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Real-Time Cardiac Mapping with a Noninvasive Imageless Electrocardiographic Imaging System
Published on: April 11, 2025
An easy-to-use technique to characterize cardiodynamics from first-return maps on ΔRR-intervals
Emeline Fresnel1, Emad Yacoub1, Ubiratan Freitas2
1CORIA UMR 6614-Normandie Université, CNRS et INSA de Rouen, Campus Universitaire du Madrillet, F-76800 Saint-Etienne du Rouvray, France.
Insights
Analyzing beat-to-beat interval variations (ΔRR) reveals distinct cardiac rhythm patterns in patients with normal sinus rhythm, congestive heart failure, and atrial fibrillation. This novel approach using Shannon entropy and asymmetry coefficients enhances cardiovascular status assessment.
Area of Science:
- Cardiology
- Nonlinear dynamics
- Biomedical signal processing
Background:
- Heart rate variability (HRV) analysis via 24-hour Holter monitoring is standard for cardiovascular assessment.
- Beat-to-beat interval variations (ΔRR) provide deeper insights into cardiodynamics than traditional RR-intervals.
- Existing HRV methods may not fully capture complex cardiac rhythm alterations in various conditions.
Purpose of the Study:
- To investigate the potential of first-return maps based on ΔRR for classifying cardiac rhythm structures.
- To introduce and validate novel quantitative measures (Shannon entropy, asymmetry coefficient) for distinguishing these structures.
- To assess the heart's rhythm modulation capacity using a characteristic time scale derived from entropy maximization.
Main Methods:
- Retrospective analysis of 24-hour Holter monitoring data from three adult groups: normal sinus rhythm, congestive heart failure, and atrial fibrillation.
- Construction of first-return maps using beat-to-beat interval variations (ΔRR).
- Calculation of Shannon entropy from symbolic dynamics and a novel asymmetry coefficient to characterize map structures; determination of a characteristic time scale.
Main Results:
- First-return maps of ΔRR exhibited three distinct geometric structures: moderate central disk, reduced central disk with segments, and large triangular shape.
- Shannon entropy and asymmetry coefficient effectively distinguished these three structures.
- The characteristic time scale, linked to maximal Shannon entropy, significantly differed across the three identified structures, indicating varying cardiac rhythm modulation abilities.
- A blind validation confirmed the technique's efficacy.
Conclusions:
- First-return maps of ΔRR, analyzed with Shannon entropy and asymmetry coefficients, offer a robust method for classifying cardiac rhythm dynamics.
- This approach distinguishes between normal sinus rhythm, congestive heart failure, and atrial fibrillation based on distinct cardiodynamic structures.
- The introduced methods provide valuable quantitative insights into cardiovascular status and the heart's adaptability.
Abstract:
Heart rate variability analysis using 24-h Holter monitoring is frequently performed to assess the cardiovascular status of a patient. The present retrospective study is based on the beat-to-beat interval variations or ΔRR, which offer a better view of the underlying structures governing the cardiodynamics than the common RR-intervals. By investigating data for three groups of adults (with normal sinus rhythm, congestive heart failure, and atrial fibrillation, respectively), we showed that the first-return maps built on ΔRR can be classified according to three structures: (i) a moderate central disk, (ii) a reduced central disk with well-defined segments, and (iii) a large triangular shape. These three very different structures can be distinguished by computing a Shannon entropy based on a symbolic dynamics and an asymmetry coefficient, here introduced to quantify the balance between accelerations and decelerations in the cardiac rhythm. The probability P111111 of successive heart beats without large beat-to-beat fluctuations allows to assess the regularity of the cardiodynamics. A characteristic time scale, corresponding to the partition inducing the largest Shannon entropy, was also introduced to quantify the ability of the heart to modulate its rhythm: it was significantly different for the three structures of first-return maps. A blind validation was performed to validate the technique.
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