Data_Sheet_1_Similarity Score for the Identification of Active Sites in Patients With Atrial Fibrillation.pdf

BackgroundAtrial fibrillation (AF) is the most common cardiac arrhythmia and precursor to other cardiac diseases. Catheter ablation is associated with limited success rates in patients with persistent AF. Currently, existing mapping systems fail to identify critical target sites for ablation. Recently, we proposed and validated several individual techniques, such as dominant frequency (DF), multiscale frequency (MSF), kurtosis (Kt), and multiscale entropy (MSE), to identify active sites of arrhythmias using simulated intracardiac electrograms (iEGMs). However, the individual performances of these techniques to identify arrhythmogenic substrates are not reliable.
ObjectiveThis study aimed to develop a similarity score using various iEGM analysis techniques to more accurately identify the spatial location of active sites of arrhythmia in patients with AF.
MethodsClinical bipolar iEGMs were obtained from patients with AF who underwent either successful (m = 4) or unsuccessful (m = 4) catheter ablation. A similarity score (0–3) was developed via the earth mover’s distance (EMD) approach based on a combination of DF, MSF, MSE, and Kt techniques.
ResultsIndividual techniques successfully discriminated between successful and unsuccessful AF ablation patients but were not reliable in identifying active spatial sites of AF. However, the proposed similarity score was able to pinpoint the spatial sites with high values (active AF sites) that were observed only in patients with unsuccessful AF termination, suggesting that these active sites were missed during the ablation procedure.
ConclusionArrhythmogenic substrates with abnormal electrical activity are identified in patients with unsuccessful AF termination after catheter ablation, suggesting clinical efficacy of similarity score.

背景：心房颤动（Atrial fibrillation, AF）是最常见的心律失常，亦是其他心脏疾病的前驱病变。对于持续性心房颤动患者，导管消融的治疗成功率较为有限。当前现有的心脏标测系统无法精准识别消融所需的关键靶点。此前，我们团队已提出并验证了多项单一分析技术，包括主导频率（dominant frequency, DF）、多尺度频率（multiscale frequency, MSF）、峰态系数（kurtosis, Kt）以及多尺度熵（multiscale entropy, MSE），可通过模拟心内电图（intracardiac electrograms, iEGMs）识别心律失常的激活位点。但上述单一技术在识别致心律失常基质时的表现并不稳定可靠。
目的：本研究旨在整合多种心内电图分析技术，构建一种相似性评分，以更精准地定位心房颤动患者心律失常激活位点的空间分布位置。
方法：本研究纳入接受导管消融治疗的心房颤动患者，其中消融成功（m=4）与消融失败（m=4）患者各4例，采集其临床双极心内电图数据。基于主导频率、多尺度频率、多尺度熵及峰态系数四项技术的组合，通过地球移动距离（earth mover’s distance, EMD）方法构建了取值范围为0~3的相似性评分。
结果：单一分析技术虽可有效区分消融成功与失败的心房颤动患者，但无法可靠识别心房颤动的激活空间位点。而本研究提出的相似性评分则能够精准定位仅在消融失败患者中观测到的高值空间位点（即心房颤动激活位点），提示此类激活位点在消融手术过程中被遗漏。
结论：导管消融后心房颤动终止失败的患者体内存在异常电活动的致心律失常基质，证实了本相似性评分具备临床应用价值。