title: A signal processing pipeline for noninvasive imaging of ventricular preexcitation.
abstract: OBJECTIVE
  Noninvasive imaging of the cardiac activation sequence in humans could guide interventional curative treatment of cardiac arrhythmias by catheter ablation. Highly automated signal processing tools are desirable for clinical acceptance. The developed signal processing pipeline reduces user interactions to a minimum, which eases the operation by the staff in the catheter laboratory and increases the reproducibility of the results.
  
  
  METHODS
  A previously described R-peak detector was modified for automatic detection of all possible targets (beats) using the information of all leads in the ECG map. A direct method was applied for signal classification. The algorithm was tuned for distinguishing beats with an adenosine induced AV-nodal block from baseline morphology in Wolff-Parkinson-White (WPW) patients. Furthermore, an automatic identification of the QRS-interval borders was implemented.
  
  
  RESULTS
  The software was tested with data from eight patients having overt ventricular preexcitation. The R-peak detector captured all QRS-complexes with no false positive detection. The automatic classification was verified by demonstrating adenosine-induced prolongation of ventricular activation with statistical significance (p <0.001) in all patients. This also demonstrates the performance of the automatic detection of QRS-interval borders. Furthermore, all ectopic or paced beats were automatically separated from sinus rhythm. Computed activation maps are shown for one patient localizing the accessory pathway with an accuracy of 1 cm.
  
  
  CONCLUSIONS
  The implemented signal processing pipeline is a powerful tool for selecting target beats for noninvasive activation imaging in WPW patients. It robustly identifies and classifies beats. The small beat to beat variations in the automatic QRS-interval detection indicate accurate identification of the time window of interest.
authors.affiliation: Institute for Biomedical Signal Processing and Imaging, University for Health Sciences, Medical Informatics and Technology, Hall i T, Austria. Gerald.Fischer@umit.at
authors.forename: G
authors.initials: G
authors.lastname: Fischer
authors.forename: F
authors.initials: F
authors.lastname: Hanser
authors.forename: B
authors.initials: B
authors.lastname: Pfeifer
authors.forename: M
authors.initials: M
authors.lastname: Seger
authors.forename: C
authors.initials: C
authors.lastname: Hintermüller
authors.forename: R
authors.initials: R
authors.lastname: Modre
authors.forename: B
authors.initials: B
authors.lastname: Tilg
authors.forename: T
authors.initials: T
authors.lastname: Trieb
authors.forename: T
authors.initials: T
authors.lastname: Berger
authors.forename: F X
authors.initials: FX
authors.lastname: Roithinger
authors.forename: F
authors.initials: F
authors.lastname: Hintringer
mesh_terms: D000200:Action Potentials; D000241:Adenosine; D000328:Adult; D000465:Algorithms; D017115:Catheter Ablation; D004562:Electrocardiography; D004594:Electrophysiology; D005260:Female; D006801:Humans; D008953:Models, Anatomic; D012815:Signal Processing, Computer-Assisted; D012984:Software; D013997:Time Factors; D018879:Ventricular Premature Complexes / Q000175:diagnosis* / Q000601:surgery; D014927:Wolff-Parkinson-White Syndrome / Q000175:diagnosis* / Q000601:surgery
chemical_list: D000241:Adenosine