Identification of Dominant Excitation Patterns and Sources of Atrial Fibrillation by Causality Analysis

• Published in: Annals of biomedical engineering 2016-08, Vol.44 (8), p.2364-2376
• Main Authors: Rodrigo, Miguel, Climent, Andreu M., Liberos, Alejandro, Calvo, David, Fernández-Avilés, Francisco, Berenfeld, Omer, Atienza, Felipe, Guillem, Maria S.
• Format: Article
• Language: English
• Subjects: Ablation; Atrial Fibrillation - physiopathology; Audio frequencies; Biochemistry; Biological and Medical Physics; Biomedical and Life Sciences; Biomedical Engineering and Bioengineering; Biomedicine; Biophysics; Catheters; Causality; Classical Mechanics; Electrophysiologic Techniques, Cardiac; Female; Fibrillation; Humans; Male; Mathematical models; Medical instruments; Methodology; Models, Cardiovascular; Patients
• ISSN: 0090-6964; 1573-9686
• DOI: 10.1007/s10439-015-1534-x

Burden of atrial fibrillation (AF) can be reduced by ablation of sources of electrical impulses driving AF but driver identification is still challenging. This study presents a new methodology based on causality analysis that allows identifying the hierarchically dominant areas driving AF. Identification of dominant propagation patterns was achieved by computing causal relations between intracardiac multi-electrode catheter recordings of four paroxysmal AF patients during sinus rhythm, pacing and AF. In addition, realistic mathematical models of the atria during AF were used to validate the methodology both in the presence and absence of dominant frequency (DF) gradients. During electrical pacing, sources of propagation patterns detected by causality analysis were consistent with the location of the stimulating catheter. During AF, propagation patterns presented temporal variability, but a dominant direction accounted for significantly more propagations than other directions (49 ± 15% vs. 14 ± 13% or less, p