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Luongo G, Vacanti G, Nitzke V, Nairn D, Nagel C, Kabiri D, Almeida TP, Soriano DC, Rivolta MW, Ng GA, Dössel O, Luik A, Sassi R, Schmitt C, Loewe A. Hybrid machine learning to localize atrial flutter substrates using the surface 12-lead electrocardiogram. Europace 2022; 24:1186-1194. [PMID: 35045172 PMCID: PMC9301972 DOI: 10.1093/europace/euab322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 12/12/2021] [Indexed: 11/12/2022] Open
Abstract
Aims Atrial flutter (AFlut) is a common re-entrant atrial tachycardia driven by self-sustainable mechanisms that cause excitations to propagate along pathways different from sinus rhythm. Intra-cardiac electrophysiological mapping and catheter ablation are often performed without detailed prior knowledge of the mechanism perpetuating AFlut, likely prolonging the procedure time of these invasive interventions. We sought to discriminate the AFlut location [cavotricuspid isthmus-dependent (CTI), peri-mitral, and other left atrium (LA) AFlut classes] with a machine learning-based algorithm using only the non-invasive signals from the 12-lead electrocardiogram (ECG). Methods and results Hybrid 12-lead ECG dataset of 1769 signals was used (1424 in silico ECGs, and 345 clinical ECGs from 115 patients—three different ECG segments over time were extracted from each patient corresponding to single AFlut cycles). Seventy-seven features were extracted. A decision tree classifier with a hold-out classification approach was trained, validated, and tested on the dataset randomly split after selecting the most informative features. The clinical test set comprised 38 patients (114 clinical ECGs). The classifier yielded 76.3% accuracy on the clinical test set with a sensitivity of 89.7%, 75.0%, and 64.1% and a positive predictive value of 71.4%, 75.0%, and 86.2% for CTI, peri-mitral, and other LA class, respectively. Considering majority vote of the three segments taken from each patient, the CTI class was correctly classified at 92%. Conclusion Our results show that a machine learning classifier relying only on non-invasive signals can potentially identify the location of AFlut mechanisms. This method could aid in planning and tailoring patient-specific AFlut treatments.
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Affiliation(s)
- Giorgio Luongo
- Institute of Biomedical Engineering (IBT), Karlsruhe Institute of Technology (KIT), Fritz-Haber-Weg 1, 76131 Karlsruhe, Germany
| | - Gaetano Vacanti
- Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Moltkestrasse, 90, 76182, Karlsruhe, Germany
| | - Vincent Nitzke
- Institute of Biomedical Engineering (IBT), Karlsruhe Institute of Technology (KIT), Fritz-Haber-Weg 1, 76131 Karlsruhe, Germany
| | - Deborah Nairn
- Institute of Biomedical Engineering (IBT), Karlsruhe Institute of Technology (KIT), Fritz-Haber-Weg 1, 76131 Karlsruhe, Germany
| | - Claudia Nagel
- Institute of Biomedical Engineering (IBT), Karlsruhe Institute of Technology (KIT), Fritz-Haber-Weg 1, 76131 Karlsruhe, Germany
| | - Diba Kabiri
- Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Moltkestrasse, 90, 76182, Karlsruhe, Germany
| | - Tiago P Almeida
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Diogo C Soriano
- Engineering, Modelling and Applied Social Sciences Centre, ABC Federal University, São Bernardo do Campo, Brazil
| | - Massimo W Rivolta
- Dipartimento di Informatica, Università degli Studi di Milano, Milan, Italy
| | - Ghulam André Ng
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Olaf Dössel
- Institute of Biomedical Engineering (IBT), Karlsruhe Institute of Technology (KIT), Fritz-Haber-Weg 1, 76131 Karlsruhe, Germany
| | - Armin Luik
- Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Moltkestrasse, 90, 76182, Karlsruhe, Germany
| | - Roberto Sassi
- Dipartimento di Informatica, Università degli Studi di Milano, Milan, Italy
| | - Claus Schmitt
- Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Moltkestrasse, 90, 76182, Karlsruhe, Germany
| | - Axel Loewe
- Institute of Biomedical Engineering (IBT), Karlsruhe Institute of Technology (KIT), Fritz-Haber-Weg 1, 76131 Karlsruhe, Germany
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Ruipérez-Campillo S, Castrejón S, Martínez M, Cervigón R, Meste O, Merino JL, Millet J, Castells F. Non-invasive characterisation of macroreentrant atrial tachycardia types from a vectorcardiographic approach with the slow conduction region as a cornerstone. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 200:105932. [PMID: 33485078 DOI: 10.1016/j.cmpb.2021.105932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/04/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Macroreentrant atrial tachyarrhythmias (MRATs) can be caused by different reentrant circuits. The treatment for each MRAT type may require ablation at different sites, either at the right or left atria. Unfortunately, the reentrant circuit that drives the arrhythmia cannot be ascertained previous to the electrophysiological intervention. METHODS A noninvasive approach based on the comparison of atrial vectorcardiogram (VCG) loops is proposed. An archetype for each group was created, which served as a reference to measure the similarity between loops. Methods were tested in a variety of simulations and real data obtained from the most common right (peritricuspid) and left (perimitral) macroreentrant circuits, each divided into clockwise and counterclockwise subgroups. Adenosine was administered to patients to induce transient AV block, allowing the recording of the atrial signal without the interference of ventricular signals. From the vectorcardiogram, we measured intrapatient loop consistence, similarity of the pathway to archetypes, characterisation of slow velocity regions and pathway complexity. RESULTS Results show a considerably higher similarity with the loop of its corresponding archetype, in both simulations and real data. We found the capacity of the vectorcardiogram to reflect a slow velocity region, consistent with the mechanisms of MRAT, and the role that it plays in the characterisation of the reentrant circuit. The intra-patient loop consistence was over 0.85 for all clinical cases while the similarity of the pathway to archetypes was found to be 0.85 ± 0.03, 0.95 ± 0.03, 0.87 ± 0.04 and 0.91 ± 0.02 for the different MRAT types (and p<0.02 for 3 of the 4 groups), and pathway complexity also allowed to discriminate among cases (with p<0.05). CONCLUSIONS We conclude that the presented methodology allows us to differentiate between the most common forms of right and left MRATs and predict the existence and location of a slow conduction zone. This approach may be useful in planning ablation procedures in advance.
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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, Zürich, Switzerland; Department of Bioengineering and Aeroespace Engineering, Universidad Carlos III de Madrid, Madrid, Spain.
| | - Sergio Castrejón
- Unidad de Arritmias y Electrofisiología Robotizada, Hospital Universitario La Paz, IdiPaz, Universidad Autónoma, Madrid, Spain
| | - Marcel Martínez
- Unidad de Arritmias y Electrofisiología Robotizada, Hospital Universitario La Paz, IdiPaz, Universidad Autónoma, Madrid, Spain
| | - Raquel Cervigón
- Escuela Politécnica, Universidad de Castilla la Mancha, Cuenca, Spain
| | - Olivier Meste
- Université Cote d'Azur, CNRS, Lab. I3S, Sophia Antipolis, France
| | - José Luis Merino
- Unidad de Arritmias y Electrofisiología Robotizada, Hospital Universitario La Paz, IdiPaz, Universidad Autónoma, Madrid, Spain
| | - José Millet
- ITACA Institute, Universitat Politècnica de València, Valencia, Spain
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