Non-invasive Characterization of Human AV-Nodal Conduction Delay and Refractory Period During Atrial Fibrillation
(2021) In Frontiers in Physiology 12.- Abstract
During atrial fibrillation (AF), the heart relies heavily on the atrio-ventricular (AV) node to regulate the heart rate. Thus, characterization of AV-nodal properties may provide valuable information for patient monitoring and prediction of rate control drug effects. In this work we present a network model consisting of the AV node, the bundle of His, and the Purkinje fibers, together with an associated workflow, for robust estimation of the model parameters from ECG. The model consists of two pathways, referred to as the slow and the fast pathway, interconnected at one end. Both pathways are composed of interacting nodes, with separate refractory periods and conduction delays determined by the stimulation history of each node. Together... (More)
During atrial fibrillation (AF), the heart relies heavily on the atrio-ventricular (AV) node to regulate the heart rate. Thus, characterization of AV-nodal properties may provide valuable information for patient monitoring and prediction of rate control drug effects. In this work we present a network model consisting of the AV node, the bundle of His, and the Purkinje fibers, together with an associated workflow, for robust estimation of the model parameters from ECG. The model consists of two pathways, referred to as the slow and the fast pathway, interconnected at one end. Both pathways are composed of interacting nodes, with separate refractory periods and conduction delays determined by the stimulation history of each node. Together with this model, a fitness function based on the Poincaré plot accounting for dynamics in RR interval series and a problem specific genetic algorithm, are also presented. The robustness of the parameter estimates is evaluated using simulated data, based on clinical measurements from five AF patients. Results show that the proposed model and workflow could estimate the slow pathway parameters for the refractory period, (Formula presented.) and ΔRSP, with an error (mean ± std) of 10.3 ± 22 and −12.6 ± 26 ms, respectively, and the parameters for the conduction delay, (Formula presented.) and (Formula presented.), with an error of 7 ± 35 and 4 ± 36 ms. Corresponding results for the fast pathway were 31.7 ± 65, −0.3 ± 77, 17 ± 29, and 43 ± 109 ms. These results suggest that both conduction delay and refractory period can be robustly estimated from non-invasive data with the proposed methodology. Furthermore, as an application example, the methodology was used to analyze ECG data from one patient at baseline and during treatment with Diltiazem, illustrating its potential to assess the effect of rate control drugs.
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- author
- Karlsson, Mattias LU ; Sandberg, Frida LU ; Ulimoen, Sara R. and Wallman, Mikael
- organization
- publishing date
- 2021-10-28
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- atrial fibrillation, atrioventricular node, cardiac electrophysiology, ECG, genetic algorithm, mathematical modeling, rate control
- in
- Frontiers in Physiology
- volume
- 12
- article number
- 728955
- publisher
- Frontiers Media S. A.
- external identifiers
-
- pmid:34777001
- scopus:85118979304
- ISSN
- 1664-042X
- DOI
- 10.3389/fphys.2021.728955
- project
- Ph.D. project: Non-invasive analysis of ANS activity in atrial fibrillation
- Diagnostic Biomarkers in Atrial Fibrillation - Autonomic Nervous System Response as a Sign of Disease Progression
- language
- English
- LU publication?
- yes
- additional info
- Publisher Copyright: © Copyright © 2021 Karlsson, Sandberg, Ulimoen and Wallman.
- id
- 8f10e505-68cb-4cde-baa6-f22116b63d0a
- date added to LUP
- 2021-11-23 09:04:25
- date last changed
- 2024-04-20 16:09:26
@article{8f10e505-68cb-4cde-baa6-f22116b63d0a, abstract = {{<p>During atrial fibrillation (AF), the heart relies heavily on the atrio-ventricular (AV) node to regulate the heart rate. Thus, characterization of AV-nodal properties may provide valuable information for patient monitoring and prediction of rate control drug effects. In this work we present a network model consisting of the AV node, the bundle of His, and the Purkinje fibers, together with an associated workflow, for robust estimation of the model parameters from ECG. The model consists of two pathways, referred to as the slow and the fast pathway, interconnected at one end. Both pathways are composed of interacting nodes, with separate refractory periods and conduction delays determined by the stimulation history of each node. Together with this model, a fitness function based on the Poincaré plot accounting for dynamics in RR interval series and a problem specific genetic algorithm, are also presented. The robustness of the parameter estimates is evaluated using simulated data, based on clinical measurements from five AF patients. Results show that the proposed model and workflow could estimate the slow pathway parameters for the refractory period, (Formula presented.) and ΔR<sup>SP</sup>, with an error (mean ± std) of 10.3 ± 22 and −12.6 ± 26 ms, respectively, and the parameters for the conduction delay, (Formula presented.) and (Formula presented.), with an error of 7 ± 35 and 4 ± 36 ms. Corresponding results for the fast pathway were 31.7 ± 65, −0.3 ± 77, 17 ± 29, and 43 ± 109 ms. These results suggest that both conduction delay and refractory period can be robustly estimated from non-invasive data with the proposed methodology. Furthermore, as an application example, the methodology was used to analyze ECG data from one patient at baseline and during treatment with Diltiazem, illustrating its potential to assess the effect of rate control drugs.</p>}}, author = {{Karlsson, Mattias and Sandberg, Frida and Ulimoen, Sara R. and Wallman, Mikael}}, issn = {{1664-042X}}, keywords = {{atrial fibrillation; atrioventricular node; cardiac electrophysiology; ECG; genetic algorithm; mathematical modeling; rate control}}, language = {{eng}}, month = {{10}}, publisher = {{Frontiers Media S. A.}}, series = {{Frontiers in Physiology}}, title = {{Non-invasive Characterization of Human AV-Nodal Conduction Delay and Refractory Period During Atrial Fibrillation}}, url = {{http://dx.doi.org/10.3389/fphys.2021.728955}}, doi = {{10.3389/fphys.2021.728955}}, volume = {{12}}, year = {{2021}}, }