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Introduction of an expert system for the discrimination of local pulmonary vein and atrial far field signals

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

Discrimination of local and far field potentials during sinus rhythm and atrial fibrillation (AF) is essential for successful pulmonary vein (PV) isolation. We sought to introduce an expert system for the classification of electrophysiologic PV signals.

Methods

For the expert system database, we analyzed ablation procedures of 50 patients with paroxysmal and persistent AF. Standard circumferential catheters and bipolar recordings were required. In a prospective trial, the expert system was compared with the performing electrophysiologists’ classifications of potentials during 15 procedures. A total of 1,343 recordings of local PV and far field signals were validated by the sudden disappearance of local potentials during ablation, the presence of dissociated PV activity, and pacing maneuvers. A fast Fourier transform was applied to the individual potentials. Analysis continued in the amplitude and phase representation.

Results

Four parameters significant (p < 0.001) for classification were identified and entered a logistic regression model. Overall sensitivity and specificity of the model was 87% with minor, nonsignificant variations for individual PVs and different underlying rhythms. Concordance with ad hoc electrophysiologists’ classification of local potentials was 70%, which increased during post hoc analysis to 86% since classification of 14% of the potentials had to be revised. For these potentials, the expert system correctly predicted their local origin in 86%.

Conclusion

An expert system for the evaluation of electrophysiologic signals based on morphology analysis using the Fourier transform is feasible. The ease of use and online availability facilitate a widespread use for AF ablation procedures.

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Financial disclosures

Dr. Hanno Klemm reports having received honoraria and travel grants from Bard Electrophysiology. Dr. Heitzer, Dr. Ruprecht, Dr. Johnsen, Dr. Meinertz, and Dr. Ventura report to conflicts of interest.

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Authors and Affiliations

  1. Heart Center Dortmund, Department of Cardiology, Dortmund, Germany

    Hanno Ulrich Klemm, Thomas Heitzer & Ute Ruprecht

  2. Department of Cardiology, University Heart Center Hamburg, Hamburg, Germany

    Christin Johnsen & Thomas Meinertz

  3. Electrophysiology Bremen, Bremen, Germany

    Rodolfo Ventura

  4. Herzzentrum am Klinikum Dortmund, Beurhausstrasse 40, 44137, Dortmund, Germany

    Hanno Ulrich Klemm

Authors
  1. Hanno Ulrich Klemm
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  2. Thomas Heitzer
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  3. Ute Ruprecht
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  6. Rodolfo Ventura
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Correspondence to Hanno Ulrich Klemm.

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All authors had full control of all primary data and agree to allow the journal to review the data if requested.

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Klemm, H.U., Heitzer, T., Ruprecht, U. et al. Introduction of an expert system for the discrimination of local pulmonary vein and atrial far field signals. J Interv Card Electrophysiol 29, 83–91 (2010). https://doi.org/10.1007/s10840-010-9508-2

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  • DOI: https://doi.org/10.1007/s10840-010-9508-2

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