TY - JOUR
T1 - Detection of focal source and arrhythmogenic substrate from body surface potentials to guide atrial fibrillation ablation
AU - Feng, Yingjing
AU - Roney, Caroline H.
AU - Bayer, Jason D.
AU - Niederer, Steven A.
AU - Hocini, Mélèze
AU - Vigmond, Edward J.
N1 - Funding Information:
We are grateful for receiving funding from the European Union Horizon 2020 Research and Innovation programme “Personalised In-silico Cardiology (PIC)” under the Marie Skłodowska-Curie grant agreement no. 764738 (https://ec.europa.eu/programmes/horizon2020/) to Y.F. and E.J.V., the French National Research Agency (ANR-10-IAHU-04) (https://anr.fr/en/) to E.J.V., the Medical Research Council Skills Development Fellowship (MR/S015086/1) (https://www.ukri.org/councils/mrc/career-and-skills-development/) to C. H.R., and the European Union Horizon 2020 Research and Innovation programme under the ERA-NET co-fund action no. 680969 with ANR (ERA-CVD SICVALVES grant ANR-19-ECVD-0006) (https://www.era-cvd.eu/256.php) to J.D.B. We thank the support of GENCI computing resources, allocation A0080310517 (https://www.genci.fr/en/) to Y.F., J.D.B. and E.J.V. The funders did not participate in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Publisher Copyright:
Copyright: © 2022 Feng et al.
PY - 2022/3
Y1 - 2022/3
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85126951999&partnerID=8YFLogxK
U2 - 10.1371/journal.pcbi.1009893
DO - 10.1371/journal.pcbi.1009893
M3 - Article
C2 - 35312675
AN - SCOPUS:85126951999
SN - 1553-734X
VL - 18
JO - PLoS Computational Biology
JF - PLoS Computational Biology
IS - 3
M1 - e1009893
ER -