Nonlinear analysis of the ECG during atrial fibrillation in patients for low energy internal cardioversion

J Diaz; C Gonzalez; OJ Escalona; BM Glover; G Manoharan

Nonlinear analysis of the ECG during atrial fibrillation in patients for low energy internal cardioversion

J Diaz, C Gonzalez, OJ Escalona, BM Glover, G Manoharan

Research output: Chapter in Book/Report/Conference proceeding › Conference contribution › peer-review

Abstract

The goal of this study was to investigate the usefulness of nonlinear analysis in determining the success of low energy internal cardioversion (IC) in patients with atrial fibrillation (AF). Nonlinear analysis has previously been used for characterizing AF patterns, and spontaneous termination in its paroxysmal form. However, the relationship between the probability to restore sinus rhythm by IC and quantitative nonlinear analysis based electrocardiographic (ECG) markers has not been explored before. Thirty nine patients with AF, for elective DC cardioversion at the Royal Victoria Hospital in Belfast, were included in this study. One catheter was positioned in the right atrial appendage and another in the coronary sinus, to deliver a biphasic shock waveform. A voltage step-up protocol (50-300 V) was used for patient cardioversion. Residual atrial fibrillatory signal (RAFS) was derived from 60 seconds of surface ECG from defibrillator pads, prior to shock delivery, by bandpass filtering and ventricular activity (QRST) cancellation. QRST complexes were cancelled using a recursive least squared (RLS) adaptive filter. The maximal Lyapunov exponent (lambda), correlation dimension (course grained estimation, CDcg) and approximate entropy (ApEn) were extracted from the RAFS. These variables were calculated from 10 s of the RAFS before shock delivery. 26 patients were successfully cardioverted, employing a maximum energy of 11.84 joules. A lower lambda (0.037 +/- 0.006 vs. 0.044 +/- 0.008, P=0.01) and CDcg (5.552 +/- 2.075 vs. 6.592 +/- 1.130, P=0.049) were found in successfully cardioverted patients than in those non successful ones, with an energy <= 3 joules. Also, there was a significant positive correlation between the minimal defibrillation energy and lambda (p=0.483, P=0.013) in cardioverted patients. In conclusion, complexity analysis of the RAFS is useful for assessing the prospective efficacy of internal low energy cardioversion of patients with atria! fibrillation.

Original language	English
Title of host publication	Unknown Host Publication
Pages	1619-1622
Number of pages	4
Publication status	Published (in print/issue) - 2008
Event	2008 30TH ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY, VOLS 1-8 - Vancouver, Canada. Duration: 1 Jan 2008 → …

Publication series

Name	IEEE Engineering in Medicine and Biology Society Conference Proceedings

Conference

Conference	2008 30TH ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY, VOLS 1-8
Period	1/01/08 → …

Bibliographical note

30th Annual International Conference of the IEEE-Engineering-in-Medicine-and-Biology-Society, Vancouver, CANADA,
AUG 20-24, 2008

Keywords

atrial defibrillation
ECG frequency analysis
cardioversion
QRS cancelation
atrial fibrillatory frequency.

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@inproceedings{4a23552628054359b8b305bdc8ac69d5,

title = "Nonlinear analysis of the ECG during atrial fibrillation in patients for low energy internal cardioversion",

abstract = "The goal of this study was to investigate the usefulness of nonlinear analysis in determining the success of low energy internal cardioversion (IC) in patients with atrial fibrillation (AF). Nonlinear analysis has previously been used for characterizing AF patterns, and spontaneous termination in its paroxysmal form. However, the relationship between the probability to restore sinus rhythm by IC and quantitative nonlinear analysis based electrocardiographic (ECG) markers has not been explored before. Thirty nine patients with AF, for elective DC cardioversion at the Royal Victoria Hospital in Belfast, were included in this study. One catheter was positioned in the right atrial appendage and another in the coronary sinus, to deliver a biphasic shock waveform. A voltage step-up protocol (50-300 V) was used for patient cardioversion. Residual atrial fibrillatory signal (RAFS) was derived from 60 seconds of surface ECG from defibrillator pads, prior to shock delivery, by bandpass filtering and ventricular activity (QRST) cancellation. QRST complexes were cancelled using a recursive least squared (RLS) adaptive filter. The maximal Lyapunov exponent (lambda), correlation dimension (course grained estimation, CDcg) and approximate entropy (ApEn) were extracted from the RAFS. These variables were calculated from 10 s of the RAFS before shock delivery. 26 patients were successfully cardioverted, employing a maximum energy of 11.84 joules. A lower lambda (0.037 +/- 0.006 vs. 0.044 +/- 0.008, P=0.01) and CDcg (5.552 +/- 2.075 vs. 6.592 +/- 1.130, P=0.049) were found in successfully cardioverted patients than in those non successful ones, with an energy <= 3 joules. Also, there was a significant positive correlation between the minimal defibrillation energy and lambda (p=0.483, P=0.013) in cardioverted patients. In conclusion, complexity analysis of the RAFS is useful for assessing the prospective efficacy of internal low energy cardioversion of patients with atria! fibrillation.",

keywords = "atrial defibrillation, ECG frequency analysis, cardioversion, QRS cancelation, atrial fibrillatory frequency.",

author = "J Diaz and C Gonzalez and OJ Escalona and BM Glover and G Manoharan",

note = "30th Annual International Conference of the IEEE-Engineering-in-Medicine-and-Biology-Society, Vancouver, CANADA, AUG 20-24, 2008; 2008 30TH ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY, VOLS 1-8 ; Conference date: 01-01-2008",

year = "2008",

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series = "IEEE Engineering in Medicine and Biology Society Conference Proceedings",

pages = "1619--1622",

booktitle = "Unknown Host Publication",

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Diaz, J, Gonzalez, C, Escalona, OJ, Glover, BM & Manoharan, G 2008, Nonlinear analysis of the ECG during atrial fibrillation in patients for low energy internal cardioversion. in Unknown Host Publication. IEEE Engineering in Medicine and Biology Society Conference Proceedings, pp. 1619-1622, 2008 30TH ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY, VOLS 1-8, 1/01/08. <http://uir.ulster.ac.uk/6011/1/EMBS2008_JDIAZ_paper.pdf>

Nonlinear analysis of the ECG during atrial fibrillation in patients for low energy internal cardioversion. / Diaz, J; Gonzalez, C; Escalona, OJ et al.
Unknown Host Publication. 2008. p. 1619-1622 (IEEE Engineering in Medicine and Biology Society Conference Proceedings).

Research output: Chapter in Book/Report/Conference proceeding › Conference contribution › peer-review

TY - GEN

T1 - Nonlinear analysis of the ECG during atrial fibrillation in patients for low energy internal cardioversion

AU - Diaz, J

AU - Gonzalez, C

AU - Escalona, OJ

AU - Glover, BM

AU - Manoharan, G

N1 - 30th Annual International Conference of the IEEE-Engineering-in-Medicine-and-Biology-Society, Vancouver, CANADA, AUG 20-24, 2008

PY - 2008

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N2 - The goal of this study was to investigate the usefulness of nonlinear analysis in determining the success of low energy internal cardioversion (IC) in patients with atrial fibrillation (AF). Nonlinear analysis has previously been used for characterizing AF patterns, and spontaneous termination in its paroxysmal form. However, the relationship between the probability to restore sinus rhythm by IC and quantitative nonlinear analysis based electrocardiographic (ECG) markers has not been explored before. Thirty nine patients with AF, for elective DC cardioversion at the Royal Victoria Hospital in Belfast, were included in this study. One catheter was positioned in the right atrial appendage and another in the coronary sinus, to deliver a biphasic shock waveform. A voltage step-up protocol (50-300 V) was used for patient cardioversion. Residual atrial fibrillatory signal (RAFS) was derived from 60 seconds of surface ECG from defibrillator pads, prior to shock delivery, by bandpass filtering and ventricular activity (QRST) cancellation. QRST complexes were cancelled using a recursive least squared (RLS) adaptive filter. The maximal Lyapunov exponent (lambda), correlation dimension (course grained estimation, CDcg) and approximate entropy (ApEn) were extracted from the RAFS. These variables were calculated from 10 s of the RAFS before shock delivery. 26 patients were successfully cardioverted, employing a maximum energy of 11.84 joules. A lower lambda (0.037 +/- 0.006 vs. 0.044 +/- 0.008, P=0.01) and CDcg (5.552 +/- 2.075 vs. 6.592 +/- 1.130, P=0.049) were found in successfully cardioverted patients than in those non successful ones, with an energy <= 3 joules. Also, there was a significant positive correlation between the minimal defibrillation energy and lambda (p=0.483, P=0.013) in cardioverted patients. In conclusion, complexity analysis of the RAFS is useful for assessing the prospective efficacy of internal low energy cardioversion of patients with atria! fibrillation.

AB - The goal of this study was to investigate the usefulness of nonlinear analysis in determining the success of low energy internal cardioversion (IC) in patients with atrial fibrillation (AF). Nonlinear analysis has previously been used for characterizing AF patterns, and spontaneous termination in its paroxysmal form. However, the relationship between the probability to restore sinus rhythm by IC and quantitative nonlinear analysis based electrocardiographic (ECG) markers has not been explored before. Thirty nine patients with AF, for elective DC cardioversion at the Royal Victoria Hospital in Belfast, were included in this study. One catheter was positioned in the right atrial appendage and another in the coronary sinus, to deliver a biphasic shock waveform. A voltage step-up protocol (50-300 V) was used for patient cardioversion. Residual atrial fibrillatory signal (RAFS) was derived from 60 seconds of surface ECG from defibrillator pads, prior to shock delivery, by bandpass filtering and ventricular activity (QRST) cancellation. QRST complexes were cancelled using a recursive least squared (RLS) adaptive filter. The maximal Lyapunov exponent (lambda), correlation dimension (course grained estimation, CDcg) and approximate entropy (ApEn) were extracted from the RAFS. These variables were calculated from 10 s of the RAFS before shock delivery. 26 patients were successfully cardioverted, employing a maximum energy of 11.84 joules. A lower lambda (0.037 +/- 0.006 vs. 0.044 +/- 0.008, P=0.01) and CDcg (5.552 +/- 2.075 vs. 6.592 +/- 1.130, P=0.049) were found in successfully cardioverted patients than in those non successful ones, with an energy <= 3 joules. Also, there was a significant positive correlation between the minimal defibrillation energy and lambda (p=0.483, P=0.013) in cardioverted patients. In conclusion, complexity analysis of the RAFS is useful for assessing the prospective efficacy of internal low energy cardioversion of patients with atria! fibrillation.

KW - atrial defibrillation

KW - ECG frequency analysis

KW - cardioversion

KW - QRS cancelation

KW - atrial fibrillatory frequency.

M3 - Conference contribution

T3 - IEEE Engineering in Medicine and Biology Society Conference Proceedings

SP - 1619

EP - 1622

BT - Unknown Host Publication

T2 - 2008 30TH ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY, VOLS 1-8

Y2 - 1 January 2008

ER -

Nonlinear analysis of the ECG during atrial fibrillation in patients for low energy internal cardioversion

Abstract

Publication series

Conference

Bibliographical note

Keywords

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