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Session: Cardiovascular diseases
Session starts: Friday 25 January, 13:00
Presentation starts: 13:00
Room: Lecture room 558

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Linda Eerikäinen (Eindhoven University of Technology, and Philips Research)
Alberto Bonomi (Philips Research)
Lukas Dekker (Catharina Hospital Eindhoven, and Eindhoven University of Technology)
Fons Schipper (Philips Research)
Rik Vullings (Eindhoven University of Technology)
Ronald Aarts (Eindhoven University of Technology, and Philips Research)

Abstract:
Background: Mechanical restitution and post-extrasystolic potentiation are the two aspects of force-interval relationship (FIR) of the heart, and represent the change in the contractile strength in relation to change in inter-beat intervals (IBI) [1]. Studies with invasive measures have shown that these relationships are present during atrial fibrillation (AF) [2], an arrhythmia in which the IBIs vary beat-by-beat. Moreover, these relationships are altered in heart failure (HF) compared to non-failing hearts [1]. AF and HF often coexist and one of the conditions can cause the other. Therefore, an unobtrusive continuous measurement of FIRs could be beneficial, possibly showing indications of deterioration in the patient’s condition. We hypothesize that FIRs could be assessed during AF with IBIs and hemodynamic changes captured unobtrusively by photoplethysmography (PPG) at the wrist, assuming a stronger correlation between the IBIs and PPG waveform changes during irregular rhythms. Methods: 14 subjects with continuous AF and 18 subjects with sinus rhythm were measured during the night with PPG at the wrist and with electrocardiography as a reference. The FIRs were assessed by correlation between either the preceding or pre-preceding IBIs and pulse onset change in the PPG waveform. The correlation coefficients r_(pre) and r_(pre-pre) were calculated in 5-minute windows over the measurement period [3]. The difference in the correlation coefficients between the two rhythms was analysed with Mann-Whitney U test and Receiver Operating Characteristics (ROC). Results: The mean and standard deviation of r_(pre) were -0.25 ± 0.08 and 0.05 ± 0.12 (p < 0.0001), and of r_(pre-pre) 0.60 ± 0.09 and 0.16 ± 0.14 (p < 0.0001), during AF and sinus rhythm, respectively. Areas under the ROC curve were 0.987 and 0.998, respectively. Conclusion: A stronger correlation between the IBIs and the PPG waveform changes was observed during atrial fibrillation, possibly representing presence of FIRs. Significance: An unobtrusive method to measure FIR in long-term in patients with AF, who therefore have the risk of developing HF, could be useful for disease management and be of interest for further studies. REFERENCES [1] Sprenkeler, D. J. & Vos, M. A., 2016. Post-extrasystolic Potentiation: Link between Ca2+ Homeostasis and Heart Failure?. Arrhythm Electrophysiol Rev, 5(1), pp. 20-26. [2] Brookes, C. I. O., White, P. A., Staples, M., Oldershaw, P. J., Redington, A. N., Collings, P. D., Noble, M. I. M., 1998. Myocardial Contractility Is Not Constant During Spontaneous Atrial Fibrillation in Patients. Circulation, 98, pp. 1762-68. [3] Eerikäinen, L.M., Bonomi, A.G., Dekker L., Schipper, F. Vullings, R., Aarts, R.M. Force-interval Relationships of the Heart Measured with Photoplethysmography during Atrial Fibrillation. Computing in Cardiology, Maastricht, Netherlands, Sep 23-26, 2018.