Abstract
The autonomic nervous system (ANS) is an important factor in cardiac arrhythmia, and information about ANS activity during atrial fibrillation (AF) may contribute to personalized treatment. In this study we aim to quantify respiratory modulation in the f-wave frequency trend from resting ECG. First, an f-wave signal is extracted from the ECG by QRST cancelation. Second, an f-wave model is fitted to the f-wave signal to obtain a high resolution f-wave frequency trend and an index for signal quality control (). Third, respiratory modulation in the f-wave frequency trend is extracted by applying a narrow band-pass filter. The center frequency of the band-pass filter is determined by the respiration rate. Respiration rate is estimated from a surrogate respiration signal, obtained from the ECG using homomorphic filtering. Peak conditioned spectral averaging, where spectra of sufficient quality from different leads are averaged, is employed to obtain a robust estimate of the respiration rate. The envelope of the filtered f-wave frequency trend is used to quantify the magnitude of respiratory induced f-wave frequency modulation. The proposed methodology is evaluated using simulated f-wave signals obtained using a sinusoidal harmonic model. Results from simulated signals show that the magnitude of the respiratory modulation is accurately estimated, quantified by an error below 0.01 Hz, if the signal quality is sufficient (). The proposed method was applied to analyze ECG data from eight pacemaker patients with permanent AF recorded at baseline, during controlled respiration, and during controlled respiration after injection of atropine, respectively. The magnitude of the respiratory induce f-wave frequency modulation was 0.15 ± 0.01, 0.18 ± 0.02, and 0.17 ± 0.03 Hz during baseline, controlled respiration, and post-atropine, respectively. Our results suggest that parasympathetic regulation affects the magnitude of respiratory induced f-wave frequency modulation.
Highlights
Despite progress in atrial fibrillation (AF) treatment, such as ablation procedures, strokeprevention procedures, and anti-arrhythmic drugs, AF still is associated with significant mortality in middle-aged and older adults, and it constitutes a substantial burden to the health economy (Hindricks et al, 2020)
Signal quality S and fwere estimated from the simulated fwave signals using the methods described in sections 2.4 and 2.5, respectively
We introduce a novel approach to quantify respiratory induced variations in the f-wave frequency from the ECG
Summary
Despite progress in atrial fibrillation (AF) treatment, such as ablation procedures, strokeprevention procedures, and anti-arrhythmic drugs, AF still is associated with significant mortality in middle-aged and older adults, and it constitutes a substantial burden to the health economy (Hindricks et al, 2020). The prevalence of AF increases with age and is Respiratory Induced Modulation in AF higher in men. In a Swedish study including 30,447 individuals, AF prevalence was 1.5% higher in men and increased from 2 per 1,000 in ages 45–49 to 29 per 1,000 in ages 70–74 (Smith et al, 2010). There are some substantial modifiers which contribute to the maintenance and progression of AF, such as atrial fibrosis and aging, ion-channel dysfunction, autonomic imbalance, and genetic background (Fabritz et al, 2016). Better understanding and monitoring of these AF-causing factors can contribute to personalized AF treatment
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