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Top stories on catheter ablation of atrial fibrillation in patients with congenital heart defects
No full textBiomechanical EngineeringSignal Processing System
Atrial fibrillation fingerprinting
No full textAtrial fibrillation (AF) is a common age-related cardiac arrhythmia. AF is characterized by rapid and irregular electrical activity of the heart leading to a higher risk of stroke and heart failure. During AF, the upper chambers of the heart, called atria, experience chaotic electrical wave propagation. However, despite the various mechanisms introduced in the literature, there is still an ongoing debate on a precise and consistent mechanism underlying the initiation and perpetuation of AF. Some studies show that AF is rooted in impaired electrical conduction and structural damage of atrial tissue, known as electropathology. Atrial electrograms (EGMs) recorded directly from heart’s surface, provide an important diagnostic tool to localize and quantify the degree of electropathology in the tissue. However, the analysis of the electrograms is currently constrained by the lack of suitable methods that can reveal the hidden electrophysiological parameters of the tissue. These parameters can be used as local indication of electropathology in the tissue. We believe that understanding AF and improving AF therapy starts with developing a proper forward model that is accurate enough (from a physiological point of view) and simultaneously simple enough to allow for subsequent parameter estimation. Therefore, the main focus of this thesis is on developing a simplified forward model that can efficiently explain the observed EGM based on AF relevant tissue parameters. An initial step before performing any analysis on the data is to remove noise and artefacts. All atrial electrogram recordings suffer from strong far-field ventricular activities (VA). Therefore, as the first step, we propose a new framework for removal of VA from atrial electrograms, which is based on interpolation and subtraction followed by low-rank and sparse matrix decomposition. The proposed framework is of low complexity, does not require high resolution multi-channel recordings, or a calibration step for each individual patient. In the next step, we develop a simplified electrogram model. We represent the model in a compact matrix form and show its linear dependence on the conductivity vector, enabling the estimation of this parameter from the recorded electrograms. The results show that despite the low resolution and all simplifying assumptions, the model can efficiently estimate the conductivity map and regenerate realistic electrograms, especially during sinus rhythm. In the next contribution of this dissertation, we propose a new approach for a better estimation of local activation times for atrial mapping by reducing the spatial blurring effect that is inherent to electrogram recordings using deconvolution. Employing sparsity based regularization and first-order time derivatives in formulating the deconvolution problem, improved performance of transmembrane current estimation is obtained. In the final part, we focus on translating our findings from research to clinical application. Therefore, we studied the effect of electrode size on electrogram properties including the length of the block line observed on the resulting activation map, percentage of observed low voltage areas, percentage of electrograms with low maximum steepness, and the number of deflections in the recorded electrograms.Signal Processing System
Local Activation Time Estimation in Fractionated Electrograms of Cardiac Mappings
No full textIn this study, we propose a novel approach for estimation of local activation times (LATs) in fractionated electrograms. Using an electrophysiological tissue model, we first formulate the electrogram array as a convolution of transmembrane currents with a distance kernel. These currents are more local activities and less affected by the heterogeneity in the tissue compared to electrograms. We then deconvolve the distance kernel with the electrograms to reconstruct the transmembrane current. To stabilize the solution of this ill-posed deconvolution, we use spatio-temporal total variation as a regularization. This helps to preserve sharp spatial and temporal deflections in the currents that are of higher importance in LAT estimation. Finally, the maximum negative slope of the reconstructed transmembrane currents are used to estimate the LATs. Instrumental comparison to two reference approaches shows that the proposed approach performs better in estimating the LATs in fractionated electrograms.Green Open Access added to TU Delft Institutional Repository ‘You share, we take care!’ – Taverne project https://www.openaccess.nl/en/you-share-we-take-care Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work publicSignal Processing System
Model-based Feature Engineering of Atrial Fibrillation
No full textAtrial Fibrillation (AF) is the most common tachyarrhythmia in the heart. Irregular RR intervals and the absence of a P wave before the QRS complex characterize AF. Although many studies have been done to detect atrial fibrillation, many aspects of this intricate disease need further analysis. AF is often diagnosed by the interpretation of multi-lead electrocardiograms (ECGs), which provide a non-invasive comprehensive evaluation of cardiac electrical activity. However, due to the poor spatial resolution of ECG recordings, the characteristics of AF cannot be fully demonstrated by using multi-lead ECG solely. Better spatial resolution is obtained by using high-resolution epicardial electrograms measured directly at the surface of the heart. The combination of multi-lead ECGs and high-resolution electrograms should provide a more detailed view of atrial fibrillation. To analyze such data, we first need to derive relevant features that can reduce the data and capture their essence. An initial aim of this research is to increase the accuracy of AF detection and identification of electropathological regions within the heart using the derived features. The ultimate goal is to (non-invasively) monitor the progression of atrial fibrillation through its subsequent stages....Signal Processing System
Estimation of Cardiac Fibre Direction Based on Activation Maps
No full textEstimating tissue conductivity parameters from electrograms (EGMs) could be an important tool for diagnosing and treating heart rhythm disorders such as atrial fibrillation (AF). One of these parameters is the fibre direction, often assumed to be known in conductivity estimation methods. In this paper, a novel method to estimate the fibre direction from EGMs is presented. This method is based on local conduction slowness vectors of a propagating activation wave. These conduction slowness vectors follow an elliptical pattern that depends on the underlying conductivity parameters. The fibre direction and conductivity anisotropy ratio can therefore be estimated by fitting an ellipse to the conduction slowness vectors. Applying the presented method on simulated data shows that it can estimate the fibre direction more accurately than existing methods, and that its performance depends mostly on the range of wavefront directions present in the measurement area. The main advantage of the presented method is that it still functions relatively well in the presence of conduction blocks, as long as the surrounding tissue is approximately homogeneous.Green Open Access added to TU Delft Institutional Repository 'You share, we take care!' - Taverne project https://www.openaccess.nl/en/you-share-we-take-care Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work public.Signal Processing System
Modelling and Analysis of Atrial Epicardial Electrograms: An approach based on graph signal processing and confirmatory factor analysis
No full textAtrial fibrillation (AF) is a frequently encountered cardiac arrhythmia characterized by rapid and irregular atrial activity, which increases the risk of strokes, heart failure and other heart-related complications. The mechanisms of AF are complicated. Although various mechanisms were proposed in previous research, the precise mechanisms of AF are not clear yet and the optimal therapy for AF patients are still under debated. A higher success rate of AF treatments requires a deeper understanding of the problem of AF and potentially a better screening of the patients. In order to study AF, instead of using human body surface ECGs, we use the epicardial electrograms (EGMs) obtained directly from the epicardial sites of the human atria during open heart surgery. This data is measured using a high-resolution mapping array and exhibits irregular properties during AF. Although different studies have analyzed electrograms in time and frequency domain, there remain many open questions that require alternative and novel tools to investigate AF. Experience in signal processing suggests that incorporating the spatial dimension into the time-frequency analysis on the multi-electrode electrograms may provide improved insights on the atrial activity. However, the electrophysiologcial models for describing spatial propagation are relatively complex and non-linear such that conventional signal processing methods are less suitable for a joint space, time, and frequency domain analysis. It is also difficult to use very detailed electrophysiologcial models to extract tissue parameters related to AF from the high-dimensional data. In this dissertation, we wish to propose a radically different approach to study and analyze the EGMs from a higher abstraction level and from different perspectives to get more understanding of the characteristics of AF. We also aim to develop a simplified electrophysiological model that can capture the spatial structure of the data and propose an efficient method to estimate the tissue parameters, which are helpful to analyze the electropathology of the tissue, e.g., cell activation time or conductivity.In the first part of this study, we put forward a graph-time spectral analysis framework to analyze EGMs during normal heart rhythm and AF with a higher-level model. To capture the frequency content along both time domain and graph domain, we propose the joint graph and short-time Fourier transform, which allows us to evaluate the temporal and spatial variation of EGMs and capture the interaction between space and time. The spectral analysis of the EGMs helps us to recognize atrial fibrillation impact on the atrial activity and identify the differences between the atrial activity and the ventricular activity. We find that the difference in graph smoothness between the atrial and ventricular activities enables us to better extract the atrial activity from the noisy measurements.The second part of this study is to find a simplified but accurate enough electrophysiological model for the high dimensional EGMs and to make more efficient use of the data to detect the arrythmogenic substrate that causes abnormalities in atrial tissue. In this dissertation, we develop the cross power spectral density matrix (CPSDM) model of the multi-electrode EGMs and make use of an effective method called confirmatory factor analysis (CFA) to jointly estimate the model parameters. The conductivity, the activation time, and the anisotropy ratio are useful parameters to determine abnormalities in cardiac tissue and are therefore the target parameters to be estimated. With the reasonable assumptions that the conductivity parameters and the anisotropy parameters are constant across different frequencies and heart beats, and the activation time of cells are constant across different frequencies, we propose simultaneous CFA (SCFA) to jointly estimate these parameters using multiple frequencies and multiple heart beats. The identifiability conditions which need to be satisfied in the CFA problem are used to find the relationship between the desired resolution and the required amount of data. Evaluations on the simulated data and the clinical data demonstrate that the proposed method can localize the conduction blocks in the tissue and reconstruct the clinical EGMs well using the estimated parameters.Signal Processing System
Tensor-based Detection of Paroxysmal and Persistent Atrial Fibrillation from Multi-channel ECG
No full textAtrial fibrillation (AF) is the most common arrhythmia in the heart. Two main types of AF are defined as paroxysmal and persistent. In this paper, we present a method to discriminate between the characteristics of paroxysmal and persistent using tensor decompositions of a multi-channel electrocardiogram (ECG) signal. For this purpose, ECG signals are segmented by applying a Hilbert transform on the thresholded signal. Dynamic time warping is used to align the separated segments of each channel and then a tensor is constructed with three dimensions as time, heartbeats and channels. A Canonical polyadic decomposition with rank 2 is computed from this tensor and the resulting loading vectors describe the characteristics of paroxysmal and persistent AF in these three dimensions. The time loading vector reveals the pattern of a single P wave or abnormal AF patterns. The heartbeat loading vector shows whether the pattern is present or absent in a specific beat. The results can be used to distinguish between the patterns in paroxysmal AF and persistent AF.Green Open Access added to TU Delft Institutional Repository 'You share, we take care!' - Taverne project https://www.openaccess.nl/en/you-share-we-take-care Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work public.Signal Processing System
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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