Extended ECG Improves Classification of Paroxysmal and Persistent Atrial Fibrillation Based on P- and f-Waves

Matthias Daniel Zink; Rita Laureanti; Ben J M Hermans; Laurent Pison; Sander Verheule; Suzanne Philippens; Nikki Pluymaekers; Mindy Vroomen; Astrid Hermans; Arne van Hunnik; Harry J G M Crijns; Kevin Vernooy; Dominik Linz; Luca Mainardi; Angelo Auricchio; Stef Zeemering; Ulrich Schotten

doi:10.3389/fphys.2022.779826

Extended ECG Improves Classification of Paroxysmal and Persistent Atrial Fibrillation Based on P- and f-Waves

Matthias Daniel Zink^*, Rita Laureanti, Ben J M Hermans, Laurent Pison, Sander Verheule, Suzanne Philippens, Nikki Pluymaekers, Mindy Vroomen, Astrid Hermans, Arne van Hunnik, Harry J G M Crijns, Kevin Vernooy, Dominik Linz, Luca Mainardi, Angelo Auricchio, Stef Zeemering, Ulrich Schotten

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background: The standard 12-lead ECG has been shown to be of value in characterizing atrial conduction properties. The added value of extended ECG recordings (longer recordings from more sites) has not been systematically explored yet.

Objective: The aim of this study is to employ an extended ECG to identify characteristics of atrial electrical activity related to paroxysmal vs. persistent atrial fibrillation (AF).

Methods: In 247 participants scheduled for AF ablation, an extended ECG was recorded (12 standard plus 3 additional leads, 5 min recording, no filtering). For patients presenting in sinus rhythm (SR), the signal-averaged P-wave and the spatiotemporal P-wave variability was analyzed. For patients presenting in AF, f-wave properties in the QRST (the amplitude complex of the ventricular electrical activity: Q-, R-, S-, and T-wave)-canceled ECG were determined.

Results: Significant differences between paroxysmal (N = 152) and persistent patients with AF (N = 95) were found in several P-wave and f-wave parameters, including parameters that can only be calculated from an extended ECG. Furthermore, a moderate, but significant correlation was found between echocardiographic parameters and P-wave and f-wave parameters. There was a moderate correlation of left atrial (LA) diameter with P-wave energy duration (r = 0.317, p < 0.001) and f-wave amplitude in lead A3 (r = -0.389, p = 0.002). The AF-type classification performance significantly improved when parameters calculated from the extended ECG were taken into account [area under the curve (AUC) = 0.58, interquartile range (IQR) 0.50-0.64 for standard ECG parameters only vs. AUC = 0.76, IQR 0.70-0.80 for extended ECG parameters, p < 0.001].

Conclusion: The P- and f-wave analysis of extended ECG configurations identified specific ECG features allowing improved classification of paroxysmal vs. persistent AF. The extended ECG significantly improved AF-type classification in our analyzed data as compared to a standard 10-s 12-lead ECG. Whether this can result in a better clinical AF type classification warrants further prospective study.

Original language	English
Article number	779826
Number of pages	12
Journal	Frontiers in physiology
Volume	13
DOIs	https://doi.org/10.3389/fphys.2022.779826
Publication status	Published - 4 Mar 2022

Keywords

ACTIVATION
COMPLEXITY
DURATION
INTERATRIAL CONDUCTION
MECHANISMS
MODELS
P-wave
P-wave variability
QRST-canceled ECG
RISK
TISSUE
VARIABILITY
atrial fibrillation
f-wave
paroxysmal
persistent
signal-averaged P-wave

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10.3389/fphys.2022.779826Licence: CC BY

Cite this

Zink, M. D., Laureanti, R., Hermans, B. J. M., Pison, L., Verheule, S., Philippens, S., Pluymaekers, N., Vroomen, M., Hermans, A., van Hunnik, A., Crijns, H. J. G. M., Vernooy, K., Linz, D., Mainardi, L., Auricchio, A., Zeemering, S., & Schotten, U. (2022). Extended ECG Improves Classification of Paroxysmal and Persistent Atrial Fibrillation Based on P- and f-Waves. Frontiers in physiology, 13, Article 779826. https://doi.org/10.3389/fphys.2022.779826

@article{13425b2758284f22b589ee0bc1e30f29,

title = "Extended ECG Improves Classification of Paroxysmal and Persistent Atrial Fibrillation Based on P- and f-Waves",

abstract = "Background: The standard 12-lead ECG has been shown to be of value in characterizing atrial conduction properties. The added value of extended ECG recordings (longer recordings from more sites) has not been systematically explored yet.Objective: The aim of this study is to employ an extended ECG to identify characteristics of atrial electrical activity related to paroxysmal vs. persistent atrial fibrillation (AF).Methods: In 247 participants scheduled for AF ablation, an extended ECG was recorded (12 standard plus 3 additional leads, 5 min recording, no filtering). For patients presenting in sinus rhythm (SR), the signal-averaged P-wave and the spatiotemporal P-wave variability was analyzed. For patients presenting in AF, f-wave properties in the QRST (the amplitude complex of the ventricular electrical activity: Q-, R-, S-, and T-wave)-canceled ECG were determined.Results: Significant differences between paroxysmal (N = 152) and persistent patients with AF (N = 95) were found in several P-wave and f-wave parameters, including parameters that can only be calculated from an extended ECG. Furthermore, a moderate, but significant correlation was found between echocardiographic parameters and P-wave and f-wave parameters. There was a moderate correlation of left atrial (LA) diameter with P-wave energy duration (r = 0.317, p < 0.001) and f-wave amplitude in lead A3 (r = -0.389, p = 0.002). The AF-type classification performance significantly improved when parameters calculated from the extended ECG were taken into account [area under the curve (AUC) = 0.58, interquartile range (IQR) 0.50-0.64 for standard ECG parameters only vs. AUC = 0.76, IQR 0.70-0.80 for extended ECG parameters, p < 0.001].Conclusion: The P- and f-wave analysis of extended ECG configurations identified specific ECG features allowing improved classification of paroxysmal vs. persistent AF. The extended ECG significantly improved AF-type classification in our analyzed data as compared to a standard 10-s 12-lead ECG. Whether this can result in a better clinical AF type classification warrants further prospective study.",

keywords = "ACTIVATION, COMPLEXITY, DURATION, INTERATRIAL CONDUCTION, MECHANISMS, MODELS, P-wave, P-wave variability, QRST-canceled ECG, RISK, TISSUE, VARIABILITY, atrial fibrillation, f-wave, paroxysmal, persistent, signal-averaged P-wave",

author = "Zink, {Matthias Daniel} and Rita Laureanti and Hermans, {Ben J M} and Laurent Pison and Sander Verheule and Suzanne Philippens and Nikki Pluymaekers and Mindy Vroomen and Astrid Hermans and {van Hunnik}, Arne and Crijns, {Harry J G M} and Kevin Vernooy and Dominik Linz and Luca Mainardi and Angelo Auricchio and Stef Zeemering and Ulrich Schotten",

note = "Copyright {\textcopyright} 2022 Zink, Laureanti, Hermans, Pison, Verheule, Philippens, Pluymaekers, Vroomen, Hermans, van Hunnik, Crijns, Vernooy, Linz, Mainardi, Auricchio, Zeemering and Schotten.",

year = "2022",

month = mar,

day = "4",

doi = "10.3389/fphys.2022.779826",

language = "English",

volume = "13",

journal = "Frontiers in physiology",

issn = "1664-042X",

publisher = "Frontiers Media S.A.",

}

Zink, MD, Laureanti, R, Hermans, BJM, Pison, L, Verheule, S , Philippens, S , Pluymaekers, N, Vroomen, M, Hermans, A , van Hunnik, A , Crijns, HJGM , Vernooy, K , Linz, D, Mainardi, L, Auricchio, A, Zeemering, S & Schotten, U 2022, 'Extended ECG Improves Classification of Paroxysmal and Persistent Atrial Fibrillation Based on P- and f-Waves', Frontiers in physiology, vol. 13, 779826. https://doi.org/10.3389/fphys.2022.779826

TY - JOUR

T1 - Extended ECG Improves Classification of Paroxysmal and Persistent Atrial Fibrillation Based on P- and f-Waves

AU - Zink, Matthias Daniel

AU - Laureanti, Rita

AU - Hermans, Ben J M

AU - Pison, Laurent

AU - Verheule, Sander

AU - Philippens, Suzanne

AU - Pluymaekers, Nikki

AU - Vroomen, Mindy

AU - Hermans, Astrid

AU - van Hunnik, Arne

AU - Crijns, Harry J G M

AU - Vernooy, Kevin

AU - Linz, Dominik

AU - Mainardi, Luca

AU - Auricchio, Angelo

AU - Zeemering, Stef

AU - Schotten, Ulrich

PY - 2022/3/4

Y1 - 2022/3/4

N2 - Background: The standard 12-lead ECG has been shown to be of value in characterizing atrial conduction properties. The added value of extended ECG recordings (longer recordings from more sites) has not been systematically explored yet.Objective: The aim of this study is to employ an extended ECG to identify characteristics of atrial electrical activity related to paroxysmal vs. persistent atrial fibrillation (AF).Methods: In 247 participants scheduled for AF ablation, an extended ECG was recorded (12 standard plus 3 additional leads, 5 min recording, no filtering). For patients presenting in sinus rhythm (SR), the signal-averaged P-wave and the spatiotemporal P-wave variability was analyzed. For patients presenting in AF, f-wave properties in the QRST (the amplitude complex of the ventricular electrical activity: Q-, R-, S-, and T-wave)-canceled ECG were determined.Results: Significant differences between paroxysmal (N = 152) and persistent patients with AF (N = 95) were found in several P-wave and f-wave parameters, including parameters that can only be calculated from an extended ECG. Furthermore, a moderate, but significant correlation was found between echocardiographic parameters and P-wave and f-wave parameters. There was a moderate correlation of left atrial (LA) diameter with P-wave energy duration (r = 0.317, p < 0.001) and f-wave amplitude in lead A3 (r = -0.389, p = 0.002). The AF-type classification performance significantly improved when parameters calculated from the extended ECG were taken into account [area under the curve (AUC) = 0.58, interquartile range (IQR) 0.50-0.64 for standard ECG parameters only vs. AUC = 0.76, IQR 0.70-0.80 for extended ECG parameters, p < 0.001].Conclusion: The P- and f-wave analysis of extended ECG configurations identified specific ECG features allowing improved classification of paroxysmal vs. persistent AF. The extended ECG significantly improved AF-type classification in our analyzed data as compared to a standard 10-s 12-lead ECG. Whether this can result in a better clinical AF type classification warrants further prospective study.

AB - Background: The standard 12-lead ECG has been shown to be of value in characterizing atrial conduction properties. The added value of extended ECG recordings (longer recordings from more sites) has not been systematically explored yet.Objective: The aim of this study is to employ an extended ECG to identify characteristics of atrial electrical activity related to paroxysmal vs. persistent atrial fibrillation (AF).Methods: In 247 participants scheduled for AF ablation, an extended ECG was recorded (12 standard plus 3 additional leads, 5 min recording, no filtering). For patients presenting in sinus rhythm (SR), the signal-averaged P-wave and the spatiotemporal P-wave variability was analyzed. For patients presenting in AF, f-wave properties in the QRST (the amplitude complex of the ventricular electrical activity: Q-, R-, S-, and T-wave)-canceled ECG were determined.Results: Significant differences between paroxysmal (N = 152) and persistent patients with AF (N = 95) were found in several P-wave and f-wave parameters, including parameters that can only be calculated from an extended ECG. Furthermore, a moderate, but significant correlation was found between echocardiographic parameters and P-wave and f-wave parameters. There was a moderate correlation of left atrial (LA) diameter with P-wave energy duration (r = 0.317, p < 0.001) and f-wave amplitude in lead A3 (r = -0.389, p = 0.002). The AF-type classification performance significantly improved when parameters calculated from the extended ECG were taken into account [area under the curve (AUC) = 0.58, interquartile range (IQR) 0.50-0.64 for standard ECG parameters only vs. AUC = 0.76, IQR 0.70-0.80 for extended ECG parameters, p < 0.001].Conclusion: The P- and f-wave analysis of extended ECG configurations identified specific ECG features allowing improved classification of paroxysmal vs. persistent AF. The extended ECG significantly improved AF-type classification in our analyzed data as compared to a standard 10-s 12-lead ECG. Whether this can result in a better clinical AF type classification warrants further prospective study.

KW - ACTIVATION

KW - COMPLEXITY

KW - DURATION

KW - INTERATRIAL CONDUCTION

KW - MECHANISMS

KW - MODELS

KW - P-wave

KW - P-wave variability

KW - QRST-canceled ECG

KW - RISK

KW - TISSUE

KW - VARIABILITY

KW - atrial fibrillation

KW - f-wave

KW - paroxysmal

KW - persistent

KW - signal-averaged P-wave

U2 - 10.3389/fphys.2022.779826

DO - 10.3389/fphys.2022.779826

M3 - Article

C2 - 35309059

SN - 1664-042X

VL - 13

JO - Frontiers in physiology

JF - Frontiers in physiology

M1 - 779826

ER -