Principal component analysis of atrial fibrillation: Inclusion of posterior ECG leads does not improve correlation with left atrial activity

Daniel Raine,Philip Langley,Ewen Shepherd,Stephen Lord,Stephen Murray,Alan Murray,John P Bourke

doi:10.1016/j.medengphy.2014.12.008

Daniel Raine, Philip Langley + Show 5 more

Open Access

https://doi.org/10.1016/j.medengphy.2014.12.008

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Abstract

BackgroundLead V1 is routinely analysed due to its large amplitude AF waveform. V1 correlates strongly with right atrial activity but only moderately with left atrial activity. Posterior lead V9 correlates strongest with left atrial activity. Aims(1) To establish whether surface dominant AF frequency (DAF) calculated using principal component analysis (PCA) of a modified 12-lead ECG (including posterior leads) has a stronger correlation with left atrial activity compared to the standard ECG. (2) To assess the contribution of individual ECG leads to the AF principal component in both ECG configurations. MethodsPatients were assigned to modified or standard ECG groups. In the modified ECG, posterior leads V8 and V9 replaced V4 and V6. AF waveform was extracted from one-minute surface ECG recordings using PCA. Surface DAF was correlated with intracardiac DAF from the high right atrium (HRA), coronary sinus (CS) and pulmonary veins (PVs). Results96 patients were studied. Surface DAF from the modified ECG did not have a stronger correlation with left atrial activity compared to the standard ECG. Both ECG configurations correlated strongly with HRA, CS and right PVs but only moderately with left PVs. V1 contributed most to the AF principal component in both ECG configurations.

Highlights

It is widely accepted that the atrial waveform seen on the surface ECG during atrial fibrillation (AF) reflects intracardiac electrical activity [1,2]
Given the evidence that posterior leads may provide a more accurate reflection of left atrial activity, the aims of this study were: (1) To establish whether surface dominant AF frequency (DAF) calculated using principal component analysis (PCA) of a modified 12-lead ECG had a stronger correlation with left atrial activity compared to the standard 12-lead ECG. (2) To assess the contribution of individual ECG leads to the AF principal component in both ECG configurations
Surface DAF from both modified and standard 12-lead ECG configurations correlated strongly with intracardiac DAF in the high right atrium (HRA), coronary sinus (CS) and right-sided pulmonary veins with all correlations being significant at the 0.01 level (Tables 2 and 3)

Summary

Introduction

It is widely accepted that the atrial waveform seen on the surface ECG during AF reflects intracardiac electrical activity [1,2]. The majority of studies analysing the body surface AF waveform using these techniques have focused on lead V1 due to the relatively large amplitude AF waveform in this lead This reliance on lead V1 detracts from the sensitivity of the results since V1 has been shown to correlate strongly with right atrial activity (r = 0.89) but only moderately with left atrial activity (r = 0.62) [2]. Aims: (1) To establish whether surface dominant AF frequency (DAF) calculated using principal component analysis (PCA) of a modified 12-lead ECG (including posterior leads) has a stronger correlation with left atrial activity compared to the standard ECG. Both ECG configurations correlated strongly with HRA, CS and right PVs but only moderately with left PVs. V1 contributed most to the AF principal component in both ECG configurations

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