Machine learning enables noninvasive prediction of atrial fibrillation driver location and acute pulmonary vein ablation success using the 12-lead ECG

Figures

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  Figure 1. A.1: Example of simulated atrial fibrillation (AF) driver located near the pulmonary veins (PVs). B.1: Example of simulated AF driver located in an extra-PV region (right atrial appendage in this case). The red arrows show the AF driver position and propagation direction. A.2, B.2: Body surface potential maps (BSPMs) on 1 magnetic resonance imaging–derived torso model. The torso potentials were obtained by solving the forward problem of electrocardiography from the simulated transmembrane voltages on the atria. A.3, B.3: f-waves for leads I, II, and V1 from the 12-lead electrocardiogram signals extracted from the BSPMs.

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  Figure 2. Example of the atrial regions used to define the classes in which the atrial fibrillation drivers are located. A: Pulmonary veins (PVs) (pink) and extra-PV areas (blue) for binary classification. B: PVs (pink), extra-PV left atrium areas (blue), and right atrium (green) for 3-class classification.

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  Figure 3. Scar lines were applied on the atrial models to simulate several ablation procedures. In the atrial model, the right endocardium is shown in white, the left endocardium in red, both epicardia in blue, and the scar lines in cyan. A: Pulmonary vein isolation (PVI): Scars added circumferentially around ipsilateral PVs. B: PVI+RL: Roofline scar added between the left PVI and the right PVI. C: PVI+RL+MI: Scar added between the left PVI and the mitral valve (mitral isthmus ablation).

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  Figure 4. A: Histogram of the 11 most selected features in the 100 iterations of the binary hold-out cross-validation classification for atrial fibrillation (AF) driver localization (pulmonary vein [PV] vs extra-PV). These 11 features were used as a feature set for the clinical test. B: Histogram of the 13 most selected features in the 100 iterations of the 3-class hold-out cross-validation classification: PV vs extra-PV left atrial vs right atrial AF drivers.