An Atrioventricular Node Model for Analysis of the Ventricular Response During Atrial Fibrillation

Corino, Valentina D. A.; Sandberg, Frida; Mainardi, Luca; Sörnmo, Leif

doi:10.1109/tbme.2011.2166262

Cited by 44 publications

(32 citation statements)

References 39 publications

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“…14 Several studies have demonstrated the association between higher heart rate and high frequent stimulation of autonomic nerves by the atrioventricular node. [15][16][17] This process may cause downregulation of ion channels located in the atrioventricular node. Moreover, sympathetic tone can also be activated by AF, but such an effect would be attenuated in the case of frequent AF episodes due to habituation.…”

Section: Clinical Factors For Distinction Of Pafmentioning

confidence: 99%

“…Moreover, sympathetic tone can also be activated by AF, but such an effect would be attenuated in the case of frequent AF episodes due to habituation. 15 Second, permanent and long-lasting AF will result in an increase in LA pressure and wall stress. Atrial hypertrophy, fibrosis, and mal-expression of gap junction are also caused by the structural remodeling in AF.…”

Section: Clinical Factors For Distinction Of Pafmentioning

confidence: 99%

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Novel Scoring System for Distinction Between Paroxysmal and Non-Paroxysmal Atrial Fibrillation

Oikawa

Niwano

Fukaya

et al. 2017

Circ J

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Background: Distinction of paroxysmal atrial fibrillation (PAF) from non-PAF is important in clinical practice, but this is often difficult at the time of first documented AF. Given that fibrillation cycle length (FCL) is longer in PAF than in non-PAF, the aim of this study was to compare various clinical parameters including FCL to establish a scoring system to distinguish PAF and non-PAF. Methods and Results:The subjects consisted of 382 consecutive patients with AF on digital ECG at the present institute between 2008 and 2011. They were divided into PAF and non-PAF groups according to the following clinical course. Propensity score matching yielded 88 matched patient pairs with similar mean age and gender between the 2 groups. FCL was evaluated using customized fibrillation wave analyzer with fast Fourier transform analysis. On multivariate analysis, higher HR, longer FCL, and smaller LAD were independent predictors of PAF. For the scoring, cut-offs for each parameter were determined according to highest sensitivity and specificity on the ROC curves, and 1 point assigned for each parameter. Using this scoring system, 2 points detected PAF with 64% sensitivity and 84% specificity. Conclusions:We propose a scoring system including FCL to distinguish PAF from non-PAF. Further studies are needed to validate the results.

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Section: Clinical Factors For Distinction Of Pafmentioning

confidence: 99%

Section: Clinical Factors For Distinction Of Pafmentioning

confidence: 99%

Novel Scoring System for Distinction Between Paroxysmal and Non-Paroxysmal Atrial Fibrillation

Oikawa

Niwano

Fukaya

et al. 2017

Circ J

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“…In our model [2][3][4], the AV node is treated as a lumped structure which accounts for concealed conduction, relative refractoriness, and dual AV nodal pathways. Atrial impulses are assumed to arrive to the AV node according to a Poisson process with mean arrival rate λ.…”

Section: Modelmentioning

confidence: 99%

“…We have previously proposed a model-based approach for joint analysis of atrial and ventricular activity in the ECG during AF [2][3][4]. The method is based on a functional model of the AV node where the model parameters reflects SP and FP refractoriness.…”

Section: Introductionmentioning

confidence: 99%

Preliminary Results from Clinical Validation Study of a Method for Non-Invasive Assessment of Atrioventricular Node Refractoriness During Atrial Fibrillation

Sandberg

Corino

Sörnmo

et al. 2017

Computing in Cardiology Conference (CinC)

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The purpose of this study is to evaluate our previously proposed model-based, non-invasive approach to assess atrioventricular (AV) node refractory periods during atrial fibrillation (AF) by comparing its estimates to the invasively assessed AV node refractory periods. Patients referred to the hospital for pulmonary vein isolation (PVI), being in AF upon arrival, are included in the study. Using our approach, we estimate the AV node refractory periods from the ECG before and during the PVI procedure. The refractory periods is estimated using both single and dual pathway models; Bayes Information Criterion is employed to select the most appropriate model. Following conversion to sinus rhythm, a S1S2 atrial pacing protocol is applied to invasively assess AV node refractory periods. Preliminary results suggest that the method for non-invasive assessment of AV node refractoriness is accurate, however, more data is needed to better establish performance. IntroductionDuring atrial fibrillation (AF), the atrioventricular (AV) node is continuously bombarded with atrial electrical impulses. The AV node is the natural barrier which restricts conduction of atrial impulses into the His-Purkinje system and is therefore very important during AF since it to some extent protects the ventricles of the heart from the extremely fast atrial rate. Electrophysiologic factors such as refractoriness of the AV node and concealed conduction influence the AV nodal blocking of impulses. Even though these properties play a prominent role in ventricular rate control, they are not routinely evaluated in clinical practice. The existence of dual AV nodal pathways, i.e., a fast pathway (FP) with a longer refractory period and a slow pathway (SP) with shorter refractory period [1] is a further complicating factor. During normal sinus rhythm atrial impulses are generally conducted though the FP, but during AF conduction may occur through the SP due to its shorter refractory period.We have previously proposed a model-based approach for joint analysis of atrial and ventricular activity in the ECG during AF [2-4]. The method is based on a functional model of the AV node where the model parameters reflects SP and FP refractoriness. The method has been used to analyze 12-lead resting ECG data from 14 patients in a phase II, open-label, sequential-group, doseescalation trial of tecadenoson administered intra venously alone and in combination with esmolol [5] as well as longterm ECG data from 60 patients in a randomized, crossover study comparing the efficacy of four different rate control drugs [6]. The results showed that changes in AV node refractoriness, as reflected in the model parameter estimates, were in agreement with previous clinical findings. This suggests that the model parameters estimated from ECG during AF may be used as a surrogate for the AV node refractory period invasively assessed through a pacing protocol [7].The purpose of the present study is to evaluate our model-based, non-invasive approach to assess AV node refractory p...

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“…A realistic sequence of RR intervals during AF was generated using the atrioventricular (AV) node model described in Corino et al [22,23]. The proposed model is defined by parameters that characterize the arrival rate of atrial impulses, the probability of an impulse choosing either one of the two AV nodal pathways, the refractory periods of these pathways, and the prolongation of the refractory periods.…”

Section: Ventricular Activitymentioning

confidence: 99%

Ventricular activity cancellation in electrograms during atrial fibrillation with constraints on residuals’ power

Corino

Rivolta

Sassi

et al. 2013

Medical Engineering & Physics

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a b s t r a c tDuring atrial fibrillation (AF), cancellation of ventricular activity from atrial electrograms (AEG) is commonly performed by template matching and subtraction (TMS): a running template, built in correspondence of QRSs, is subtracted from the AEG to uncover atrial activity (AA). However, TMS can produce poor cancellation, leaving high-power residues. In this study, we propose to modulate the templates before subtraction, in order to make the residuals as similar as possible to the nearby atrial activity, avoiding high-power ones. The coefficients used to modulate the template are estimated by maximizing, via Multi-swarm Particle Swarm Optimization, a fitness function. The modulated TMS method (mTMS) was tested on synthetic and real AEGs. Cancellation performances were assessed using: normalized mean squared error (NMSE, computed on simulated data only), reduction of ventricular activity (VDR), and percentage of segments (PP) whose power was outside the standard range of the atrial power. All testings suggested that mTMS is an improvement over TMS alone, being, on simulated data, NMSE and PP significantly decreased while VDR significantly increased. Similar results were obtained on real electrograms (median values of CS1 recordings PP: 2.44 vs. 0.38 p < 0.001; VDR: 6.71 vs. 8.15 p < 0.001).

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An Atrioventricular Node Model for Analysis of the Ventricular Response During Atrial Fibrillation

Cited by 44 publications

References 39 publications

Novel Scoring System for Distinction Between Paroxysmal and Non-Paroxysmal Atrial Fibrillation

Novel Scoring System for Distinction Between Paroxysmal and Non-Paroxysmal Atrial Fibrillation

Preliminary Results from Clinical Validation Study of a Method for Non-Invasive Assessment of Atrioventricular Node Refractoriness During Atrial Fibrillation

Ventricular activity cancellation in electrograms during atrial fibrillation with constraints on residuals’ power

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