Combination of frequency-and time-domain characteristics of the fibrillatory waves for enhanced prediction of persistent atrial fibrillation recurrence after catheter ablation

Catheter ablation (CA) remains the cornerstone alternative to cardioversion for sinus rhythm (SR) restoration in patients with atrial fibrillation (AF). Unfortunately, despite the last methodological and technological advances, this procedure is not consistently effective in treating persistent AF.

An Efficient Algorithm Based on Wavelet Transform to Reduce Powerline Noise From Electrocardiograms

Nowadays, the electrocardiogram (ECG) is still the most widely used signal for the diagnosis of cardiac pathologies. However, this recording is often disturbed by the powerline interference (PLI), its removal being mandatory to avoid misdiagnosis. Although a broad variety of methods have been proposed for that purpose, often they substantially alter the original signal morphology or are computationally expensive. Hence, the present work introduces a simple and efficient algorithm to suppress the PLI from the ECG. Briefly, the input signal is decomposed into four Wavelet levels and the resulting coefficients are thresholded to remove the PLI estimated from the TQ intervals. The denoised ECG signal is then reconstructed by computing the inverse Wavelet transform. The method has been validated making use of fifty 10-min length clean ECG segments obtained from the MIT BIH Normal Sinus Rhythm database, which were contaminated with a sinusoidal signal of 50 Hz and variable harmonic content. Comparing the original and denoised ECG signals through a signed correlation index, improvements between 10 - 72% have been observed with respect to common adaptive notch filtering, implemented for comparison. These results suggest that the proposed method is featured by an enhanced trade-off between noise reduction and signal morphology preservation.

Application of Joint Notch Filtering and Wavelet Transform for Enhanced Powerline Interference Removal in Atrial Fibrillation Electrograms

Analysis of intra-atrial electrograms (EGMs) nowadays constitutes the most common way to gain new insights about the mechanisms triggering and maintaining atrial fibrillation (AF). However, these recordings are highly contaminated by powerline interference (PLI) due to the large amount of electrical devices operating simultaneously in the electrophysiology laboratory. To remove this perturbation, conventional notch filtering has been widely used. However, this method adds artificial fractionation to the EGMs, thus concealing their accurate interpretation. Hence, the development of novel algorithms for PLI suppression in EGMs is still an unresolved challenge. Within this context, the present work introduces the joint application of common notch filtering and Wavelet denoising for enhanced PLI removal in AF EGMs. The algorithm was validated on a set of 100 unipolar EGM signals, which were synthesized with different noise levels. Original and denoised EGMs were compared in terms of a signed correlation index (SCI), computed both in time and frequency domains. Compared with the single use of notch filtering, improvements between 4 and 15% were reached with Wavelet denoising in both domains. As a consequence, the proposed algorithm was able to efficiently reduce high levels of PLI and simultaneously preserve the original morphology of AF EGMs.

The Stationary Wavelet Transform as an Efficient Reductor of Powerline Interference for Atrial Bipolar Electrograms in Cardiac Electrophysiology

Objective: The most relevant source of signal contamination in the cardiac electrophysiology (EP) laboratory is the ubiquitous powerline interference (PLI). To reduce this perturbation, algorithms including common fixed bandwidth and adaptive notch filters have been proposed. Although such methods have proven to add artificial fractionation to intra atrial electrograms (EGMs), they are still frequently used. However, such morphological alteration can conceal the accurate interpretation of EGMs, specially to evaluate the mechanisms supporting atrial fibrillation (AF), which is the most common cardiac arrhythmia. Given the clinical relevance of AF, a novel algorithm aimed at reducing PLI on highly contaminated bipolar EGMs and, simultaneously, preserving their morphology is proposed. Approach: The method is based on the wavelet shrinkage and has been validated through customized indices on a set of synthesized EGMs to accurately quantify the achieved level of PLI reduction and signal morphology alteration. Visual validation of the algorithms performance has also been included for some real EGM excerpts. Main results: The method has outperformed common filtering-based and wavelet based strategies in the analyzed scenario. Moreover, it possesses advantages such as insensitivity to amplitude and frequency variations in the PLI, and the capability of joint removal of several interferences. Significance: The use of this algorithm in routine cardiac EP studies may enable improved and truthful evaluation of AF mechanisms.