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HEART ELECTRICAL ACTIVATION 1 By: Elnaz Shokrollahi Supervisors: Dr. S. Krishnan Dr. K. Nanthakumar SIGNAL PROPAGATION IN HEART 1. Stimulus originates in the SA node and travels across the walls of the atria, causing them to contract. 2. Stimulus arrives at the AV node and travels along the AV bundle 3. Stimulus descends to the apex of the heart through the bundle branches 4. After stimulus reaches the Purkinje fibers, the ventricles contract. 2 CARDIAC ARRHYTHMIA Cardiac arrhythmia is when the electrical activity of the heart is irregular (faster/slower) than normal. Tachycardia (Fast Heartbeat) Bradycardia (Slow Heartbeat) Ventricular Fibrillation 3 CARDIAC ELECTROPHYSIOLOGY (EP) 4 CONVENTIONAL EP MAPPING Point-by-point mapping acquisition. Direct voltage mapping. Many Disadvantages: Identification of areas of low voltage is timeconsuming catheter manipulation. Focal lesion creation may not be sufficient to ablate VT conduction through a broad isthmus region. Identification breakthrough points may be challenging. 5 NON-CONTACT MAPPING Catheter of its own. Non-contact mapping uses unipolar Virtual Electrograms (VE) 6 ILLUSTRATION OF GEOMETRY AND POSITION OF PACED AREAS 7 ELECTROGRAM o Recording of cardiac potentials from electrodes directly in contact with the heart. 8 TIME-DOMAIN ANALYSIS -Peak Negative Voltage (PNV) in (mV) -Maximal Negative dV/dt (mV/ms) -Area Under the Curve (AUC) -Presence of an initial R-wave -Duration -Presence of low-amplitude depolarization 9 RESULTS OF TIME-DOMAIN ANALYSIS Case Endocardial Epicardial Latency 14.5 ± 5.3 ms 18.2 ± 7.8 ms Duration 18.8 ± 6.2 ms 22.2 ± 5.3 ms PNV -2 ± 1 mV -3 ± 5.3 ms Low Amp. Depo 0% 60% Max Neg dV/dt 1.6 ± 0.2mV/ms 2.27 ± 0.4mV/ms AUC 881 ± 36 1090 ± 50.5 R-wave 0% 80% 10 FREQUENCY- DOMAIN ANALYSIS FFT requires large quantities of data to produce significant result. X (k ) x( j ) N j 1 AR modeling ( j 1)( k 1) N i p xn ai xn i n i 1 11 RESULTS OF CLASSIFICATION Results with AR Coefficients Method Groups Endocardial Epicardial Total Original Endocardial Epicardial Endocardial Epicardial Endocardial Epicardial Endocardial Epicardial 44 9 97.8 15 42 11 93.3 18.3 1 51 2.2 85 3 49 6.7 81.7 45 60 100 100 45 60 100 100 % Cross-Validated % CONCLUSIONS Presented electrographic parameters. Morphologies of electrograms allowed the discrimination of endo/epicardially paced activation. Possibility of combination of the criteria will improve the perception over any single criterion. Allow to detect tachycardia originating epicardially using noncontact mapping. 13 BRAIN STORMING Thank you for your attention! 14