Novel approaches for mapping-specific rotor ablation in AF
AF is the most common sustained cardiac arrhythmia in humans, and is a prognostic marker for stroke, heart failure and even death. Recent animal and human research have shown that AF may also be maintained by rapid reentry sources (rotors), which can either be localized to a specific spatial location in the atria, or meander around the atria. Catheter ablation is one common treatment approach used to control AF, but it is associated with limited success rates in patients with persistent AF, which is mostly maintained by rotors that are located outside of the pulmonary veins (PV) regions. Currently existing commercial mapping systems cannot accurately identify the rotor location outside of the PV regions in patients with persistent AF. My lab developed several novel signal analysis approaches (multi-scale frequency, multiscale-entropy and Kurtosis) to identify the pivot points of rotors, and validated these approaches using optical mapping experiments in ex-vivo rabbit hearts, where electrical activity can be directly visualized. We also demonstrated that these techniques are accurate under some clinical limitations, such as reduced time duration of the signal and decreased spatial resolution. Further, these techniques can be used for different types of signals, including intracardiac electrograms (iEGMs). The translation of the techniques in clinical settings is important for the future of personalized therapy that will subsequently lead to successful diagnosis and treatment for, essentially, all other arrhythmias.
- Nicholas Tan, Georgios Christopoulos, Thomas P. Ladas, Zhi Jiang, Alan M. Sugrue, Jason A. Tri, Elena G. Tolkacheva, Freddy Del-Carpio Munoz, Christopher J. McLeod, Samuel J. Asirvatham, Christopher V. DeSimone, “Regional and Temporal Variations of Ventricular and Conduction Tissue Activity during Ventricular Fibrillation: Insights from an Experimental Model of Induced Ventricular Fibrillation“, Circulation Arrhythm Electrophysiol. 2021 Oct;14(10):e010281. doi: 10.1161/CIRCEP.121.010281. Epub 2021 Sep 27.
- Ravikumar V, Annoni E, Parthiban P, Zlochiver Sh, Roukoz H, Mulpuru SK, Tolkacheva EG, “Novel mapping techniques for rotor core detection using simulated intracardiac electro grams”, J Cardiovasc Electrophysiol. 2021;1–13., DOI: 10.1111/jce.14948
- Jieun Lee, Yugene Guo, Vasanth Ravikumar, and E.G. Tolkacheva. Towards development of approaches to discriminate AF from NSR using a Single-Lead ECG, Entropy, 2020, 22, 531; doi:10.3390/e220505312020
- Arunachalam SP, Kapa S, Mulpuru KS, Friedman PA, Tolkacheva EG, Improved Multiscale Entropy Technique with Nearest-Neighbor Moving Average Kernel for Non-Linear and Non-stationary Short Time Biomedical Signal Analysis, Journal of Healthcare Engineering, 2017.
- Annoni E.M., Arunachalam S.P., Suraj K., Mulpuru S.K., Friedman P.A., Tolkacheva E.G. Novel quantitative analytical approaches for rotor identification and associated implications for mapping, 2017, TBME, doi:10.1109/TBME.2017.2763460. February 2018 Featured issue.
- Arunachalam S.P., Kapa, S., Mulpuru S.K., Friedman P.A., Tolkacheva E.G. Rotor Pivot Point Identification using Recurrence Period Density Entropy, 2017
- Arunachalam S.P., Mulpuru S.K., Friedman P.A., Tolkacheva E.G.Robust Discrimination of Normal Sinus Rhythm and Atrial Fibrillation on ECG Using a Multiscale Frequency Technique, DMD 2017
- Arunachalam S.P., and Tolkacheva E.G. Intelligent Fractional-Order PID (FOPID) Heart Rate Controller for Cardiac Pacemaker, proceedings of IEEE EMBC 2016.
- Shivaram Poigai Arunachalam, Suraj Kapa, Siva Mulpuru, Paul Friedman, and Elena Tolkacheva. Novel Approaches for Quantitative Electrogram Analysis for Intraprocedural Guidance for Catheter Ablation: A Case of a Patient with Persistent Atrial Fibrillation, Journal of Nuclear Medicine and Biomedical Imaging, 2017, doi: 10.15761/NMBI.1000121
- Arunachalam S.P., Mulpuru S.K., Friedman P.A., Tolkacheva E.G. Rotor pivot point identification with intrinsic mode function complexity index using empirical mode decomposition; 2016 IEEE EMBS ISC; DOI: 10.1109/EMBSISC.2016.7508597
- Arunachalam S.P., Mulpuru S.K., Friedman P.A., Tolkacheva E.G. Kurtosis as a statistical approach to identify the pivot point of the rotor. Proceedings of IEEE conference, 2016, doi: 10.1109/EMBC.2016.7590748.
VIEgram: Visualization of clinical intracardiac electrograms on a patient-specific 3D heart model.
Currently, novel techniques for analyzing intracardiac electrograms (iEGMs) are being developed to identify the atrial fibrillation (AF) maintaining sites. Proprietary electroanatomical mapping systems used in clinics like CARTO (Biosense Webster), EnSite Precision (Abbott), etc., are used for mapping the results of the analysis on a patient's 3D heart model. The constrained access to these mapping systems has had been a hurdle in the development of novel techniques. The open-source platform is developed for mapping the results of the analysis on a patient's 3D heart model. It eliminates the dependency on the proprietary mapping systems thereby making the process of retrospective mapping extremely convenient and time-efficient for academic researchers. The developed software can be used for visual inspection of electrograms and implementing different techniques on extracted iEGM dataset. It allows performing region-wise analysis of atria. Also, CT/MRI based 3D heart model can be integrated with the generated 3D model to incorporate fibrosis and scar data. The ability to visualize novel approaches as 3D maps and their availability help in the development of spatial analysis techniques and region-specific monitoring of Human atria for academicians, thus providing a testing and validation capability prior to clinical implementation.