Comput. Biol. Med. - The dominant morphology of fractionated atrial electrograms has greater temporal stability in persistent as compared with paroxysmal atrial fibrillation.

Tópicos

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Resumo

CKGROUND: Measurements of both the dominant frequency (DF) and the time series morphology of complex fractionated atrial electrograms (CFAE) are useful to distinguish persistent from paroxysmal atrial fibrillation (AF). In this study, an algorithm was devised to extract morphologic components according to frequency, and its usefulness for distinguishing CFAE was shown.METHOD: CFAE of length 16s were obtained at two sites each from the four pulmonary vein ostia (PV), and from anterior and posterior left atrial free wall (FW), in nine paroxysmal and 10 longstanding persistent AF patients. The DF was computed for each of two 8s CFAE segments in each 16s recording. Each CFAE segment was then transformed into a set of basis vectors, which represent electrogram morphology at each frequency. The dominant morphology (DM) is defined as the ensemble average of sequential signal segments, with the segment length equal to the period at the DF. The DMs of the two 8s pairs were correlated. Normalized correlation coefficients were tabulated for all data, and separately for PV and FW. The means and coefficients of variation of the DM correlation coefficients were then plotted, and a linear discriminant function was used to classify persistent versus paroxysmal AF data. For comparison with DM results, CFE-mean and interval confidence level (ICL) were also calculated for persistent versus paroxysmal AF data.RESULTS: Mean correlation of the DM, 1st 8s versus 2nd 8s data, was 0.62+0.22 for persistent versus 0.50+0.19 for paroxysmal CFAE for all recording sites (p<0.001). At single anatomical locations, correlation was greater in persistents than paroxysmals at all sites, but achieved significance only at the left superior (p<0.001) and right superior (p<0.05) PV. Spatial variation in correlation coefficient was greater in paroxysmal than persistent AF (not significant). Using the means of DF correlation coefficients, 17/19 patients were classified correctly. The CFE-mean parameter averaged 89.01?20.99 ms in persistents versus 93.96?33.81 ms in paroxysmals (p<0.05), while ICL averaged 94.54?18.52 deflections/8s for persistents versus 90.70?19.28 deflections/8s for paroxysmals (p<0.05).CONCLUSIONS: In CFAE recordings, the DM parameter was found to have greater temporal morphologic variation in paroxysmal as compared with persistent AF data (p<0.001). In contrast, only moderate significance between paroxysmal versus persistent AF data was found when using the of CFE-mean and ICL parameters (p<0.05). The DM parameter may thus be useful as a new measure to discern both temporal and spatial variations in CFAE in paroxysmal versus persistent AF recordings.

Resumo Limpo

ckground measur domin frequenc df time seri morpholog complex fraction atrial electrogram cfae use distinguish persist paroxysm atrial fibril af studi algorithm devis extract morpholog compon accord frequenc use distinguish cfae shownmethod cfae length s obtain two site four pulmonari vein ostia pv anterior posterior left atrial free wall fw nine paroxysm longstand persist af patient df comput two s cfae segment s record cfae segment transform set basi vector repres electrogram morpholog frequenc domin morpholog dm defin ensembl averag sequenti signal segment segment length equal period df dms two s pair correl normal correl coeffici tabul data separ pv fw mean coeffici variat dm correl coeffici plot linear discrimin function use classifi persist versus paroxysm af data comparison dm result cfemean interv confid level icl also calcul persist versus paroxysm af dataresult mean correl dm st s versus nd s data persist versus paroxysm cfae record site p singl anatom locat correl greater persist paroxysm site achiev signific left superior p right superior p pv spatial variat correl coeffici greater paroxysm persist af signific use mean df correl coeffici patient classifi correct cfemean paramet averag ms persist versus ms paroxysm p icl averag deflectionss persist versus deflectionss paroxysm pconclus cfae record dm paramet found greater tempor morpholog variat paroxysm compar persist af data p contrast moder signific paroxysm versus persist af data found use cfemean icl paramet p dm paramet may thus use new measur discern tempor spatial variat cfae paroxysm versus persist af record

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