Atrial fibrillation fingerprinting

Research output: ThesisDissertation (TU Delft)

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Abstract

Atrial fibrillation (AF) is a common age-related cardiac arrhythmia. AF is characterized by rapid and irregular electrical activity of the heart leading to a higher risk of stroke and heart failure. During AF, the upper chambers of the heart, called atria, experience chaotic electrical wave propagation. However, despite the various mechanisms introduced in the literature, there is still an ongoing debate on a precise and consistent mechanism underlying the initiation and perpetuation of AF. Some studies show that AF is rooted in impaired electrical conduction and structural damage of atrial tissue, known as electropathology. Atrial electrograms (EGMs) recorded directly from heart’s surface, provide an important diagnostic tool to localize and quantify the degree of electropathology in the tissue. However, the analysis of the electrograms is currently constrained by the lack of suitable methods that can reveal the hidden electrophysiological parameters of the tissue. These parameters can be used as local indication of electropathology in the tissue. We believe that understanding AF and improving AF therapy starts with developing a proper forward model that is accurate enough (from a physiological point of view) and simultaneously simple enough to allow for subsequent parameter estimation. Therefore, the main focus of this thesis is on developing a simplified forward model that can efficiently explain the observed EGM based on AF relevant tissue parameters. An initial step before performing any analysis on the data is to remove noise and artefacts. All atrial electrogram recordings suffer from strong far-field ventricular activities (VA). Therefore, as the first step, we propose a new framework for removal of VA from atrial electrograms, which is based on interpolation and subtraction followed by low-rank and sparse matrix decomposition. The proposed framework is of low complexity, does not require high resolution multi-channel recordings, or a calibration step for each individual patient. In the next step, we develop a simplified electrogram model. We represent the model in a compact matrix form and show its linear dependence on the conductivity vector, enabling the estimation of this parameter from the recorded electrograms. The results show that despite the low resolution and all simplifying assumptions, the model can efficiently estimate the conductivity map and regenerate realistic electrograms, especially during sinus rhythm. In the next contribution of this dissertation, we propose a new approach for a better estimation of local activation times for atrial mapping by reducing the spatial blurring effect that is inherent to electrogram recordings using deconvolution. Employing sparsity based regularization and first-order time derivatives in formulating the deconvolution problem, improved performance of transmembrane current estimation is obtained. In the final part, we focus on translating our findings from research to clinical application. Therefore, we studied the effect of electrode size on electrogram properties including the length of the block line observed on the resulting activation map, percentage of observed low voltage areas, percentage of electrograms with low maximum steepness, and the number of deflections in the recorded electrograms.
Original languageEnglish
Awarding Institution
  • Delft University of Technology
Supervisors/Advisors
  • Hendriks, R.C., Supervisor
  • van der Veen, A.J., Supervisor
  • de Groot, N.M.S., Supervisor
Award date27 Oct 2021
Print ISBNs978-94-6384-260-0
DOIs
Publication statusPublished - 2021

Keywords

  • atrial fibrillation
  • atrial electrograms
  • atrial mapping
  • fractionation
  • local activation time estimation
  • electrogram model
  • transmembrane current
  • conductivity estimation
  • electrophysiological model
  • inverse problem
  • reaction-diffusion equation
  • deconvolution
  • electrode size
  • electrogram morphology
  • activation map
  • electrogram interpolation

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