Automated Classification and Identification of Slow Wave Propagation Patterns in Gastric Dysrhythmia

The advent of high-resolution (HR) electrical mapping of slow wave activity has significantly improved the understanding of gastric slow wave activity in normal and dysrhythmic states. One of the current limitations of this technique is it generates a vast amount of data, making manual analysis a tedious task for research and clinical development. In this study we present new automated methods to classify, identify, and locate patterns of interest in gastric slow wave propagation. The classification method uses a similarity metric to classify slow wave propagations, while the identification algorithm uses the divergence and mean curvature of the slow wave propagation to identify and regionalize patterns of interest. The methods were applied to synthetic and experimental datasets and were also compared to manual analysis. The methods classified and identified patterns of slow wave propagation in less than 1 s, compared to manual analysis which took up to 40 min. The automated methods achieved 96% accuracy in classifying AT maps, and 95% accuracy in identifying the propagation pattern with a mean spatial error of 1.5 mm in comparison to manual methods. These new methods will facilitate the efficient translation of gastrointestinal HR mapping techniques to clinical practice.

[1]  Tamara N. Fitzgerald,et al.  Identification of cardiac rhythm features by mathematical analysis of vector fields , 2005, IEEE Transactions on Biomedical Engineering.

[2]  W. Lammers,et al.  Focal activities and re-entrant propagations as mechanisms of gastric tachyarrhythmias. , 2008, Gastroenterology.

[3]  P. Nielsen,et al.  High-resolution Mapping of In Vivo Gastrointestinal Slow Wave Activity Using Flexible Printed Circuit Board Electrodes: Methodology and Validation , 2009, Annals of Biomedical Engineering.

[4]  H. Parkman,et al.  Electrogastrography: a document prepared by the gastric section of the American Motility Society Clinical GI Motility Testing Task Force , 2003, Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society.

[5]  A. Pullan,et al.  Biophysically Based Modeling of the Interstitial Cells of Cajal: Current Status and Future Perspectives , 2011, Front. Physio..

[6]  Andrew J. Pullan,et al.  Quantification of velocity anisotropy during gastric electrical arrhythmia , 2011, 2011 Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[7]  W. Lammers,et al.  Gut peristalsis is governed by a multitude of cooperating mechanisms. , 2009, American journal of physiology. Gastrointestinal and liver physiology.

[8]  A. Pullan,et al.  Origin, propagation and regional characteristics of porcine gastric slow wave activity determined by high‐resolution mapping , 2010, Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society.

[9]  H. Parkman,et al.  Gastric electrical stimulation with Enterra therapy improves symptoms from diabetic gastroparesis in a prospective study. , 2010, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[10]  R. McCallum,et al.  Gastric myoelectrical activity and gastric emptying in patients with functional dyspepsia , 1998, American Journal of Gastroenterology.

[11]  P. Pasricha,et al.  Clinical‐histological associations in gastroparesis: results from the Gastroparesis Clinical Research Consortium , 2012, Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society.

[12]  Leo K. Cheng,et al.  The gastrointestinal electrical mapping suite (GEMS): software for analyzing and visualizing high-resolution (multi-electrode) recordings in spatiotemporal detail , 2012, BMC Gastroenterology.

[13]  Richard A. Gray,et al.  Measuring curvature and velocity vector fields for waves of cardiac excitation in 2-D media , 2005, IEEE Transactions on Biomedical Engineering.

[14]  Luc Ver Donck,et al.  Origin and propagation of the slow wave in the canine stomach: the outlines of a gastric conduction system. , 2009, American journal of physiology. Gastrointestinal and liver physiology.

[15]  Leo K. Cheng,et al.  A novel laparoscopic device for measuring gastrointestinal slow-wave activity , 2009, Surgical Endoscopy.

[16]  Leo K. Cheng,et al.  Origin and propagation of human gastric slow-wave activity defined by high-resolution mapping. , 2010, American journal of physiology. Gastrointestinal and liver physiology.

[17]  Leo K. Cheng,et al.  Toward the virtual stomach: progress in multiscale modeling of gastric electrophysiology and motility , 2013, Wiley interdisciplinary reviews. Systems biology and medicine.

[18]  Andrew J. Pullan,et al.  Abnormal initiation and conduction of slow-wave activity in gastroparesis, defined by high-resolution electrical mapping. , 2012, Gastroenterology.

[19]  M. Allessie,et al.  Intra-atrial reentry as a mechanism for atrial flutter induced by acetylcholine and rapid pacing in the dog. , 1984, Circulation.

[20]  A. Gray,et al.  Modern Differential Geometry of Curves and Surfaces with Mathematica, Third Edition (Studies in Advanced Mathematics) , 2006 .

[21]  W. Lammers,et al.  Arrhythmias in the gut , 2013, Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society.

[22]  Andrew J. Pullan,et al.  Automated Gastric Slow Wave Cycle Partitioning and Visualization for High-resolution Activation Time Maps , 2010, Annals of Biomedical Engineering.

[23]  Andrew J. Pullan,et al.  A framework for the online analysis of multi-electrode gastric slow wave recordings , 2011, 2011 Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[24]  G O'Grady,et al.  High‐resolution spatial analysis of slow wave initiation and conduction in porcine gastric dysrhythmia , 2011, Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society.

[25]  R. Ideker,et al.  Recurrent wavefront morphologies: A method for quantifying the complexity of epicardial activation patterns , 1997, Annals of Biomedical Engineering.

[26]  Jeffrey E. Saffitz,et al.  Reentrant and Focal Mechanisms Underlying Ventricular Tachycardia in the Human Heart , 1992, Circulation.

[27]  K. Koch The electrifying stomach , 2011, Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society.

[28]  A. Pullan,et al.  Circumferential and functional re‐entry of in vivo slow‐wave activity in the porcine small intestine , 2013, Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society.

[29]  Fernand Meyer,et al.  Topographic distance and watershed lines , 1994, Signal Process..

[30]  G O'Grady,et al.  Rapid high‐amplitude circumferential slow wave propagation during normal gastric pacemaking and dysrhythmias , 2012, Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society.

[31]  G. O’Grady,et al.  Comparison of filtering methods for extracellular gastric slow wave recordings , 2013, Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society.

[32]  Raymond E. Ideker,et al.  A quantitative framework for analyzing epicardial activation patterns during ventricular fibrillation , 1997, Annals of Biomedical Engineering.

[33]  Andrew J. Pullan,et al.  Improved signal processing techniques for the analysis of high resolution serosal slow wave activity in the stomach , 2011, 2011 Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[34]  W. Hasler,et al.  Physiology and pathophysiology of the interstitial cells of Cajal: from bench to bedside. VI. Pathogenesis and therapeutic approaches to human gastric dysrhythmias. , 2002, American journal of physiology. Gastrointestinal and liver physiology.

[35]  Herbert F. Voigt,et al.  IEEE Engineering in Medicine and Biology Society , 2019, IEEE Transactions on Biomedical Engineering.

[36]  Andrew J. Pullan,et al.  Falling-Edge, Variable Threshold (FEVT) Method for the Automated Detection of Gastric Slow Wave Events in High-Resolution Serosal Electrode Recordings , 2010, Annals of Biomedical Engineering.

[37]  W. Hasler,et al.  Effects of ginger on motion sickness and gastric slow-wave dysrhythmias induced by circular vection. , 2003, American journal of physiology. Gastrointestinal and liver physiology.

[38]  Andrew J. Pullan,et al.  An Improved Method for the Estimation and Visualization of Velocity Fields from Gastric High-Resolution Electrical Mapping , 2012, IEEE Transactions on Biomedical Engineering.