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- Saiz-Vivó, Javier, et al.
(författare)
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Atrial fibrillation episode patterns as predictor of clinical outcome of catheter ablation
- 2023
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Ingår i: Medical and Biological Engineering and Computing. - : Springer Science and Business Media LLC. - 0140-0118 .- 1741-0444. ; 61:2, s. 317-327
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Tidskriftsartikel (refereegranskat)abstract
- Methods for characterization of atrial fibrillation (AF) episode patterns have been introduced without establishing clinical significance. This study investigates, for the first time, whether post-ablation recurrence of AF can be predicted by evaluating episode patterns. The dataset comprises of 54 patients (age 56 ± 11 years; 67% men), with an implantable cardiac monitor, before undergoing the first AF catheter ablation. Two parameters of the alternating bivariate Hawkes model were used to characterize the pattern: AF dominance during the monitoring period (log(mu)) and temporal aggregation of episodes (beta1). Moreover, AF burden and AF density, a parameter characterizing aggregation of AF burden, were studied. The four parameters were computed from an average of 29 AF episodes before ablation. The risk of AF recurrence after catheter ablation using the Hawkes parameters log(mu) and beta1, AF burden, and AF density was evaluated. While the combination of AF burden and AF density is related to a non-significant hazard ratio, the combination of log(mu) and beta1 is related to a hazard ratio of 1.95 (1.03–3.70; p < 0.05). The Hawkes parameters showed increased risk of AF recurrence within 1 year after the procedure for patients with high AF dominance and high episode aggregation and may be used for pre-ablation risk assessment.
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| 2. |
- Saiz-Vivo, Javier, et al.
(författare)
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Heart rate characteristic based modelling of atrial fibrillatory rate using implanted cardiac monitor data
- 2023
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Ingår i: Physiological Measurement. - : IOP Publishing. - 0967-3334 .- 1361-6579. ; 44:3
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The objective of the present study is to investigate the feasibility of using heart rate characteristics to estimate atrial fibrillatory rate (AFR) in a cohort of atrial fibrillation (AF) patients continuously monitored with an implantable cardiac monitor (ICM). We will use a mixed model approach to investigate population effect and patient specific effects of heart rate characteristics on AFR, and will correct for the effect of previous ablations, episode duration, and onset date and time.APPROACH: The f-wave signals, from which AFR is estimated, were extracted using a QRST cancellation process of the AF episodes in a cohort of 99 patients (67% male; 57±12 years) monitored for 9.2(0.2-24.3) months as median(min-max). The AFR from 2453 f-wave signals included in the analysis was estimated using a model-based approach. The association between AFR and heart rate characteristics, prior ablations, and episode-related features were modelled using fixed-effect and mixed-effect modelling approaches.MAIN RESULTS: The mixed-effect models had a better fit to the data than fixed-effect models showing higher coefficients of determination (R2=0.49 vs R2=0.04) when relating the variations of AFR to the heart rate features. However, when correcting for the other factors, the mixed-effect model showed the best fit (R2=0.56). AFR was found to be significantly affected by previous catheter ablations (p<0.05), episode duration (p<0.05), and irregularity of the RR interval series (p<0.05).SIGNIFICANCE: Mixed-effect models are more suitable for AFR modelling. AFR was shown to be faster in episodes with longer duration, less organized RR intervals and after several ablation procedures.
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