Detection of focal source and arrhythmogenic substrate from body surface potentials to guide atrial fibrillation ablation.
Focal sources (FS) are believed to be important triggers and a perpetuation mechanism for paroxysmal atrial fibrillation (AF). Detecting FS and determining AF sustainability in atrial tissue can help guide ablation targeting. We hypothesized that sustained rotors during FS-driven episodes indicate a...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2022-03-01
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| Series: | PLoS Computational Biology |
| Online Access: | https://doi.org/10.1371/journal.pcbi.1009893 |
| _version_ | 1797867518430281728 |
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| author | Yingjing Feng Caroline H Roney Jason D Bayer Steven A Niederer Mélèze Hocini Edward J Vigmond |
| author_facet | Yingjing Feng Caroline H Roney Jason D Bayer Steven A Niederer Mélèze Hocini Edward J Vigmond |
| author_sort | Yingjing Feng |
| collection | DOAJ |
| description | Focal sources (FS) are believed to be important triggers and a perpetuation mechanism for paroxysmal atrial fibrillation (AF). Detecting FS and determining AF sustainability in atrial tissue can help guide ablation targeting. We hypothesized that sustained rotors during FS-driven episodes indicate an arrhythmogenic substrate for sustained AF, and that non-invasive electrical recordings, like electrocardiograms (ECGs) or body surface potential maps (BSPMs), could be used to detect FS and AF sustainability. Computer simulations were performed on five bi-atrial geometries. FS were induced by pacing at cycle lengths of 120-270 ms from 32 atrial sites and four pulmonary veins. Self-sustained reentrant activities were also initiated around the same 32 atrial sites with inexcitable cores of radii of 0, 0.5 and 1 cm. FS fired for two seconds and then AF inducibility was tested by whether activation was sustained for another second. ECGs and BSPMs were simulated. Equivalent atrial sources were extracted using second-order blind source separation, and their cycle length, periodicity and contribution, were used as features for random forest classifiers. Longer rotor duration during FS-driven episodes indicates higher AF inducibility (area under ROC curve = 0.83). Our method had accuracy of 90.6±1.0% and 90.6±0.6% in detecting FS presence, and 93.1±0.6% and 94.2±1.2% in identifying AF sustainability, and 80.0±6.6% and 61.0±5.2% in determining the atrium of the focal site, from BSPMs and ECGs of five atria. The detection of FS presence and AF sustainability were insensitive to vest placement (±9.6%). On pre-operative BSPMs of 52 paroxysmal AF patients, patients classified with initiator-type FS on a single atrium resulted in improved two-to-three-year AF-free likelihoods (p-value < 0.01, logrank tests). Detection of FS and arrhythmogenic substrate can be performed from ECGs and BSPMs, enabling non-invasive mapping towards mechanism-targeted AF treatment, and malignant ectopic beat detection with likely AF progression. |
| first_indexed | 2024-04-09T23:42:32Z |
| format | Article |
| id | doaj.art-407cb79ab3844105882dd510dda696b8 |
| institution | Directory Open Access Journal |
| issn | 1553-734X 1553-7358 |
| language | English |
| last_indexed | 2024-04-09T23:42:32Z |
| publishDate | 2022-03-01 |
| publisher | Public Library of Science (PLoS) |
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| series | PLoS Computational Biology |
| spelling | doaj.art-407cb79ab3844105882dd510dda696b82023-03-18T05:31:31ZengPublic Library of Science (PLoS)PLoS Computational Biology1553-734X1553-73582022-03-01183e100989310.1371/journal.pcbi.1009893Detection of focal source and arrhythmogenic substrate from body surface potentials to guide atrial fibrillation ablation.Yingjing FengCaroline H RoneyJason D BayerSteven A NiedererMélèze HociniEdward J VigmondFocal sources (FS) are believed to be important triggers and a perpetuation mechanism for paroxysmal atrial fibrillation (AF). Detecting FS and determining AF sustainability in atrial tissue can help guide ablation targeting. We hypothesized that sustained rotors during FS-driven episodes indicate an arrhythmogenic substrate for sustained AF, and that non-invasive electrical recordings, like electrocardiograms (ECGs) or body surface potential maps (BSPMs), could be used to detect FS and AF sustainability. Computer simulations were performed on five bi-atrial geometries. FS were induced by pacing at cycle lengths of 120-270 ms from 32 atrial sites and four pulmonary veins. Self-sustained reentrant activities were also initiated around the same 32 atrial sites with inexcitable cores of radii of 0, 0.5 and 1 cm. FS fired for two seconds and then AF inducibility was tested by whether activation was sustained for another second. ECGs and BSPMs were simulated. Equivalent atrial sources were extracted using second-order blind source separation, and their cycle length, periodicity and contribution, were used as features for random forest classifiers. Longer rotor duration during FS-driven episodes indicates higher AF inducibility (area under ROC curve = 0.83). Our method had accuracy of 90.6±1.0% and 90.6±0.6% in detecting FS presence, and 93.1±0.6% and 94.2±1.2% in identifying AF sustainability, and 80.0±6.6% and 61.0±5.2% in determining the atrium of the focal site, from BSPMs and ECGs of five atria. The detection of FS presence and AF sustainability were insensitive to vest placement (±9.6%). On pre-operative BSPMs of 52 paroxysmal AF patients, patients classified with initiator-type FS on a single atrium resulted in improved two-to-three-year AF-free likelihoods (p-value < 0.01, logrank tests). Detection of FS and arrhythmogenic substrate can be performed from ECGs and BSPMs, enabling non-invasive mapping towards mechanism-targeted AF treatment, and malignant ectopic beat detection with likely AF progression.https://doi.org/10.1371/journal.pcbi.1009893 |
| spellingShingle | Yingjing Feng Caroline H Roney Jason D Bayer Steven A Niederer Mélèze Hocini Edward J Vigmond Detection of focal source and arrhythmogenic substrate from body surface potentials to guide atrial fibrillation ablation. PLoS Computational Biology |
| title | Detection of focal source and arrhythmogenic substrate from body surface potentials to guide atrial fibrillation ablation. |
| title_full | Detection of focal source and arrhythmogenic substrate from body surface potentials to guide atrial fibrillation ablation. |
| title_fullStr | Detection of focal source and arrhythmogenic substrate from body surface potentials to guide atrial fibrillation ablation. |
| title_full_unstemmed | Detection of focal source and arrhythmogenic substrate from body surface potentials to guide atrial fibrillation ablation. |
| title_short | Detection of focal source and arrhythmogenic substrate from body surface potentials to guide atrial fibrillation ablation. |
| title_sort | detection of focal source and arrhythmogenic substrate from body surface potentials to guide atrial fibrillation ablation |
| url | https://doi.org/10.1371/journal.pcbi.1009893 |
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