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Localizing Atrial Flutter Circuit Using Variability in the Vectorcardiographic Loop Parameters

Abstract : Atrial flutter circuit localization is usually determined during a catheter ablation procedure. Knowledge of this information beforehand could aid clinicians assess and plan the operation in advance to improve efficacy. Variability as a marker to discriminate localization non-invasively was suggested in the literature, and evaluated by one group. However, variability may originate from respiratory motion which may affect right and left AFL differently. This is hypothesized to be the reason for difference in right and left AFL variability. To address this, we analyzed the effect of removing respiratory motion influence from f wave observations on classification accuracy. ECG records from patients with AFL were processed using a novel approach: respiratory motion was estimated and removed in order to recover variability intrinsic to AFL. Vectorcardiographic loop parameters were estimated from each observation and statistical measures of the set of parameter values were calculated before being fed into a classification algorithm. The results show that f waves are negligibly affected by respiratory motion. It is also possible to discriminate circuit localization with good accuracy. 1. Introduction Knowledge of the characteristics of macro-reentrant tachyarrhythmia is crucial for a successful and quality catheter ablation: an increasingly popular treatment today, targeted towards atrial fibrillation and atrial flutter (AF and AFL). This information, however, is accessible only during the procedure itself. In the case of AFL, one significant information is the localization of the circuit: either the left or right atrium. The ability to estimate circuit localization prior to the procedure could aid clinicians in pre-operative assessment and planning in order to improve procedural efficacy. The most common form of AFL is called typical AFL, associated with several stereotypic characteristics (right atrial localization and passage by a set of stable, well-defined obstacles). Atypical AFL is defined as any circuit that do not match one or either of the criteria. Both forms are observable via the electrocardiogram (ECG), allowing for a non-invasive analysis and estimation of the characteristics. As a result, information regarding the pathology can be made available without additional invasive operations. It was found that spatiotemporal coherence can predict a left localization with 84% sensitivity and 75% specificity [1]. Many other studies suggest its association with lower atrial activity regularity, and hence larger variability. On the other hand, respiratory motion affects the ECG signal by shifting the electrical axis of the cardiac dipole. This is introduces artificial variability and it may be a reason why discrimination between right and left AFL was possible: consider the different location of the right and left atrium in the thoracic cavity. Right AFL may be affected differently than left AFL. If this variability is the origin of the difference between right and left AFL variability, then if removed, we expect right and left AFL to present similar variability, and hence cannot be discriminated. If it is not the origin of the difference, then removing its contribution may affect right and left AFL variability, but discrimination could still be done reliably. We aim to test this hypothesis by employing several novel approaches.
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Contributor : Olivier Meste <>
Submitted on : Saturday, October 13, 2018 - 10:21:35 AM
Last modification on : Wednesday, October 14, 2020 - 4:23:03 AM
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  • HAL Id : hal-01883582, version 2



Muhammad Haziq Azman, Olivier Meste, Kushsairy Kadir, Decebal Gabriel Latcu. Localizing Atrial Flutter Circuit Using Variability in the Vectorcardiographic Loop Parameters. Computing in Cardiology, Sep 2018, Maastricht, Netherlands. ⟨hal-01883582v2⟩



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