Andréa Buttu

Sleep Apnea Detection using Features from the Respiration and the ECG recorded with Smart-Shirts

The automatic detection of sleep apnea episodes, without the need of polysomnography and outside a clinical facility, could help facilitate the diagnosis of this disorder. In this work, features to detect sleep apnea events were computed from respiration and electrocardiogram recordings acquired with a wearable smart-shirt. First, a classical scheme exploiting the amplitude decrease of the respiration during apnea episodes was presented. Second, a novel measure of the phase coupling between the respiration and the respiratory sinus arrhythmia from the ECG was introduced. It was shown that these features were significantly different during sleep apnea episodes than for normal breathing.

Nonlinear analysis of right atrial electrograms predicts termination of persistent atrial fibrillation within the left atrium by catheter ablation

The termination of long-standing persistent atrial fibrillation (LS-pAF) can be achieved by stepwise catheter ablation (step-CA) within the left atrium (LA). Our study aims to applying complexity measures derived from nonlinear time series analysis in order to characterize LS-pAF in terms of organization and to identify patients in whom AF can be terminated from those in whom AF cannot be terminated by step-CA within the LA. A total of 33 consecutive patients (age 61  ±  7 years, sustained AF duration 19  ±  11 months) with LS-pAF underwent step-CA. The organization of right bipolar electrograms before and during the ablation procedure was assessed using the coarse-grained correlation dimension. LS-pAF was terminated into sinus rhythm or atrial tachycardia in 22 patients during step-CA within the LA (left terminated patients-LT). In 11 patients the ablation procedure failed to terminate AF within LA (not left terminated patients-NLT). The statistical analysis of the estimated coarse-grained correlation dimension revealed that a higher right atrial (RA) organization before step-CA was associated to AF termination within the LA. During the ablation procedure, the level of RA organization displayed distinctive evolution between LT and NLT patients with a significant organization increase before AF termination for the LT patients.

Extracting atrial activations from intracardiac signals during atrial fibrillation using adaptive mathematical morphology

The detection of intracardiac activities is a major issue in the processing of atrial fibrillation signals. we evaluate a method based on mathematical morphology with an adaptive structuring element in order to extract the atrial activations from intracardiac electrograms. The structuring element is continuously updated for each activation based on the morphological characteristics of the previously detected activations. A dataset of recordings from patients with chronic atrial fibrillation who underwent catheter ablation were used in order to evaluate the performance of the proposed method. Results show high performance compared to a dataset manually annotated by an expert. The detection rate, sensitivity and positive prediction value (PPV) were respectively 99.1%, 99.5%, 99.5%. The proposed method is fast and offers low computational cost, which makes it a suitable approach for real-time/online scenarios.

Divergent patterns of atrial ECG organization during catheter ablation of persistent atrial fibrillation revealed by adaptive harmonic frequency schemes

Introduction: We hypothesized that organization indices based on the analysis of atrial ECG harmonic components may help identify patients (pts) with persistent AF (pAF) unresponsive to pulmonary vein isolation (PVI) and left atrial (LA) ablation. Using adaptive harmonic frequency tracking schemes, we computed on the atrial ECG: 1) the variance of the phase difference (aPD) between the dominant frequency (DF) and the 1st harmonic (H1), and 2) the organization index (AOI) defined as the ratio of the power of the DF and H1 over the total power of the unprocessed atrial signal as measures of AF regularity. Methods: In 34 consecutive pts (61±7 y, pAF duration: 19±11 m), PVI and LA ablation were performed until AF termination. 40-sec ECG time series devoid of QRST were recorded at baseline (BL), after PVI (end_PVI) and at the end of LA ablation (end_ABL). APD and AOI were estimated on leads V1 and V6b (placed on the pts back). Results: pAF was terminated within the LA in 68% (23/34 LT - left terminated) of the pts, while 32% (11/34 NLT - not left terminated) did not. The figure shows that: 1) LT pts displayed higher AOI values at BL indicative of greater atrial ECG organization that increased significantly (p<0.05 for V1 and V6b) during LA ablation as opposed to NLT pts, and 2) NLT pts displayed higher APD values at BL indicative of greater atrial ECG disorganization that decreased during LA ablation, but did not reach LT pts values. Conclusion: Estimation of the level of organization of atrial ECG based on adaptive harmonic schemes appears as promising tools for the measure of pAF complexity and prediction of procedural outcome.