Role of fibrillatory waves amplitude as predictors of immediate arrhythmia termination after Maze surgery of atrial fibrillation

Cox-Maze surgery is an effective procedure to terminate atrial fibrillation (AF) in patients requiring open-heart surgery associated to another heart disease. After the intervention, AF spontaneous reversion occurs immediately in some patients, but not in others. This work analyzes 23 twelve-lead preoperative ECGs from patients in AF to predict immediate termination of the arrythmia. To carry out the prediction, three indices have been studied: the dominant atrial frequency (DAF), the sample entropy (SampEn) and the fibrillatory waves average power (fWP). Results for the DAF yielded a Sensitivity (Se), Specificity (Sp) and Accuracy (Acc) of 78%, 71% and 74%, respectively. For SampEn 78%, 79% and 78%, respectively and for fWP were 89%, 71% and 78%, respectively. Finally, to improve the prognosis capability a classification tree combining the analyzed parameters was created yielding Se, Sp and Acc of 89%, 93% and 91%, respectively. As conclusion, the combination of fWP with DAF and SampEn has provided very auspicious results to predict whether AF would terminate immediately after the Cox-Maze surgery.

[1]  L. Sörnmo,et al.  Non-invasive assessment of the atrial cycle length during atrial fibrillation in man: introducing, validating and illustrating a new ECG method. , 1998, Cardiovascular research.

[2]  Raúl Alcaraz,et al.  The application of nonlinear metrics to assess organization differences in short recordings of paroxysmal and persistent atrial fibrillation , 2010, Physiological measurement.

[3]  Roberto Hornero,et al.  Optimal parameters study for sample entropy-based atrial fibrillation organization analysis , 2010, Comput. Methods Programs Biomed..

[4]  J. Richman,et al.  Physiological time-series analysis using approximate entropy and sample entropy. , 2000, American journal of physiology. Heart and circulatory physiology.

[5]  M. Paluš,et al.  Detecting nonlinearity and phase synchronization with surrogate data , 1998, IEEE Engineering in Medicine and Biology Magazine.

[6]  Pablo Laguna,et al.  Bioelectrical Signal Processing in Cardiac and Neurological Applications , 2005 .

[7]  Raúl Alcaraz,et al.  Sample entropy of the main atrial wave predicts spontaneous termination of paroxysmal atrial fibrillation. , 2009, Medical engineering & physics.

[8]  J. Boineau,et al.  The Cox maze III procedure for atrial fibrillation: long-term efficacy in patients undergoing lone versus concomitant procedures. , 2003, The Journal of thoracic and cardiovascular surgery.

[9]  T. Ohkubo,et al.  Predictors of sinus rhythm restoration after Cox maze procedure concomitant with other cardiac operations. , 1997, The Annals of thoracic surgery.

[10]  E.J. Berbari,et al.  A high-temporal resolution algorithm for quantifying organization during atrial fibrillation , 1999, IEEE Transactions on Biomedical Engineering.

[11]  Raúl Alcaraz,et al.  A non-invasive method to predict electrical cardioversion outcome of persistent atrial fibrillation , 2008, Medical & Biological Engineering & Computing.

[12]  Haitham M. Al-Angari,et al.  Atrial fibrillation and waveform characterization , 2006, IEEE Engineering in Medicine and Biology Magazine.

[13]  Raúl Alcaraz,et al.  Classification of Paroxysmal and Persistent Atrial Fibrillation in Ambulatory ECG Recordings , 2011, IEEE Transactions on Biomedical Engineering.

[14]  N. Ad.  The Cox-Maze procedure: History, results, and predictors for failure , 2007, Journal of Interventional Cardiac Electrophysiology.

[15]  J. J. Rieta,et al.  Adaptive singular value cancelation of ventricular activity in single-lead atrial fibrillation electrocardiograms , 2008, Physiological measurement.

[16]  P. Welch.  The use of fast Fourier transform for the estimation of power spectra: A method based on time averaging over short, modified periodograms , 1967 .

[17]  Haitham M. Al-Angari,et al.  Atrial fibrillation and waveform characterization. A time domain perspective in the surface ECG. , 2006, IEEE engineering in medicine and biology magazine : the quarterly magazine of the Engineering in Medicine & Biology Society.

[18]  E. Lefrak,et al.  Impact of follow-up on the success rate of the cryosurgical maze procedure in patients with rheumatic heart disease and enlarged atria. , 2006, The Journal of thoracic and cardiovascular surgery.