Estimating atrial activity in epicardial electrograms

Abstract

The most common serious heart rhythm disease is atrial fibrillation. It is not fatal on its own but does increase the risk of heart failures and strokes. There is little understanding about the mechanisms behind the disease, so more insight is desired. Using an array of electrodes, measurements are being performed of the electrical atrial activity directly on the heart tissue. These signals are, however, not clean and suffer from far-field interference coming from the ventricles.

During normal sinus rhythm these atrial and ventricular activities are separated in time and easy to distinguish. In case of atrial fibrillation this is not always the case. Luckily, there is a major difference between both signals: the ventricular signal comes from far away and arrives therefore approximately simultaneously at all electrodes. A simple, but effective way to remove this ventricular activity is to use a bipolar electrode. It produces the difference between two normal unipolar electrodes, thus removing the common ventricular signal component.

The bipolar electrode, however, distorts the atrial signal component, which in some orientations can even lead to removing it altogether. This bipolar electrode is known as a differential beamformer from the field of array signal processing. There are more complex beamformers that can keep the atrial component undistorted and therefore produce better results than the bipolar electrode.

This thesis proposes a Fourier-domain signal model for all available electrodes relying on an atrial and ventricular transfer function. It is possible to estimate these transfer functions from the data blindly. Three beamformers are derived utilizing the signal model and the transfer functions. The bipolar electrode is extended to multiple electrodes like the other beamformers as well.

Experiments with simulated data show that the complex beamformers indeed keep the atrial activity undistorted and are still able to remove the ventricular activity effectively when using multiple electrodes, except for very complex data where the signal model is not valid. For low numbers of electrodes the beamformers are not useful, they hardly remove the ventricular activity while keeping the atrial component undistorted, where the bipolar electrode does the opposite.

The electrograms are also used to estimate local activation times of the cells underneath the electrodes which says something about the health of the cardiac tissue. Besides the mentioned filtering, this thesis proposes a method to estimate those moments in time by looking at the time-domain version of the atrial transfer function, called the atrial impulse response. For simple data, it performs well compared to state-of-the-art methods, but for more complicated data, it does not.