Electrical Cardioversion Outcome Prognosis: A Multivariate Multiscale Entropy Characterization of Atrial Activity in Persistent Atrial Fibrillation

dc.contributor.authorCirugeda Roldan, Eva Maria
dc.contributor.authorPlancha, Eva
dc.contributor.authorHidalgo, Victor Manuel
dc.contributor.authorCalero, Sofía
dc.contributor.authorRieta, José Joaquín
dc.contributor.authorAlcaraz, Raúl
dc.date.accessioned2025-07-31T06:24:04Z
dc.date.available2025-07-31T06:24:04Z
dc.date.issued2025-07-24
dc.description.abstractBackground: Atrial fibrillation (AF) remains a significant cause of stroke, heart failure, and cardiovascular morbidity worldwide. Despite advancements in AF management, electrical cardioversion (ECV) remains the most commonly used technique for sinus rhythm (SR) restoration although presenting a limited success rate in the mid-term along with a high number of side-effects which can lead to an increase in patients health deterioration and, consequently, in healthcare costs. Hence, predicting ECV outcome in the mid-term remains a challenging task. Here, a new framework based on multivariate multiscale entropy (MMSE) characterization of atrial activity is proposed to improve ECV outcome prediction in the mid-term. Methods: 58 patients with persistent AF scheduled for ECV were considered. A 12-Lead standard ECG segment of 1.5 min duration prior to the first electrical shock was analyzed. The atrial activity (AA) is estimated from the 12-lead surface ECG using a QT segment removal algorithm based on QRS complex estimation and pattern recognition techniques. AA is characterized by means of multivariate extensions of traditional indices such as the amplitude of the fibrillatory waves and dominant frequency along with multivariate extensions of complexity measures as multivariate Sample Entropy and finally Multivariate Multiscale Entropy (MMSE). These indices were estimated over 12-lead ECG records from 58 ECV derived patients who were classified based on SR maintenance after 30-day follow up (mid-term evaluation). ECV prognosis was evaluated using ROC curves and Youden’s Criteria for optimal threshold establishment. Performance was compared to that of unidimensional indices. Results: Patients who maintained SR post-ECV exhibited distinct complexity patterns compared to those who relapsed into AF. Specifically, MMSE provided higher discriminant accuracy than traditional unidimensional indices. When considering only the limb leads in the analysis, the best performance was achieved, over 83% accurate classification of SR restoration in the mid-term (Se = 0.74, Sp = 0.85, p ≤ 0.001). Additionally, the accumulated entropy and slope of the MMSE curves, offered robust predictors of ECV outcomes providing better balanced sensitivity and specificity ROC curves. Conclusions: This work highlights the importance of multivariate approaches in AF characterization and provides a comprehensive framework for improving ECV outcome prediction, providing an increase in almost a 30% of correct predictions in the mid-term. Future research should explore the integration of these methods into clinical practice to optimize treatment strategies for AF patients and reduced healthcare costs.
dc.identifier.citationEva María Cirugeda Roldan, Eva Plancha, Victor M. Hidalgo, Sofía Calero, Jose Joaquín Rieta, Raul Alcaraz, Electrical Cardioversion Outcome Prognosis: A Multivariate Multiscale Entropy Characterization of Atrial Activity in Persistent Atrial Fibrillation, IRBM, Volume 46, Issue 5, 2025, 100905, ISSN 1959-0318, https://doi.org/10.1016/j.irbm.2025.100905.
dc.identifier.doi10.1016/j.irbm.2025.100905
dc.identifier.issn1959-0318
dc.identifier.urihttps://hdl.handle.net/10115/96677
dc.language.isoen
dc.publisherElsevier
dc.rightsAttribution-NonCommercial 4.0 Internationalen
dc.rights.accessRightsinfo:eu-repo/semantics/openAccess
dc.rights.urihttp://creativecommons.org/licenses/by-nc/4.0/
dc.subjectAtrial fibrillation
dc.subjectComplexity analysis
dc.subjectElectrical cardioversion
dc.subjectMultivariate multi-scale entropy
dc.subjectSpatial complexity
dc.subject12-Lead surface electrocardiogram
dc.titleElectrical Cardioversion Outcome Prognosis: A Multivariate Multiscale Entropy Characterization of Atrial Activity in Persistent Atrial Fibrillation
dc.typeArticle

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