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Saha S, Linz D, Saha D, McEwan A, Baumert M. Overcoming Uncertainties in Electrogram-Based Atrial Fibrillation Mapping: A Review. Cardiovasc Eng Technol 2024; 15:52-64. [PMID: 37962813 DOI: 10.1007/s13239-023-00696-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023]
Abstract
In clinical rhythmology, intracardiac bipolar electrograms (EGMs) play a critical role in investigating the triggers and substrates inducing and perpetuating atrial fibrillation (AF). However, the interpretation of bipolar EGMs is ambiguous due to several aspects of electrodes, mapping algorithms and wave propagation dynamics, so it requires several variables to describe the effects of these uncertainties on EGM analysis. In this narrative review, we critically evaluate the potential impact of such uncertainties on the design of cardiac mapping tools on AF-related substrate characterization. Literature suggest uncertainties are due to several variables, including the wave propagation vector, the wave's incidence angle, inter-electrode spacing, electrode size and shape, and tissue contact. The preprocessing of the EGM signals and mapping density will impact the electro-anatomical representation and the features extracted from the local electrical activities. The superposition of multiple waves further complicates EGM interpretation. The inclusion of these uncertainties is a nontrivial problem but their consideration will yield a better interpretation of the intra-atrial dynamics in local activation patterns. From a translational perspective, this review provides a concise but complete overview of the critical variables for developing more precise cardiac mapping tools.
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Affiliation(s)
- Simanto Saha
- School of Biomedical Engineering, The University of Sydney, Sydney, NSW, 2008, Australia.
| | - Dominik Linz
- Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, SA, 5000, Australia
| | - Dyuti Saha
- Kumudini Women's Medical College, The University of Dhaka, Tangail, 1940, Dhaka, Bangladesh
| | - Alistair McEwan
- School of Biomedical Engineering, The University of Sydney, Sydney, NSW, 2008, Australia
| | - Mathias Baumert
- School of Electrical and Mechanical Engineering, The University of Adelaide, Adelaide, SA, 5000, Australia
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Pancorbo L, Ruipérez-Campillo S, Tormos Á, Guill A, Cervigón R, Alberola A, Chorro FJ, Millet J, Castells F. Vector Field Heterogeneity for the Assessment of Locally Disorganised Cardiac Electrical Propagation Wavefronts From High-Density Multielectrodes. IEEE OPEN JOURNAL OF ENGINEERING IN MEDICINE AND BIOLOGY 2023; 5:32-44. [PMID: 38445238 PMCID: PMC10914212 DOI: 10.1109/ojemb.2023.3344349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/22/2023] [Accepted: 11/28/2023] [Indexed: 03/07/2024] Open
Abstract
High-density multielectrode catheters are becoming increasingly popular in cardiac electrophysiology for advanced characterisation of the cardiac tissue, due to their potential to identify impaired sites. These are often characterised by abnormal electrical conduction, which may cause locally disorganised propagation wavefronts. To quantify it, a novel heterogeneity parameter based on vector field analysis is proposed, utilising finite differences to measure direction changes between adjacent cliques. The proposed Vector Field Heterogeneity metric has been evaluated on a set of simulations with controlled levels of organisation in vector maps, and a variety of grid sizes. Furthermore, it has been tested on animal experimental models of isolated Langendorff-perfused rabbit hearts. The proposed parameter exhibited superior capturing ability of heterogeneous propagation wavefronts compared to the classical Spatial Inhomogeneity Index, and simulations proved that the metric effectively captures gradual increments in disorganisation in propagation patterns. Notably, it yielded robust and consistent outcomes for [Formula: see text] grid sizes, underscoring its suitability for the latest generation of orientation-independent cardiac catheters.
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Affiliation(s)
- Lucía Pancorbo
- ITACA InstituteUniversitat Politècnica de València46022ValenciaSpain
| | | | - Álvaro Tormos
- ITACA InstituteUniversitat Politècnica de València46022ValenciaSpain
| | - Antonio Guill
- ITACA InstituteUniversitat Politècnica de València46022ValenciaSpain
| | | | - Antonio Alberola
- Departamento de FisiologíaUniversidad de València46010ValenciaSpain
- Instituto de Investigación INCLIVA46010ValenciaSpain
- CIBER E. Cardiovasculares28029MadridSpain
| | - Francisco Javier Chorro
- CIBER E. Cardiovasculares28029MadridSpain
- Departamento de MedicinaUniversidad de València46010ValenciaSpain
- Instituto de Investigación INCLIVA46010ValenciaSpain
- Servicio de CardiologíaHospital Clínic Universitari de València46010ValenciaSpain
| | - José Millet
- ITACA InstituteUniversitat Politècnica de València46022ValenciaSpain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovascular28029MadridSpain
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Ruipérez-Campillo S, Crespo M, Tormos Á, Guill A, Cebrián A, Alberola A, Heimer J, Chorro FJ, Millet J, Castells F. Evaluation and assessment of clique arrangements for the estimation of omnipolar electrograms in high density electrode arrays: an experimental animal model study. Phys Eng Sci Med 2023; 46:1193-1204. [PMID: 37358782 PMCID: PMC10480253 DOI: 10.1007/s13246-023-01287-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 05/28/2023] [Indexed: 06/27/2023]
Abstract
High-density catheters combined with Orientation Independent Sensing (OIS) methods have emerged as a groundbreaking technology for cardiac substrate characterisation. In this study, we aim to assess the arrangements and constraints to reliably estimate the so-called omnipolar electrogram (oEGM). Performance was evaluated using an experimental animal model. Thirty-eight recordings from nine retrospective experiments on isolated perfused rabbit hearts with an epicardial HD multielectrode were used. We estimated oEGMs according to the classic triangular clique (4 possible orientations) and a novel cross-orientation clique arrangement. Furthermore, we tested the effects of interelectrode spacing from 1 to 4 mm. Performance was evaluated by means of several parameters that measured amplitude rejection ratios, electric field loop area, activation pulse width and morphology distortion. Most reliable oEGM estimations were obtained with cross-configurations and interelectrode spacings [Formula: see text] mm. Estimations from triangular cliques resulted in wider electric field loops and unreliable detection of the direction of the propagation wavefront. Moreover, increasing interelectrode distance resulted in increased pulse width and morphology distortion. The results prove that current oEGM estimation techniques are insufficiently accurate. This study opens a new standpoint for the design of new-generation HD catheters and mapping software.
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Affiliation(s)
- Samuel Ruipérez-Campillo
- ITACA Institute, Universitat Politècnica de València, Valencia, Spain.
- Department of Information Technology and Electrical Engineering, Swiss Federal Institute of Technology (ETH), Zürich, Switzerland.
- School of Medicine, Stanford University, Stanford, CA, USA.
| | - Marina Crespo
- ITACA Institute, Universitat Politècnica de València, Valencia, Spain
| | - Álvaro Tormos
- ITACA Institute, Universitat Politècnica de València, Valencia, Spain
| | - Antonio Guill
- ITACA Institute, Universitat Politècnica de València, Valencia, Spain
| | - Antonio Cebrián
- ITACA Institute, Universitat Politècnica de València, Valencia, Spain
| | - Antonio Alberola
- Departamento de Fisiología, Universitat de València, Valencia, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovascular (CIBERCV), Madrid, Spain
| | - Jakob Heimer
- Department of Mathematics, Seminar for Statistics, Swiss Federal Institute of Technology (ETH), Zürich, Switzerland
| | - Francisco J Chorro
- Centro de Investigación Biomédica en Red Enfermedades Cardiovascular (CIBERCV), Madrid, Spain
- Departamento de Medicina, Universitat de València, Valencia, Spain
- Servicio de Cardiología, Hospital Clínic Universitari de València, Valencia, Spain
| | - José Millet
- ITACA Institute, Universitat Politècnica de València, Valencia, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovascular (CIBERCV), Madrid, Spain
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Segarra I, Cebrian A, Ruiperez-Campillo S, Tormos A, Chorro FJ, Castells F, Alberola A, Millet J. Mini Peltier Cell Array System for the Generation of Controlled Local Epicardial Heterogeneities. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38082704 DOI: 10.1109/embc40787.2023.10340369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The present study aims to design and fabricate a system capable of generating heterogeneities on the epicardial surface of an isolated rabbit heart perfused in a Langendorff system. The system consists of thermoelectric modules that can be independently controlled by the developed hardware, thereby allowing for the generation of temperature gradients on the epicardial surface, resulting in conduction slowing akin to heterogeneities of pathological origin. A comprehensive analysis of the system's viability was performed through modeling and thermal simulation, and its practicality was validated through preliminary tests conducted at the experimental cardiac electrophysiology laboratory of the University of Valencia. The design process involved the use of Fusion 360 for 3D designs, MATLAB/Simulink for algorithms and block diagrams, LTSpice and Altium Designer for schematic captures and PCB design, and the integration of specialized equipment for animal experimentation. The objective of the study was to efficiently capture epicardial recordings under varying conditions.Clinical relevance- The proposed system aims to induce local epicardial heterogeneities to generate labeled correct signals that can serve as a golden standard for improving algorithms that identify and characterize fibrotic substrates. This improvement will enhance the efficacy of ablation processes and potentially reduce the ablated surface area.
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Crespo M, Campillo SR, Casado-Arroyo R, Millet J, Castells F. Assessment of the Interelectrode Distance Effect over the Omnipole with High Multielectrode Arrays. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38083486 DOI: 10.1109/embc40787.2023.10341063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The development of high-density multielectrode catheters has significantly advanced cardiac electrophysiology mapping. High-density grid catheters have enabled the creation of a novel technique for reconstructing electrogram (EGM) signals known as "omnipole," which is believed to be more reliable than other methods, especially in terms of orientation independence. This study aims to evaluate how distance affects the omnipolar reconstruction of EGMs by comparing different configurations. Using an animal set up of perfused isolated rabbit hearts, recordings were taken using an ad hoc high-density epicardial multielectrode catheter. Inter-electrode distances ranging from 1 to 4 mm were analysed for their effect on the quality of resulting EGMs. Two biomarkers were computed to evaluate the robustness of the reconstructions: the areas contained within the bipolar loops and the amplitudes of the omnipoles. We hypothesised that both bipolar and omnipolar electrograms would be more robust at shorter inter-electrode distances. The results showed that an increase in distance triggers an increase in loop areas and amplitudes, which supports the hypothesis. This finding provides a more reliable estimate of wavefront propagation for the cross-omnipolar reconstruction method. These results emphasise the importance of distance in cardiac electrophysiology mapping and provide valuable insights into the use of high-density multielectrode catheters for EGM reconstruction.Clinical Relevance- The results of this study have direct clinical relevance in the application of the described techniques to recording systems in the cardiac electrophysiology laboratory, enabling clinicians to obtain more precise characterisation of signals in the myocardium.
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