Are drivers recurring or ephemeral? observations from serial mapping of persistent atrial fibrillation.

Aims: Rotational re-entries and ectopic foci, or 'drivers', are proposed mechanisms for persistent atrial fibrillation (persAF), but driver-based interventions have had mixed success in clinical trials. Selective targeting of drivers with multi-month stability may improve these interventions, but no prior work has investigated whether drivers can be stable on such a long timescale.

Objective: We hypothesized that drivers could recur even several months after initial observation.

Transfer Learning for Improved Classification of Drivers in Atrial Fibrillation.

"Drivers" are theorized mechanisms for persistent atrial fibrillation. Machine learning algorithms have been used to identify drivers, but the small size of current driver datasets limits their performance. We hypothesized that pretraining with unsupervised learning on a large dataset of unlabeled electrograms would improve classifier accuracy on a smaller driver dataset.

Exercise Capacity Correlates With Left Atrial Structural Remodeling as Detected by Late Gadolinium-Enhanced Cardiac Magnetic Resonance in Patients With Atrial Fibrillation.

Objectives: This study hypothesized that left atrial structural remodeling (LA-TR) correlates with exercise capacity (EC) in a cohort of patients with atrial fibrillation (AF).

Background: Late gadolinium-enhanced cardiac magnetic resonance (LGE-CMR) imaging provides a method of assessing LA-TR in patients with AF.

Methods: A total of 145 patients (32% female, mean age 63.

Assessment of regularization techniques for electrocardiographic imaging.

A widely used approach to solving the inverse problem in electrocardiography involves computing potentials on the epicardium from measured electrocardiograms (ECGs) on the torso surface. The main challenge of solving this electrocardiographic imaging (ECGI) problem lies in its intrinsic ill-posedness. While many regularization techniques have been developed to control wild oscillations of the solution, the choice of proper regularization methods for obtaining clinically acceptable solutions is still a subject of ongoing research.

Supplemented standard 12-lead electrocardiogram for optimal diagnosis and reconstruction of significant body surface map patterns.

In this study, based on 120-lead body surface potential maps (BSPMs), we explored the improvement in electrocardiogram (ECG) diagnosis obtained by adding additional leads and using estimation of unmeasured leads. We found that adding a few leads observed to be optimal for diagnosis or signal capture combined with the existing 12-lead ECG improves diagnostic performance. Separately, using reconstruction (estimation) of BSPMs and using diagnostic criteria derived for maps also improve diagnostic performance over that provided by the recorded 12-lead ECG alone.

Epicardial and intramural excitation during ventricular pacing: effect of myocardial structure.

Published studies show that ventricular pacing in canine hearts produces three distinct patterns of epicardial excitation: elliptical isochrones near an epicardial pacing site, with asymmetric bulges; areas with high propagation velocity, up to 2 or 3 m/s and numerous breakthrough sites; and lower velocity areas (<1 m/s), where excitation moves across the epicardial projection of the septum. With increasing pacing depth, the magnitude of epicardial potential maxima becomes asymmetric. The electrophysiological mechanisms that generate the distinct patterns have not been fully elucidated.

Application of stochastic finite element methods to study the sensitivity of ECG forward modeling to organ conductivity.

Because numerical simulation parameters may significantly influence the accuracy of the results, evaluating the sensitivity of simulation results to variations in parameters is essential. Although the field of sensitivity analysis is well developed, systematic application of such methods to complex biological models is limited due to the associated high computational costs and the substantial technical challenges for implementation. In the specific case of the forward problem in electrocardiography, the lack of robust, feasible, and comprehensive sensitivity analysis has left many aspects of the problem unresolved and subject to empirical and intuitive evaluation rather than sound, quantitative investigation.

Ischemic preconditioning protects against arrhythmogenesis through maintenance of both active as well as passive electrical properties in ischemic canine hearts.

Background: The mechanisms for the antiarrhythmogenic effects of preconditioning in ischemic hearts, although well demonstrated, are not clear. We measured indices of activation and repolarization using data from a high-resolution epicardial sock electrode array in preconditioned (PC) and non-PC hearts in an attempt to gain further insight into protective mechanisms.

Methods And Results: Five canine hearts were subjected to a coronary artery occlusion lasting at least 1 hour, and 5 were subjected to a similar occlusion preceded by a preconditioning protocol.

Instance selection for estimation of epicardial activation sequence from venous catheter measurements.

Catheter-based electrophysiological studies of the outer surface of the heart (epicardium) are limited to regions near the heart vessels or require transthoracic access. We have developed a statistical signal processing approach by which to estimate high-resolution epicardial activation maps from multi-electrode venous catheter measurements. This technique uses a linear minimum mean-squared Bayesian estimation model that derives a relationship between venous catheter measurements and unmeasured epicardial sites from a set of previously recorded, high-resolution epicardial activation-time maps used as a training data set.

Methods of solving reduced lead systems for inverse electrocardiography.

In the context of inverse electrocardiography, we examine the problem of using measurements from sets of electrocardiographic leads that are smaller than the number of nodes in the associated geometric models of the torso. We compared several methods to estimate the solution from such reduced-lead measurements sets both with and without knowledge of prior statistics of the measurements. We present here simulation results that indicate that deleting rows of the forward matrix corresponding to the unmeasured leads performs best in the absence of prior statistics, and that Bayesian (or least-squares) estimation performs best in the presence of prior statistics.

Venous catheter based mapping of epicardial ectopic activation.

Catheter based electrophysiological studies of the epicardium are limited to regions near the coronary vessels or require transthoracic access. We have developed a statistical approach by which to estimate high-resolution maps of epicardial activation from very low-resolution multielectrode venous catheter measurements. Essential components of this approach are the training data set composition and the catheter electrode locations used to determine the relationship between catheter sites and the remaining measurement sites on the epicardium.

Improved performance of bayesian solutions for inverse electrocardiography using multiple information sources.

The usual goal in inverse electrocardiography (ECG) is to reconstruct cardiac electrical sources from body surface potentials and a mathematical model that relates the sources to the measurements. Due to attenuation and smoothing that occurs in the thorax, the inverse ECG problem is ill-posed and imposition of a priori constraints is needed to combat this ill-posedness. When the problem is posed in terms of reconstructing heart surface potentials, solutions have not yet achieved clinical utility; limitations include the limited availability of good a priori information about the solution and the lack of a "good" error metric.

Wavefront-based models for inverse electrocardiography.

We introduce two wavefront-based methods for the inverse problem of electrocardiography, which we term wavefront-based curve reconstruction (WBCR) and wavefront-based potential reconstruction (WBPR). In the WBCR approach, the epicardial activation wavefront is modeled as a curve evolving on the heart surface, with the evolution governed by factors derived phenomenologically from prior measured data. The body surface potential/wavefront relationship is modeled via an intermediate mapping of wavefront to epicardial potentials, again derived phenomenologically.

Generalized training subset selection for statistical estimation of epicardial activation maps from intravenous catheter measurements.

Catheter-based electrophysiological studies of the epicardium are limited to regions near the coronary vessels or require transthoracic access. We have developed a statistical approach by which to estimate high-resolution maps of epicardial activation from very low-resolution multi-electrode venous catheter measurements. This technique uses a linear estimation model that derives a relationship between venous catheter measurements and unmeasured epicardial sites from a set of previously recorded, high-resolution epicardial activation-time maps used as a training data set based on the spatial covariance of the measurement sites.

Venous catheter based mapping of ectopic epicardial activation: training data set selection for statistical estimation.

A source of error in most of the existing catheter cardiac mapping approaches is that they are not capable of acquiring epicardial potentials even though arrhythmic substrates involving epicardial and subepicardial layers account for about 15% of the ventricular tachycardias. In this subgroup of patients, mapping techniques that are limited to the endocardium result in localization errors and failure in subsequent ablation procedures. In addition, catheter-based electrophysiological studies of the epicardium are limited to regions near the coronary vessels or require transthoracic access.

Mechanisms of ischemia-induced ST-segment changes.

Many aspects of ischemia-induced changes in the electrocardiogram lack solid biophysical underpinnings although variations in ST segments form the predominant basis for diagnostic and monitoring of patients. This incomplete knowledge certainly plays a role in the poor performance of some forms of electrocardiogram-based detection and characterization of ischemia, especially when it is limited to the subendocardium. The focus of our recent studies has been to develop a comprehensive mechanistic model of the electrocardiographic effects of ischemia.

Bayesian solutions and performance analysis in bioelectric inverse problems.

In bioelectric inverse problems, one seeks to recover bioelectric sources from remote measurements using a mathematical model that relates the sources to the measurements. Due to attenuation and spatial smoothing in the medium between the sources and the measurements, bioelectric inverse problems are generally ill-posed. Bayesian methodology has received increasing attention recently to combat this ill-posedness, since it offers a general formulation of regularization constraints and additionally provides statistical performance analysis tools.

The effect of intrathoracic heart position on electrocardiogram autocorrelation maps.

We studied the influence of the heart position in the thorax on the autocorrelation (AC) maps consisting of correlation coefficients between each pair of instantaneous electrocardiogram potential distributions over a time interval. We used a thorax-shaped electrolytic-filled tank with an isolated and perfused dog heart placed at positions spanning 5 cm on each space direction. The correlation coefficient between QRST AC maps was in the range of 0.

Spatial methods of epicardial activation time determination in normal hearts.

The purpose of this study was to demonstrate errors in activation time maps created using the time derivative method on fractionated unipolar electrograms, to characterize the epicardial distribution of those fractionated electrograms, and to investigate spatial methods of activation time determination. Electrograms (EGs) were recorded using uniform grids of electrodes (1 or 2 mm spacing) on the epicardial surface of six normal canine hearts. Activation times were estimated using the time of the minimum time derivative, maximum spatial gradient, and zero Laplacian and compared with the time of arrival of the activation wave front as assessed from a time series of potential maps as the standard.

Multielectrode venous catheter mapping as a high quality constraint for electrocardiographic inverse solution.

A persistent challenge in solving inverse problems in electrocardiography is the application of suitable constraints to the calculation of cardiac sources. Whether one formulates the inverse problem in terms of epicardial potentials or activation wavefronts, the problem is physically ill-posed and hence results in numerically unstable computations. Suitable physiological constraints applied with appropriate weighting can recover useful inverse solutions.