BACKGROUND—Specific noninvasive signal processing was applied to identify drivers in distinct categories of persistent atrial fibrillation (AF).
METHODS AND RESULTS—In 103 consecutive patients with ...persistent AF, accurate biatrial geometry relative to an array of 252 body surface electrodes was obtained from a noncontrast computed tomography scan. The reconstructed unipolar AF electrograms acquired at bedside from multiple windows (duration, 9±1 s) were signal processed to identify the drivers (focal or reentrant activity) and their cumulative density map. The driver domains were catheter ablated by using AF termination as the procedural end point in comparison with the stepwise-ablation control group. The maps showed incessantly changing beat-to-beat wave fronts and varying spatiotemporal behavior of driver activities. Reentries were not sustained (median, 2.6 rotations lasting 449±89 ms), meandered substantially but recurred repetitively in the same region. In total, 4720 drivers were identified in 103 patients3802 (80.5%) reentries and 918 (19.5%) focal breakthroughs; most of them colocalized. Of these, 69% reentries and 71% foci were in the left atrium. Driver ablation alone terminated 75% and 15% of persistent and long-lasting AF, respectively. The number of targeted driver regions increased with the duration of continuous AF2 in patients presenting in sinus rhythm, 3 in AF lasting 1 to 3 months, 4 in AF lasting 4 to 6 months, and 6 in AF lasting longer. The termination rate sharply declined after 6 months. The mean radiofrequency delivery to AF termination was 28±17 minutes versus 65±33 minutes in the control group (P<0.0001). At 12 months, 85% patients with AF termination were free from AF, similar to the control population (87%,); P=not significant.
CONCLUSIONS—Persistent AF in early months is maintained predominantly by drivers clustered in a few regions, most of them being unstable reentries.
Atrial fibrillation (AF) is a cardiac arrhythmia characterized by rapid and irregular atrial electrical activity with a high clinical impact on stroke incidence. Best available therapeutic strategies ...combine pharmacological and surgical means. But when successful, they do not always prevent long-term relapses. Initial success becomes all the more tricky to achieve as the arrhythmia maintains itself and the pathology evolves into sustained or chronic AF. This raises the open crucial issue of deciphering the mechanisms that govern the onset of AF as well as its perpetuation. In this study, we develop a wavelet-based multi-scale strategy to analyze the electrical activity of human hearts recorded by catheter electrodes, positioned in the coronary sinus (CS), during episodes of AF. We compute the so-called multifractal spectra using two variants of the wavelet transform modulus maxima method, the moment (partition function) method and the magnitude cumulant method. Application of these methods to long time series recorded in a patient with chronic AF provides quantitative evidence of the multifractal intermittent nature of the electric energy of passing cardiac impulses at low frequencies, i.e., for times (≳0.5 s) longer than the mean interbeat (≃ 10
s). We also report the results of a two-point magnitude correlation analysis which infers the absence of a multiplicative time-scale structure underlying multifractal scaling. The electric energy dynamics looks like a "multifractal white noise" with quadratic (log-normal) multifractal spectra. These observations challenge concepts of functional reentrant circuits in mechanistic theories of AF, still leaving open the role of the autonomic nervous system (ANS). A transition is indeed observed in the computed multifractal spectra which group according to two distinct areas, consistently with the anatomical substrate binding to the CS, namely the left atrial posterior wall, and the ligament of Marshall which is innervated by the ANS. In a companion paper (II. Modeling), we propose a mathematical model of a denervated heart where the kinetics of gap junction conductance alone induces a desynchronization of the myocardial excitable cells, accounting for the multifractal spectra found experimentally in the left atrial posterior wall area.
We present significant improvements to our previous work on noise reduction in Herschel observation maps by defining sparse filtering tools capable of handling, in a unified formalism, a ...significantly improved noise reduction as well as a deconvolution in order to reduce effects introduced by the limited instrumental response (beam). We implement greater flexibility by allowing a wider choice of parsimonious priors in the noise-reduction process. More precisely, we introduce a sparse filtering and deconvolution approach approach of type $l^2$-$l^p$, with $p > 0$ variable and apply it to a larger set of molecular clouds using Herschel $m data in order to demonstrate their wide range of application. In the Herschel data, we are able to use this approach to highlight extremely fine filamentary structures and obtain singularity spectra that tend to show a significantly less log -normal behavior and a filamentary nature in the less dense regions. We also use high-resolution adaptive magneto-hydrodynamic simulation data to assess the quality of deconvolution in such a simulated beaming framework.
Observations of the interstellar medium (ISM) show a complex density and velocity structure, which is in part attributed to turbulence. Consequently, the multifractal formalism should be applied to ...observation maps of the ISM in order to characterize its turbulent and multiplicative cascade properties. However, the multifractal formalism, even in its more advanced and recent canonical versions, requires a large number of realizations of the system, which usually cannot be obtained in astronomy. We present a self-contained introduction to the multifractal formalism in a “microcanonical” version, which allows us, for the first time, to compute precise turbulence characteristic parameters from a single observational map without the need for averages in a grand ensemble of statistical observables (e.g., a temporal sequence of images). We compute the singularity exponents and the singularity spectrum for both observations and magnetohydrodynamic simulations, which include key parameters to describe turbulence in the ISM. For the observations we focus on the 250 μm
Herschel
map of the Musca filament. Scaling properties are investigated using spatial 2D structure functions, and we apply a two-point log-correlation magnitude analysis over various lines of the spatial observation, which is known to be directly related to the existence of a multiplicative cascade under precise conditions. It reveals a clear signature of a multiplicative cascade in Musca with an inertial range from 0.05–0.65 pc. We show that the proposed microcanonical approach provides singularity spectra that are truly scale invariant, as required to validate any method used to analyze multifractality. The obtained singularity spectrum of Musca, which is sufficiently precise for the first time, is clearly not as symmetric as usually observed in log-normal behavior. We claim that the singularity spectrum of the ISM toward Musca features a more log-Poisson shape. Since log-Poisson behavior is claimed to exist when dissipation is stronger for rare events in turbulent flows, in contrast to more homogeneous (in volume and time) dissipation events, we suggest that this deviation from log-normality could trace enhanced dissipation in rare events at small scales, which may explain, or is at least consistent with, the dominant filamentary structure in Musca. Moreover, we find that subregions in Musca tend to show different multifractal properties: While a few regions can be described by a log-normal model, other regions have singularity spectra better fitted by a log-Poisson model. This strongly suggests that different types of dynamics exist inside the Musca cloud. We note that this deviation from log-normality and these differences between subregions appear only after reducing noise features, using a sparse edge-aware algorithm, which have the tendency to “log-normalize” an observational map. Implications for the star formation process are discussed. Our study establishes fundamental tools that will be applied to other galactic clouds and simulations in forthcoming studies.
The paper assesses stationary probability distributions in out of equilibrium systems. In the phenomenology proposed, no free energy can be well defined. Fluctuations of Landau free energy couplings ...arise when the intrinsic chemical potential leads to intrinsic disorder. The relaxation is shown to take the form of a geometrical random process. Systems of this kind show criticality features as well as that of first order transitions, which encapsulate in the form of a generalized static fluctuation dissipation relation. This will help determine three classes of distributions, which are, by defining a Hurst exponent for the relaxation rate: the regular Maxwell-Boltzmann for all H < 1/2; the usual scale free universal distributions with power law tails for H in 1/2,1; and a new class. The latter lies in the intermediate case, when H = 1/2. The distribution functions are scale free close to the origin, and cross-over to a Maxwell-Boltzmann asymptotic behavior, with both the scaling exponent and an effective temperature that depend on the magnitude of the intrinsic disorder.
Ma thèse développe essentiellement la phénoménologie d'une forme particulière de relaxation pour le non équilibre ; d'abord dans le cas du plasma magnétisé, où il est identifié en un sens précis un ...point critique, autour duquel la relaxation est intermittente, puis dans un cadre plus général. Est reconsidéré la résonance entre ondes de Langmuir et particules : "l'amortissement Landau" n'est pas de nature cinétique, pour la simple raison que le champ est moyen. La preuve est apportée par le calcul des susceptibilités. Etablir cette preuve nécessite de recourir à l'hypothèse de linéarité thermodynamique, or l'instabilité est du type Rayleigh, qui développe une turbulence loin de l'équilibre. Il s'avère que dans une description de type Van der Waals, la définition de l'énergie libre est compromise par des coefficients fluctuants : des cycles s'effectuent entre les régions sur-critique et métastable. Par extrapolation de la théorie de Landau, ou avec l'argument d'une orbite de renormalisation chaotique,à cause de la présence d'un champ extérieur, intrinsèque et non nul, on détermine les exposants critiques. Ils sont notoirement différentes de ceux que livrent la théorie statique ou même la théorie dynamique critique. En particulier, z=1. Dans le régime stationnaire, l'hypothèse d'invariance d'échelle permet d'associer une généralisation de la relation de fluctuation-dissipation. Il y a l'amorce de la détermination, assez universelle, des distributions non maxwelliennes.
Measuring the mean cycle length (CL) of a rapidly beating heart is considered an efficient way to monitor arrhythmia such as atrial fibrillation (AF). Routinely, sequential CL mapping, using contact ...catheters in the atria, provides indications on the localization of regions involved in AF. In particular, this technique helps the practitioner, during ablation procedures, to identify some features of the arrhythmia, as, for instance, the driving atrium, or the fastest regions, or its complexity. In this study, we propose a non invasive mapping of CL (niCL), using phase information extracted from electrocardiographic imaging signals (ECGI). niCL mapping provides with a real time ablation planning to the bedside of patients, prior to ablation procedure. The results of this study validate the method in showing a direct correlation between endocavitory (inside the heart) measurements of CL (enCL) and niCL mapping.
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