QT interval Adaptation to Heart Rate Changes in Atrial Fibrillation as a Predictor of Sudden Cardiac Death

Objective: The clinical significance of QT interval adaptation to heart rate changes has been poorly investigated in atrial fibrillation (AF), since QT delineation in the presence of f-waves is challenging. Therefore, the objective of the present study is to investigate new techniques for QT adaptat...

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Autores: Martin-Yebra, A., Sornmo, L., Laguna, P.
Tipo de documento: artigo
Estado:Versión aceptada para publicación
Data de publicação:2022
País:España
Recursos:Universidad de Zaragoza
Repositório:Zaguán. Repositorio Digital de la Universidad de Zaragoza
OAI Identifier:oai:zaguan.unizar.es:118887
Acesso em linha:http://zaguan.unizar.es/record/118887
Access Level:Acceso aberto
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spelling QT interval Adaptation to Heart Rate Changes in Atrial Fibrillation as a Predictor of Sudden Cardiac DeathMartin-Yebra, A.Sornmo, L.Laguna, P.Objective: The clinical significance of QT interval adaptation to heart rate changes has been poorly investigated in atrial fibrillation (AF), since QT delineation in the presence of f-waves is challenging. Therefore, the objective of the present study is to investigate new techniques for QT adaptation estimation in permanent AF. Methods: A multilead strategy based on generalized periodic component analysis is proposed for QT delineation, involving a spatial, linear transformation which emphasizes Twave periodicity and attenuates f-waves. QT adaptation is modeled by a linear, time-invariant filter, whose impulse response describes the dependence between the current QT interval and the preceding RR intervals, followed by a memoryless, possibly nonlinear, function. The QT adaptation time lag is determined from the estimated impulse response. Results: Using simulated ECGs in permanent AF, the transformed lead was found to offer more accurate QT delineation and time lag estimation than did the original ECG leads for a wide range of f-wave amplitudes (the time lag estimation error was found to be -0.2+/-0.6 s for SNR = 12 dB). In a population with chronic heart failure and permanent AF, the time lag estimated from the transformed lead was found to have the strongest, statistically significant association with sudden cardiac death (SCD) (hazard ratio = 3.49), whereas none of the original, orthogonal leads had any such association. Conclusions: Periodic component analysis provides more accurate QT delineation and improves time lag estimation in AF. A prolonged adaptation time of the QT interval to heart rate changes is associated with a high risk for SCD. Significance: This study demonstrates that SCD risk markers, originally developed for sinus rhythm, can also be used in AF, provided that Twave periodicity is emphasized. The time lag is a potentially useful marker for identifying patients at high risk for SCD, guiding clinicians in adopting effective therapeutic decisions. IEEE2022info:eu-repo/semantics/articleinfo:eu-repo/semantics/acceptedVersionapplication/pdfhttp://zaguan.unizar.es/record/118887reponame:Zaguán. Repositorio Digital de la Universidad de Zaragozainstname:Universidad de ZaragozaInglésinfo:eu-repo/grantAgreement/ES/DGA-FSE/T39-20R-BSICoS groupinfo:eu-repo/grantAgreement/ES/MICINN-FEDER/PID2019-104881RB-I00info:eu-repo/grantAgreement/ES/MICINN-FEDER/PID2019-105674RB-I00info:eu-repo/semantics/openAccessoai:zaguan.unizar.es:1188872026-05-29T13:59:51Z
dc.title.none.fl_str_mv QT interval Adaptation to Heart Rate Changes in Atrial Fibrillation as a Predictor of Sudden Cardiac Death
title QT interval Adaptation to Heart Rate Changes in Atrial Fibrillation as a Predictor of Sudden Cardiac Death
spellingShingle QT interval Adaptation to Heart Rate Changes in Atrial Fibrillation as a Predictor of Sudden Cardiac Death
Martin-Yebra, A.
title_short QT interval Adaptation to Heart Rate Changes in Atrial Fibrillation as a Predictor of Sudden Cardiac Death
title_full QT interval Adaptation to Heart Rate Changes in Atrial Fibrillation as a Predictor of Sudden Cardiac Death
title_fullStr QT interval Adaptation to Heart Rate Changes in Atrial Fibrillation as a Predictor of Sudden Cardiac Death
title_full_unstemmed QT interval Adaptation to Heart Rate Changes in Atrial Fibrillation as a Predictor of Sudden Cardiac Death
title_sort QT interval Adaptation to Heart Rate Changes in Atrial Fibrillation as a Predictor of Sudden Cardiac Death
dc.creator.none.fl_str_mv Martin-Yebra, A.
Sornmo, L.
Laguna, P.
author Martin-Yebra, A.
author_facet Martin-Yebra, A.
Sornmo, L.
Laguna, P.
author_role author
author2 Sornmo, L.
Laguna, P.
author2_role author
author
description Objective: The clinical significance of QT interval adaptation to heart rate changes has been poorly investigated in atrial fibrillation (AF), since QT delineation in the presence of f-waves is challenging. Therefore, the objective of the present study is to investigate new techniques for QT adaptation estimation in permanent AF. Methods: A multilead strategy based on generalized periodic component analysis is proposed for QT delineation, involving a spatial, linear transformation which emphasizes Twave periodicity and attenuates f-waves. QT adaptation is modeled by a linear, time-invariant filter, whose impulse response describes the dependence between the current QT interval and the preceding RR intervals, followed by a memoryless, possibly nonlinear, function. The QT adaptation time lag is determined from the estimated impulse response. Results: Using simulated ECGs in permanent AF, the transformed lead was found to offer more accurate QT delineation and time lag estimation than did the original ECG leads for a wide range of f-wave amplitudes (the time lag estimation error was found to be -0.2+/-0.6 s for SNR = 12 dB). In a population with chronic heart failure and permanent AF, the time lag estimated from the transformed lead was found to have the strongest, statistically significant association with sudden cardiac death (SCD) (hazard ratio = 3.49), whereas none of the original, orthogonal leads had any such association. Conclusions: Periodic component analysis provides more accurate QT delineation and improves time lag estimation in AF. A prolonged adaptation time of the QT interval to heart rate changes is associated with a high risk for SCD. Significance: This study demonstrates that SCD risk markers, originally developed for sinus rhythm, can also be used in AF, provided that Twave periodicity is emphasized. The time lag is a potentially useful marker for identifying patients at high risk for SCD, guiding clinicians in adopting effective therapeutic decisions. IEEE
publishDate 2022
dc.date.none.fl_str_mv 2022
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dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
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info:eu-repo/grantAgreement/ES/MICINN-FEDER/PID2019-105674RB-I00
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