Non-Invasive and Quantitative Estimation of Left Atrial Fibrosis Based on P Waves of the 12-Lead ECG—A Large-Scale Computational Study Covering Anatomical Variability
Abstract
:1. Introduction
2. Materials and Methods
2.1. Database
2.2. Modeling Methodology of Fibrotic Tissue
2.3. Electrophysiological Simulations
2.4. ECG Analysis and Feature Extraction
2.5. Regression Using Neural Networks
3. Results
3.1. Influence of Geometries, Rotation Angles and Electrode Positions on P wave Features
3.2. Effect of the Fibrotic LA Volume Fraction on P Wave Features
3.3. Estimating the Amount of Fibrosis with Neural Networks
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
AF | atrial fibrillation |
AR | anisotropy ratio |
CV | conduction velocity |
ECG | electrocardiogram |
FAM | fibrotic atrial cardiomyopathy |
LA | left atrium |
LAT | local activation time |
MRI | magnetic resonance imaging |
NN | neural network |
PTF V1 | P wave terminal force in lead V1 |
PWD | P wave duration |
RMSE | root mean square error |
SR | sinus rhythm |
Appendix A. Calculation of the PWD
References
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Utah Stage | Fibrotic LA Volume Fraction | Fibrotic RA Volume Fraction |
---|---|---|
Utah I | 0–5% | 1.27 ± 0.38% |
Utah II | 5–20% | 4.65 ± 0.70% |
Utah III | 20–35% | 9.40 ± 2.16% |
Utah IV | >35% | 12.66 ± 3.0% |
Tissue Region | CV in m/s | Anisotropy Ratio (AR) |
---|---|---|
Bulk right and left atrium | 0.591 | 2.090 |
Crista terminalis | 0.591 | 2.843 |
Pectinate muscles | 0.461 | 3.780 |
Inter-atrial connections | 0.645 | 3.339 |
Inferior isthmus | 0.540 | 1 |
Fibrosis (non-conductive) | 0 | NA |
Fibrosis (slow conducting) | 0.2 × CV | 2.5 × AR |
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Nagel, C.; Luongo, G.; Azzolin, L.; Schuler, S.; Dössel, O.; Loewe, A. Non-Invasive and Quantitative Estimation of Left Atrial Fibrosis Based on P Waves of the 12-Lead ECG—A Large-Scale Computational Study Covering Anatomical Variability. J. Clin. Med. 2021, 10, 1797. https://doi.org/10.3390/jcm10081797
Nagel C, Luongo G, Azzolin L, Schuler S, Dössel O, Loewe A. Non-Invasive and Quantitative Estimation of Left Atrial Fibrosis Based on P Waves of the 12-Lead ECG—A Large-Scale Computational Study Covering Anatomical Variability. Journal of Clinical Medicine. 2021; 10(8):1797. https://doi.org/10.3390/jcm10081797
Chicago/Turabian StyleNagel, Claudia, Giorgio Luongo, Luca Azzolin, Steffen Schuler, Olaf Dössel, and Axel Loewe. 2021. "Non-Invasive and Quantitative Estimation of Left Atrial Fibrosis Based on P Waves of the 12-Lead ECG—A Large-Scale Computational Study Covering Anatomical Variability" Journal of Clinical Medicine 10, no. 8: 1797. https://doi.org/10.3390/jcm10081797