Non-invasive atrial fibrillation organization follow-up under successive attempts of electrical cardioversion

Developing a New Computer-Aided Clinical Decision Support System for Prediction of Successful Postcardioversion Patients with Persistent Atrial Fibrillation

We propose a new algorithm to predict the outcome of direct-current electric (DCE) cardioversion for atrial fibrillation (AF) patients. AF is the most common cardiac arrhythmia and DCE cardioversion is a noninvasive treatment to end AF and return the patient to sinus rhythm (SR). Unfortunately, there is a high risk of AF recurrence in persistent AF patients; hence clinically it is important to predict the DCE outcome in order to avoid the procedure's side effects. This study develops a feature extraction and classification framework to predict AF recurrence patients from the underlying structure of atrial activity (AA). A multiresolution signal decomposition technique, based on matching pursuit (MP), was used to project the AA over a dictionary of wavelets. Seven novel features were derived from the decompositions and were employed in a quadratic discrimination analysis classification to predict the success of post-DCE cardioversion in 40 patients with persistent AF. The proposed algorithm achieved 100% sensitivity and 95% specificity, indicating that the proposed computational approach captures detailed structural information about the underlying AA and could provide reliable information for effective management of AF.

Central tendency measure and wavelet transform combined in the non-invasive analysis of atrial fibrillation recordings

Background

Atrial fibrillation (AF) is the most common supraventricular arrhythmia in the clinical practice, being the subject of intensive research.

Methods

The present work introduces two different Wavelet Transform (WT) applications to electrocardiogram (ECG) recordings of patients in AF. The first one predicts spontaneous termination of paroxysmal AF (PAF), whereas the second one deals with the prediction of electrical cardioversion (ECV) outcome in persistent AF patients. In both cases, the central tendency measure (CTM) from the first differences scatter plot was applied to the AF wavelet decomposition. In this way, the wavelet coefficients vector CTM associated to the AF frequency scale was used to assess how atrial fibrillatory (f) waves variability can be related to AF events.

Results

Structural changes into the f waves can be assessed by combining WT and CTM to reflect atrial activity organization variation. This fact can be used to predict organization-related events in AF. To this respect, results in the prediction of PAF termination regarding sensitivity, specificity and accuracy were 100%, 91.67% and 96%, respectively. On the other hand, for ECV outcome prediction, 82.93% sensitivity, 90.91% specificity and 85.71% accuracy were obtained. Hence, CTM has reached the highest diagnostic ability as a single predictor published to date.

Conclusions

Results suggest that CTM can be considered as a promising tool to characterize non-invasive AF signals. In this sense, therapeutic interventions for the treatment of paroxysmal and persistent AF patients could be improved, thus, avoiding useless procedures and minimizing risks.