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Computer assisted characterization of rapid repetitive electrical activations in the pulmonary veins during atrial fibrillation

Lookup NU author(s): Dr Philip Langley, Dr Daniel Raine, Dr Stephen Furniss, Dr John Bourke, Emeritus Professor Alan MurrayORCiD


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Our group has described previously the identification of arrhythmogenic pulmonary veins by rapid local electrical activations during atrial fibrillation. We have now investigated an algorithm for automated computer detection of this phenomenon from catheter electrodes in the upper pulmonary veins and assessed its performance in identifying arrhymogenic veins. Ten patients with persistent atrial fibrillation scheduled for pulmonary vein isolation at this hospital were studied. Electrogram recordings in the upper pulmonary veins were recorded and analyzed. Arrhythmogenic veins were identified by focal activity during sinus rhythm at electrophysiological studies. Recordings were visually assessed by a cardiologist for the presence of rapid repetitive electrical activations during atrial fibrillation. An index of rapid repetitive electrical activity (RREA index), the ratio of the number of activations with cycle lengths in the range 50 ms to 100 ms to the number of activations with cycle lengths in the range 100 ms to 200 ms, was devised to describe the extent of such activity automatically. The index was assessed as a predictor of arrhythmogenic veins. Electrograms from 19 upper pulmonary veins were recorded. Rapid activity was evident in 15 veins by visual manual assessment. The mean (range) automatic RREA index was 0.07 (0 to 0.16) for those identified as having no such activity manually, and 0.83 (0.22 to 1.68) for those identified with rapid activity (p < 0.0001). With a threshold of RREA index in the range 0.17 to 0.21, the identification of veins with rapid firing was exactly the same as for manual assessment. Eleven upper pulmonary veins were identified as arrhythmogenic during electrophysiological study, and the identification of these veins by both manual and automatic assessment of rapid repetitive electrical activations gave a sensitivity of 100% (11/11) and specificity of 50% (4/8). A technique for automatic characterization of electrogram. cycle length has been demonstrated and could be used online as a tool for identifying candidate sites for pulmonary vein isolation in patients despite persistent atrial fibrillation.

Publication metadata

Author(s): Langley P, O'Donnell D, Raine D, Furniss SS, Bourke JP, Murray A

Publication type: Conference Proceedings (inc. Abstract)

Publication status: Published

Conference Name: International Journal of Bifurcation and Chaos in Applied Sciences and Engineering: Meeting on Virtual Tissue Engineering of the Heart

Year of Conference: 2003

Pages: 3657-3663

ISSN: 0218-1274

Publisher: World Scientific Publishing Co. Pte. Ltd.

Library holdings: Search Newcastle University Library for this item

ISBN: 17936551