Temporal and spatial phase analyses of the electrocardiogram stratify intra-atrial and intra-ventricular organization

TitleTemporal and spatial phase analyses of the electrocardiogram stratify intra-atrial and intra-ventricular organization
Publication TypeJournal Article
Year of Publication2004
AuthorsNarayan, S. M., and V. K. Bhargava
JournalBiomedical Engineering, IEEE Transactions on
Pagination1749 -1764
Date Publishedoct.
KeywordsAdult, Aged, Algorithms, Arrhythmias, atrial fibrillation, atrial tachycardia, atrioventricular nodal tachycardia, broad band spectra, Cardiac, cardiovascular system, Computer-Assisted, correlation series, Diagnosis, electrocardiogram, Electrocardiography, Female, Heart Atria, Heart Conduction System, Heart Ventricles, Humans, intra-atrial organization, intra-ventricular organization, isthmus-dependent atrial flutter, Male, medical signal processing, Middle Aged, nonisthmus-dependent atrial flutter, orthodromic reciprocating tachycardia, Reproducibility of Results, Sensitivity and Specificity, spatial phase analyses, supraventricular tachycardias, temporal coherence, temporal phase analyses, ventricular arrhythmias, Ventricular Fibrillation, ventricular tachycardia

We hypothesized that electrocardiogram (ECG) spatial phase analysis would define a spectrum of intracardiac organization from atrial fibrillation (AF), nonisthmus-dependent and isthmus-dependent atrial flutter (AFL) to supraventricular tachycardias (SVT), and similarly for ventricular arrhythmias. We analyzed arrhythmia ECGs of 33 patients with isthmus (n=9) and nonisthmus (n=5) dependent AFL and SVT: atrial (n=3), atrioventricular nodal (n=3), and orthodromic reciprocating (n=3) tachycardias, as well as AF (n=5), ventricular tachycardia (monomorphic, VT-MM; n=7), and fibrillation (VF; n=3). ECG spatial phase was considered coherent when the correlation coefficient of an atrial (or ventricular) template to its ECG over time maintained a constant relationship in XY, XZ, and YZ planes. Regularity was quantified spectrally from ECG and correlation series. Spatial coherence occurred in 9/9 cases of isthmus- but only 1/5 of cases of nonisthmus-dependent AFL (p<0.01; chi;2). All showed one dominant spectral peak (temporal coherence). In AF, spatial phase was inconsistent in all planes and spectra were broad band. Temporal and spatial coherence occurred in other SVT. VT-MM maintained spatial phase and a single spectral peak, while VF displayed neither. Our conclusions are that temporal and spatial phase analysis from the ECG stratifies intra-atrial and intra-ventricular organization and reveals subtle variability lost on visual inspection.


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