Minimizing discordances in automated classification of fractionated electrograms in human persistent atrial fibrillation

Almeida, T.P., Chu, G.S., Salinet, J.L., Vanheusden, F.J. ORCID: 0000-0003-2369-6189, Li, X., Tuan, J.H., Stafford, P.J., Ng, G.A. and Schlindwein, F.S., 2016. Minimizing discordances in automated classification of fractionated electrograms in human persistent atrial fibrillation. Medical & Biological Engineering & Computing, 54 (11), pp. 1695-1706. ISSN 0140-0118

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Abstract

Ablation of persistent atrial fibrillation (persAF) targeting complex fractionated atrial electrograms (CFAEs) detected by automated algorithms has produced conflicting outcomes in previous electrophysiological studies. We hypothesize that the differences in these algorithms could lead to discordant CFAE classifications by the available mapping systems, giving rise to potential disparities in CFAE-guided ablation. This study reports the results of a head-to-head comparison of CFAE detection performed by NavX (St. Jude Medical) versus CARTO (Biosense Webster) on the same bipolar electrogram data (797 electrograms) from 18 persAF patients. We propose revised thresholds for both primary and complementary indices to minimize the differences in CFAE classification performed by either system. Using the default thresholds [NavX: CFEMean ≤ 120 ms; CARTO: ICL ≥ 7], NavX classified 70 % of the electrograms as CFAEs, while CARTO detected 36 % (Cohen’s kappa κ ≈ 0.3, P < 0.0001). Using revised thresholds found using receiver operating characteristic curves [NavX: CFE-Mean ≤ 84 ms, CFE-SD ≤ 47 ms; CARTO: ICL ≥ 4, ACI ≤ 82 ms, SCI ≤ 58 ms], NavX classified 45 %, while CARTO detected 42 % (κ ≈ 0.5, P < 0.0001). Our results show that CFAE target identification is dependent on the system and thresholds used by the electrophysiological study. The thresholds found in this work counterbalance the differences in automated CFAE classification performed by each system. This could facilitate comparisons of CFAE ablation outcomes guided by either NavX or CARTO in future works.

Item Type: Journal article
Publication Title: Medical & Biological Engineering & Computing
Creators: Almeida, T.P., Chu, G.S., Salinet, J.L., Vanheusden, F.J., Li, X., Tuan, J.H., Stafford, P.J., Ng, G.A. and Schlindwein, F.S.
Publisher: Springer
Date: November 2016
Volume: 54
Number: 11
ISSN: 0140-0118
Identifiers:
NumberType
10.1007/s11517-016-1456-2DOI
1456Publisher Item Identifier
Rights: This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Divisions: Schools > School of Science and Technology
Depositing User: Jill Tomkinson
Date Added: 28 Nov 2018 15:54
Last Modified: 28 Nov 2018 15:54
URI: http://irep.ntu.ac.uk/id/eprint/35158

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