Atrial Fibrillation Instantaneous Frequency Through Signal Decomposition Correlates with Recurrence After Electrical Cardioversion

Pietro Bonizzi1, olivier Meste2, Joël MH Karel3, Ralf L.M. Peeters4, Iris Huijben3, Ulrich Schotten3, Stef Zeemering3
1Department of Advanced Computing Sciences, Maastricht University, 2Université Côte d'Azur, CNRS, I3S, 3Maastricht University, 4Dept. Advanced Computing Sciences, Maastricht University


Abstract

Aims: In persistent atrial fibrillation (AF), the faster the atrial activity is propagating, the more stable its propagation paths are on the short-term, suggesting a locally more homogeneous cardiac tissue. In this study, we further investigate this hypothesis by analyzing the instantaneous frequencies of atrial propagation patterns. Methods: High-density body surface potential maps (120 anterior, 64 posterior electrodes) were recorded in 75 patients in persistent AF (31 non-recurrent after electrical cardioversion, 32 recurrent, 12 unknown). For each patient, the body-surface atrial signals were decomposed by means of two data-driven signal decomposition methods: Singular-Spectrum Decomposition (SSD) and Variational Mode Decomposition (VMD). Only the signal components in the frequency ranges 3.5-10Hz (AF activation band) and 10-22Hz (harmonics or fractionation-related content) were kept, and instantaneous frequencies were estimated from those (i.e., a time series of instantaneous frequencies for each subject, each electrode, and each frequency range). We then analyzed the distributions of the instantaneous frequencies. Results: In both ranges 3.5-10Hz and 10-22Hz, the instantaneous frequency distributions of AF patients that did not have AF recurrence after electrical cardioversion showed higher values than those of patients with recurring AF (overall mean+/-STD, SSD 3.5-10Hz: 6.82+/-0.05 vs. 6.70+/-0.05Hz; SSD 10-22Hz: 15.25+/-0.11Hz vs. 14.99+/-0.11Hz; VMD 3.5-10Hz: 6.76+/-0.06Hz vs. 6.55+/-0.05Hz; VMD 10-22Hz: 14.93+/-0.10Hz vs. 14.67+/-0.10Hz; t-test: all p-values < 0.001). Additionally, the spatial distributions of instantaneous frequencies over the body surface showed that the range 3.5-10Hz is mainly prevalent at the front, while the range 10-22Hz is mainly prevalent at the back, Conclusion: The noninvasive analysis of instantaneous frequencies during persistent AF through signal decomposition suggests that faster AF propagation patterns may be linked to a more organized AF substrate. This subtle behavior is lost when signal decomposition is not applied.