fibrillation (AF) and assessing its eventual relationship with reduced exercise tolerance are lacking. The present study aims at investigating the impact of resting HR on the hemodynamic response to exercise in permanent AF patients by means of a computational cardiovascular model. Methods. The AF lumped-parameter model was run to simulate resting (1 Metabolic Equivalent of Task-MET) and various exercise conditions (4 METs: brisk walking; 6 METs: skiing; 8 METs: running), considering differ…
Atrial fibrillation (AF) is associated with cognitive impairment/dementia, independently of clinical cerebrovascular events (stroke/TIA). One of the plausible mechanisms is the occurrence of AF-induced transient critical hemodynamic events; however, it is presently unknown, if ventricular response rate during AF may impact on cerebral hemodynamics. AF was simulated at different ventricular rates (50, 70, 90, 110, 130 bpm) by two coupled lumped parameter validated models (systemic and cerebral circulation), and compared to corresponding control normal sinus rhythm simulations (NSR). Hemodynamic…
Background. Different mechanisms have been proposed to relate atrial fibrillation (AF) and coronary flow impairment, even in absence of relevant coronary artery disease (CAD). However, the underlying hemodynamics remains unclear. Aim of the present work is to computationally explore whether and to what extent ventricular rate during AF affects the coronary perfusion. Methods. AF is simulated at different ventricular rates (50, 70, 90, 110, 130 bpm) through a 0D-1D multiscale validated model, which combines the left heart-arterial tree together with the coronary circulation. Artificially-built …
A network-based approach is presented to investigate the cerebrovascular flow patterns during atrial fibrillation (AF) with respect to normal sinus rhythm (NSR). AF, the most common cardiac arrhythmia with faster and irregular beating, has been recently and independently associated with the increased risk of dementia. However, the underlying hemodynamic mechanisms relating the two pathologies remain mainly undetermined so far; thus the contribution of modeling and refined statistical tools is valuable. Pressure and flow rate temporal series in NSR and AF are here evaluated along representative…
There has recently been growing evidence that atrial fibrillation (AF), the most common cardiac arrhythmia, is independently associated with the risk of dementia. This represents a very recent frontier with high social impact for the number of individuals involved and for the expected increase in AF incidence in the next 40 years. Although a number of potential haemodynamic processes, such as microembolisms, altered cerebral blood flow, hypoperfusion and microbleeds, arise as connecting links between the two pathologies, the causal mechanisms are far from clear. An in silico approach is propos…
Background. Despite the routine prescription of rate control therapy for atrial fibrillation (AF), clinical evidence demonstrating a heart rate target is lacking. Aim of the present study was to run a mathematical model simulating AF episodes with a different heart rate (HR) to predict hemodynamic parameters for each situation. Methods. The lumped model, representing the pumping heart together with systemic and pulmonary circuits, was run to simulate AF with HR of 50, 70, 90, 110 and 130 bpm, respectively. Results. Left ventricular pressure increased by 56.7%, from 33.92+-37.56 mmHg to 53.15+-…
We measure the content of random uncorrelated noise in heart rate variability using a general method of noise level estimation using a coarse grained entropy. We show that usually - except for atrial fibrillation - the level of such noise is within 5 - 15% of the variance of the data and that the variability due to the linearly correlated processes is dominant in all cases analysed but atrial fibrillation. The nonlinear deterministic content of heart rate variability remains significant and may not be ignored.
