{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T03:12:21Z","timestamp":1760238741903,"version":"build-2065373602"},"reference-count":77,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2022,6,1]],"date-time":"2022-06-01T00:00:00Z","timestamp":1654041600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003329","name":"public grants","doi-asserted-by":"publisher","award":["DPI2017-83952-C3","PID2021-00X128525-IV0","PID2021-123804OB-I00","TED2021-129996B-I00","SBPLY\/17\/180501\/000411","Generalitat Valenciana"],"award-info":[{"award-number":["DPI2017-83952-C3","PID2021-00X128525-IV0","PID2021-123804OB-I00","TED2021-129996B-I00","SBPLY\/17\/180501\/000411","Generalitat Valenciana"]}],"id":[{"id":"10.13039\/501100003329","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003329","name":"Spanish Government 10.13039\/501100011033 jointly with the European Regional Development Fund (EU)","doi-asserted-by":"publisher","award":["DPI2017-83952-C3","PID2021-00X128525-IV0","PID2021-123804OB-I00","TED2021-129996B-I00","SBPLY\/17\/180501\/000411","Generalitat Valenciana"],"award-info":[{"award-number":["DPI2017-83952-C3","PID2021-00X128525-IV0","PID2021-123804OB-I00","TED2021-129996B-I00","SBPLY\/17\/180501\/000411","Generalitat Valenciana"]}],"id":[{"id":"10.13039\/501100003329","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011698","name":"Junta de Comunidades de Castilla-La Mancha","doi-asserted-by":"publisher","award":["DPI2017-83952-C3","PID2021-00X128525-IV0","PID2021-123804OB-I00","TED2021-129996B-I00","SBPLY\/17\/180501\/000411","Generalitat Valenciana"],"award-info":[{"award-number":["DPI2017-83952-C3","PID2021-00X128525-IV0","PID2021-123804OB-I00","TED2021-129996B-I00","SBPLY\/17\/180501\/000411","Generalitat Valenciana"]}],"id":[{"id":"10.13039\/501100011698","id-type":"DOI","asserted-by":"publisher"}]},{"name":"AICO\/2021\/286","award":["DPI2017-83952-C3","PID2021-00X128525-IV0","PID2021-123804OB-I00","TED2021-129996B-I00","SBPLY\/17\/180501\/000411","Generalitat Valenciana"],"award-info":[{"award-number":["DPI2017-83952-C3","PID2021-00X128525-IV0","PID2021-123804OB-I00","TED2021-129996B-I00","SBPLY\/17\/180501\/000411","Generalitat Valenciana"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Coronary sinus (CS) catheterization is critical during catheter ablation (CA) of atrial fibrillation (AF). However, the association of CS electrical activity with atrial substrate modification has been barely investigated and mostly limited to analyses during AF. In sinus rhythm (SR), atrial substrate modification is principally assessed at a global level through P-wave analysis. Cross-correlating CS electrograms (EGMs) and P-waves\u2019 features could potentiate the understanding of AF mechanisms. Five-minute surface lead II and bipolar CS recordings before, during, and after CA were acquired from 40 paroxysmal AF patients. Features related to duration, amplitude, and heart-rate variability of atrial activations were evaluated. Heart-rate adjustment (HRA) was applied. Correlations between each P-wave and CS local activation wave (LAW) feature were computed with cross-quadratic sample entropy (CQSE), Pearson correlation (PC), and linear regression (LR) with 10-fold cross-validation. The effect of CA between different ablation steps was compared with PC. Linear correlations: poor to mediocre before HRA for analysis at each P-wave\/LAW (PC: max. +18.36%, p = 0.0017, LR: max. +5.33%, p = 0.0002) and comparison between two ablation steps (max. +54.07%, p = 0.0205). HRA significantly enhanced these relationships, especially in duration (P-wave\/LAW: +43.82% to +69.91%, p &lt; 0.0001 for PC and +18.97% to +47.25%, p &lt; 0.0001 for LR, CA effect: +53.90% to +85.72%, p &lt; 0.0210). CQSE reported negligent correlations (0.6\u20131.2). Direct analysis of CS features is unreliable to evaluate atrial substrate modification due to CA. HRA substantially solves this problem, potentiating correlation with P-wave features. Hence, its application is highly recommended.<\/jats:p>","DOI":"10.3390\/jcdd9060176","type":"journal-article","created":{"date-parts":[[2022,6,1]],"date-time":"2022-06-01T12:48:31Z","timestamp":1654087711000},"page":"176","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Relevance of Heart Rate Fluctuation When Evaluating Atrial Substrate Electrical Features in Catheter Ablation of Paroxysmal Atrial Fibrillation"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5984-904X","authenticated-orcid":false,"given":"Aikaterini","family":"Vraka","sequence":"first","affiliation":[{"name":"BioMIT.org, Electronic Engineering Department, Universitat Politecnica de Valencia, 46022 Valencia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4070-6476","authenticated-orcid":false,"given":"Jos\u00e9","family":"Moreno-Arribas","sequence":"additional","affiliation":[{"name":"Cardiology Department, Saint John\u2019s University Hospital, 03550 Alicante, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5277-3847","authenticated-orcid":false,"given":"Juan M.","family":"Gracia-Baena","sequence":"additional","affiliation":[{"name":"Cardiovascular Surgery Department, Hospital Cl\u00ednico Universitario de Valencia, 46010 Valencia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7560-2781","authenticated-orcid":false,"given":"Fernando","family":"Hornero","sequence":"additional","affiliation":[{"name":"Cardiovascular Surgery Department, Hospital Cl\u00ednico Universitario de Valencia, 46010 Valencia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0942-3638","authenticated-orcid":false,"given":"Ra\u00fal","family":"Alcaraz","sequence":"additional","affiliation":[{"name":"Research Group in Electronic, Biomedical and Telecommunication Engineering, University of Castilla-La Mancha, 16071 Cuenca, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3364-6380","authenticated-orcid":false,"given":"Jos\u00e9 J.","family":"Rieta","sequence":"additional","affiliation":[{"name":"BioMIT.org, Electronic Engineering Department, Universitat Politecnica de Valencia, 46022 Valencia, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,6,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e139","DOI":"10.1161\/CIR.0000000000000757","article-title":"Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association","volume":"141","author":"Virani","year":"2020","journal-title":"Circulation"},{"key":"ref_2","first-page":"374","article-title":"2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS)","volume":"42","author":"Hindricks","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1056\/NEJM199809033391003","article-title":"Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins","volume":"339","author":"Haissaguerre","year":"1998","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1055\/s-2007-1013198","article-title":"Catheter Ablation of Pulmonary Vein Foci for Atrial Fibrillation","volume":"47","author":"Shah","year":"1999","journal-title":"Thorac. Cardiovasc. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/S1062-1458(02)00739-0","article-title":"Pulmonary vein isolation for paroxysmal and persistent atrial fibrillation","volume":"11","author":"Oral","year":"2002","journal-title":"ACC Curr. J. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1016\/j.hrthm.2019.03.028","article-title":"Ten-year ablation outcomes of patients with paroxysmal atrial fibrillation undergoing pulmonary vein isolation","volume":"16","author":"Cheng","year":"2019","journal-title":"Heart Rhythm"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1016\/j.hlc.2017.05.119","article-title":"Pathophysiology of Paroxysmal and Persistent Atrial Fibrillation: Rotors, Foci and Fibrosis","volume":"26","author":"Lau","year":"2017","journal-title":"Heart Lung Circ."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.jcmg.2016.11.003","article-title":"Left Atrial Reverse Remodeling: Mechanisms, Evaluation, and Clinical Significance","volume":"10","author":"Thomas","year":"2017","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_9","first-page":"271","article-title":"Left atrial anatomy, atrial fibrillation burden, and P-wave duration-relationships and predictors for single-procedure success after pulmonary vein isolation","volume":"20","author":"Knecht","year":"2018","journal-title":"EP Eur."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1007\/s10840-019-00576-1","article-title":"Reverse electrical and structural remodelling of the left atrium occurs early after pulmonary vein isolation for persistent atrial fibrillation","volume":"58","author":"Maille","year":"2020","journal-title":"J. Interv. Card. Electrophysiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s12947-021-00250-5","article-title":"Post Procedural Peak Left Atrial Contraction Strain Predicts Recurrence of Arrhythmia after Catheter Ablation of Atrial Fibrillation","volume":"19","author":"Wen","year":"2021","journal-title":"Cardiovasc. Ultrasound"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/j.jelectrocard.2021.10.003","article-title":"P wave duration \u2265 150 ms predicts poor left atrial function and ablation outcomes in non-paroxysmal atrial fibrillation","volume":"69","author":"Liu","year":"2021","journal-title":"J. Electrocardiol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Vraka, A., Bertomeu-Gonz\u00e1lez, V., F\u00e1cila, L., Moreno-Arribas, J., Alcaraz, R., and Rieta, J.J. (2022). The Dissimilar Impact in Atrial Substrate Modificationof Left and Right Pulmonary Veins Isolation after Catheter Ablation of Paroxysmal Atrial Fibrillation. J. Pers. Med., 12.","DOI":"10.3390\/jpm12030462"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1016\/j.hrthm.2017.02.030","article-title":"Techniques for the provocation, localization, and ablation of non\u2013pulmonary vein triggers for atrial fibrillation","volume":"14","author":"Santangeli","year":"2017","journal-title":"Heart Rhythm"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1002\/joa3.12379","article-title":"Using coronary sinus ostium as the reference for the slow pathway ablation of atrioventricular nodal reentrant tachycardia in children","volume":"36","author":"Young","year":"2020","journal-title":"J. Arrhythmia"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1790","DOI":"10.1161\/01.CIR.98.17.1790","article-title":"Electrical conduction between the right atrium and the left atrium via the musculature of the coronary sinus","volume":"98","author":"Antz","year":"1998","journal-title":"Circulation"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1046\/j.1540-8167.2001.01187.x","article-title":"Iterative atrial tachycardia originating from the coronary sinus musculature","volume":"12","author":"Tritto","year":"2001","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1046\/j.1460-9592.2002.00414.x","article-title":"Mapping the coronary sinus and great cardiac vein","volume":"25","author":"Giudici","year":"2002","journal-title":"PACE"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1159\/000501819","article-title":"Coronary Sinus Ablation Is a Key Player Substrate in Recurrence of Persistent Atrial Fibrillation","volume":"143","author":"Ahmed","year":"2019","journal-title":"Cardiology"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1582","DOI":"10.1111\/pace.14026","article-title":"Coronary sinus diverticulum: Importance, function, and treatment","volume":"43","author":"Natale","year":"2020","journal-title":"PACE"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1016\/j.hrthm.2011.11.041","article-title":"The role of coronary sinus musculature in the induction of atrial fibrillation","volume":"9","author":"Morita","year":"2012","journal-title":"Heart Rhythm"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1329","DOI":"10.1046\/j.1540-8167.2003.03222.x","article-title":"Role of the coronary sinus in maintenance of atrial fibrillation","volume":"14","author":"Oral","year":"2003","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1111\/j.1540-8167.2007.00764.x","article-title":"Impact of catheter ablation of the coronary sinus on paroxysmal or persistent atrial fibrillation","volume":"18","author":"Hocini","year":"2007","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1111\/j.1540-8167.2008.01175.x","article-title":"Complex electrograms within the coronary sinus: Time- and frequency-domain characteristics, effects of antral pulmonary vein isolation, and relationship to clinical outcome in patients with paroxysmal and persistent atrial fibrillation","volume":"19","author":"Yoshida","year":"2008","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.1016\/j.hrthm.2013.06.007","article-title":"Characteristics of atrial fibrillation cycle length predict restoration of sinus rhythm by catheter ablation","volume":"10","author":"Marco","year":"2013","journal-title":"Heart Rhythm"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e004869","DOI":"10.1161\/JAHA.116.004869","article-title":"Frequency Gradient Within Coronary Sinus Predicts the Long-Term Outcome of Persistent Atrial Fibrillation Catheter Ablation","volume":"6","author":"Yin","year":"2017","journal-title":"J. Am. Heart Assoc."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1016\/j.hrthm.2009.11.024","article-title":"A critical decrease in dominant frequency and clinical outcome after catheter ablation of persistent atrial fibrillation","volume":"7","author":"Yoshida","year":"2010","journal-title":"Heart Rhythm"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.1016\/j.hrthm.2010.05.011","article-title":"Prevalence of fractionated electrograms in the coronary sinus: Comparison between patients with persistent or paroxysmal atrial fibrillation and a control population","volume":"7","author":"Teh","year":"2010","journal-title":"Heart Rhythm"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/j.ijcard.2019.10.044","article-title":"Elongation of the high right atrium to coronary sinus conduction time predicts the recurrence of atrial fibrillation after radiofrequency catheter ablation","volume":"300","author":"Kanemaru","year":"2020","journal-title":"Int. J. Cardiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1809","DOI":"10.4022\/jafib.1809","article-title":"Coronary Sinus Electrograms May Predict New-onset Atrial Fibrillation After Typical Atrial Flutter Radiofrequency Ablation (CSE-AF)","volume":"11","author":"Boles","year":"2018","journal-title":"J. Atr. Fibrillation"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"McGuinness, S., McKee, A., and Sidebotham, D. (2007). Chapter 8\u2014Monitoring. Cardiothoracic Critical Care, Butterworth-Heinemann.","DOI":"10.1016\/B978-075067572-7.50011-4"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/S0022-0736(97)80013-1","article-title":"Spectrotemporal and spectral turbulence analysis of the signal-averaged P wave in paroxysmal atrial fibrillation","volume":"30","author":"Stafford","year":"1997","journal-title":"J. Electrocardiol."},{"key":"ref_33","first-page":"798","article-title":"Changes in P-wave area and P-wave duration after circumferential pulmonary vein isolation","volume":"12","author":"Houben","year":"2010","journal-title":"EP Eur."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.ijcard.2010.08.029","article-title":"Novel non-invasive P wave analysis for the prediction of paroxysmal atrial fibrillation recurrences in patients without structural heart disease: A prospective pilot study","volume":"153","author":"Vassilikos","year":"2011","journal-title":"Int. J. Cardiol."},{"key":"ref_35","first-page":"519","article-title":"P wave indices to predict atrial fibrillation recurrences post pulmonary vein isolation","volume":"101","author":"Salah","year":"2013","journal-title":"Arq. Bras. Cardiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1016\/j.jelectrocard.2014.04.010","article-title":"Impact of catheter ablation on P-wave parameters on 12-lead electrocardiogram in patients with atrial fibrillation","volume":"47","author":"Maan","year":"2014","journal-title":"J. Electrocardiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1111\/anec.12240","article-title":"The P Wave Time-Frequency Variability Reflects Atrial Conduction Defects before Paroxysmal Atrial Fibrillation","volume":"20","author":"Alcaraz","year":"2015","journal-title":"Ann. Noninvasive Electrocardiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1111\/anec.12364","article-title":"Changes in Electrocardiographic P Wave Parameters after Cryoballoon Ablation and Their Association with Atrial Fibrillation Recurrence","volume":"21","author":"Kizilirmak","year":"2016","journal-title":"Ann. Noninvasive Electrocardiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"102500","DOI":"10.1016\/j.bspc.2021.102500","article-title":"Variation of P-wave indices in paroxysmal atrial fibrillation patients before and after catheter ablation","volume":"66","author":"Ortigosa","year":"2021","journal-title":"Biomed. Signal Process. Control"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1016\/0002-9149(82)90471-4","article-title":"Atrial excitability and conduction in patients with interatrial conduction defects","volume":"50","author":"Simpson","year":"1982","journal-title":"Am. J. Cardiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1811","DOI":"10.1111\/jce.14070","article-title":"Association between prolonged P wave duration and left atrial scarring in patients with paroxysmal atrial fibrillation","volume":"30","author":"Chen","year":"2019","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e12653","DOI":"10.1111\/anec.12653","article-title":"Prolonged P-wave duration in sinus rhythm pre-ablation is associated with atrial fibrillation recurrence after pulmonary vein isolation-A systematic review and meta-analysis","volume":"24","author":"Pranata","year":"2019","journal-title":"Ann. Noninvasive Electrocardiol."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Vraka, A., Bertomeu-Gonz\u00e1lez, V., Hornero, F., Quesada, A., Alcaraz, R., and Rieta, J.J. (2022). Splitting the P-Wave: Improved Evaluation of Left Atrial Substrate Modification after Pulmonary Vein Isolation of Paroxysmal Atrial Fibrillation. Sensors, 22.","DOI":"10.3390\/s22010290"},{"key":"ref_44","unstructured":"Task Force of the European Society of Cardiology the North American Society of Pacing Electrophysiology (1996). Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Eur. Heart J., 17, 354\u2013381."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1111\/jce.12402","article-title":"Heart rate variability findings as a predictor of atrial fibrillation in middle-aged population","volume":"25","author":"Ukkola","year":"2014","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1684","DOI":"10.1016\/j.amjcard.2019.08.025","article-title":"Resting Heart Rate, Short-Term Heart Rate Variability and Incident Atrial Fibrillation (from the Multi-Ethnic Study of Atherosclerosis (MESA))","volume":"124","author":"Habibi","year":"2019","journal-title":"Am. J. Cardiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.jelectrocard.2003.09.021","article-title":"Measurement of heart rate variability by methods based on nonlinear dynamics","volume":"36","author":"Huikuri","year":"2003","journal-title":"J. Electrocardiol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2237","DOI":"10.1161\/01.CIR.100.22.2237","article-title":"Alterations of heart rate variability after radiofrequency catheter ablation of focal atrial fibrillation originating from pulmonary veins","volume":"100","author":"Hsieh","year":"1999","journal-title":"Circulation"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1350","DOI":"10.1111\/jce.14448","article-title":"The predictive value of heart rate variability indices tested in early period after radiofrequency catheter ablation for the recurrence of atrial fibrillation","volume":"31","author":"Zhu","year":"2020","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"2075","DOI":"10.1111\/pace.14408","article-title":"High vagal tone predicts pulmonary vein reconnection after cryoballoon ablation for paroxysmal atrial fibrillation","volume":"44","author":"Osorio","year":"2021","journal-title":"PACE"},{"key":"ref_51","first-page":"1298","article-title":"Electrocardiogram (ECG) Signal Processing","volume":"Volume 2","author":"Laguna","year":"2006","journal-title":"Wiley Encyclopedia of Biomedical Engineering"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"115006","DOI":"10.1088\/1361-6579\/aae8b1","article-title":"A novel wavelet-based filtering strategy to remove powerline interference from electrocardiograms with atrial fibrillation","volume":"39","author":"Rieta","year":"2018","journal-title":"Physiol. Meas."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Mart\u00ednez, A., Alcaraz, R., and Rieta, J.J. (September, January 30). Detection and removal of ventricular ectopic beats in atrial fibrillation recordings via principal component analysis. Proceedings of the 2011 Annual International Conference of the IEEE Engineering in Medicine and Biology Society, Boston, MA, USA.","DOI":"10.1109\/IEMBS.2011.6091162"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"922","DOI":"10.3389\/fphys.2018.00922","article-title":"Quantitative Analysis of the Effect of an Ectopic Beat on the Heart Rate Variability in the Resting Condition","volume":"9","author":"Choi","year":"2018","journal-title":"Front. Physiol."},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Martinez, A., Alcaraz, R., and Rieta, J.J. (September, January 31). A new method for automatic delineation of ECG fiducial points based on the Phasor Transform. Proceedings of the 2010 Annual International Conference of the IEEE Engineering in Medicine and Biology, Buenos Aires, Argentina.","DOI":"10.1109\/IEMBS.2010.5626498"},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Gonz\u00e1lez, F., Alcaraz, R., and Rieta, J.J. (2017, January 24\u201327). Electrocardiographic P-wave delineation based on adaptive slope Gaussian detection. Proceedings of the 2017 Computing in Cardiology (CinC), Rennes, France.","DOI":"10.22489\/CinC.2017.236-033"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.1088\/0967-3334\/29\/12\/001","article-title":"Adaptive singular value cancelation of ventricular activity in single-lead atrial fibrillation electrocardiograms","volume":"29","author":"Alcaraz","year":"2008","journal-title":"Physiol. Meas."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"075003","DOI":"10.1088\/1361-6579\/ab2cb8","article-title":"The stationary wavelet transform as an efficient reductor of powerline interference for atrial bipolar electrograms in cardiac electrophysiology","volume":"40","author":"Rieta","year":"2019","journal-title":"Physiol. Meas."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Osorio, D., Alcaraz, R., and Rieta, J.J. (2017, January 24\u201327). A fractionation-based local activation wave detector for atrial electrograms of atrial fibrillation. Proceedings of the 2017 Computing in Cardiology (CinC), Rennes, France.","DOI":"10.22489\/CinC.2017.202-031"},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Vraka, A., Bertomeu-Gonz\u00e1lez, V., Osca, J., Ravelli, F., Alcaraz, R., and Rieta, J.J. (2020, January 29\u201330). Study on How Catheter Ablation Affects Atrial Structures in Patients with Paroxysmal Atrial Fibrillation: The Case of the Coronary Sinus. Proceedings of the 2020 International Conference on e-Health and Bioengineering (EHB), Iasi, Romania.","DOI":"10.1109\/EHB50910.2020.9280243"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"2551","DOI":"10.1038\/s41598-020-59480-8","article-title":"Physiologic heart rate dependency of the PQ interval and its sex differences","volume":"10","author":"Toman","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Shapiro, S.S., and Wilk, M.B. (1965). An Analysis of Variance Test for Normality (Complete Samples), Oxford University Press.","DOI":"10.2307\/2333709"},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Yan, X., and Su, X.G. (2009). Simple Linear Regression. Linear Regression Analysis: Theory and Computing, World Scientific.","DOI":"10.1142\/6986"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/S0076-6879(00)21192-0","article-title":"Irregularity and asynchrony in biologic network signals","volume":"Volume 321","author":"Pincus","year":"2000","journal-title":"Numerical Computer Methods, Part C"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1000","DOI":"10.1016\/j.bspc.2013.01.009","article-title":"Nonlinear synchronization assessment between atrial and ventricular activations series from the surface ECG in atrial fibrillation","volume":"8","author":"Alcaraz","year":"2013","journal-title":"Biomed. Signal Process. Control"},{"key":"ref_66","first-page":"H319","article-title":"Accurate estimation of entropy in very short physiological time series: The problem of atrial fibrillation detection in implanted ventricular devices","volume":"300","author":"Lake","year":"2011","journal-title":"Am. J. Physiol."},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Vraka, A., Hornero, F., Bertomeu-Gonz\u00e1lez, V., Osca, J., Alcaraz, R., and Rieta, J.J. (2020). Short-Time Estimation of Fractionation in Atrial Fibrillation with Coarse-Grained Correlation Dimension for Mapping the Atrial Substrate. Entropy, 22.","DOI":"10.3390\/e22020232"},{"key":"ref_68","first-page":"313","article-title":"Critical appraisal of technologies to assess electrical activity during atrial fibrillation: A position paper from the European Heart Rhythm Association and European Society of Cardiology Working Group on eCardiology in collaboration with the Heart Rhythm Society, Asia Pacific Heart Rhythm Society, Latin American Heart Rhythm Society and Computing in Cardiology","volume":"24","author":"Shah","year":"2021","journal-title":"EP Eur."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1002\/bem.22115","article-title":"Heart rate variability affected by radiofrequency electromagnetic field in adolescent students","volume":"39","author":"Misek","year":"2018","journal-title":"Bioelectromagnetics"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"633","DOI":"10.33549\/physiolres.934425","article-title":"Radiofrequency Electromagnetic Field Affects Heart Rate Variability in Rabbits","volume":"69","author":"Misek","year":"2020","journal-title":"Physiol. Res."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1500","DOI":"10.1161\/CIRCRESAHA.114.303772","article-title":"Role of the autonomic nervous system in atrial fibrillation: Pathophysiology and therapy","volume":"114","author":"Chen","year":"2014","journal-title":"Circ. Res."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1959","DOI":"10.1088\/0967-3334\/33\/12\/1959","article-title":"Study on the P-wave feature time course as early predictors of paroxysmal atrial fibrillation","volume":"33","author":"Alcaraz","year":"2012","journal-title":"Physiol. Meas."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"e007700","DOI":"10.1161\/CIRCEP.119.007700","article-title":"Noninvasive Assessment of Complexity of Atrial Fibrillation: Correlation With Contact Mapping and Impact of Ablation","volume":"13","author":"Rodrigo","year":"2020","journal-title":"Circ. Arrhythmia Electrophysiol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1111\/j.1540-8159.1998.tb01064.x","article-title":"Abnormalities of electrocardiographic P wave morphology and their relation to electrophysiological parameters of the atrium in patients with sick sinus syndrome","volume":"21","author":"Liu","year":"1998","journal-title":"PACE"},{"key":"ref_75","unstructured":"Yahyazadeh, S., Firoozabadi, S., Haghjoo, M., and Parvaneh, S. (2010, January 26\u201329). Quantitative relation between chaotic features of surface electrocardiogram and Intracardiac Electrogram. Proceedings of the 2010 Computing in Cardiology, Belfast, UK."},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Alcaraz, R., Hornero, F., and Rieta, J.J. (September, January 30). Validation of surface atrial fibrillation organization indicators through invasive recordings. Proceedings of the 2011 Annual International Conference of the IEEE Engineering in Medicine and Biology Society, Boston, MA, USA.","DOI":"10.1109\/IEMBS.2011.6091408"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"e017069","DOI":"10.1161\/JAHA.120.017069","article-title":"Simultaneous Endo-Epicardial Mapping of the Human Right Atrium: Unraveling Atrial Excitation","volume":"9","author":"Kharbanda","year":"2020","journal-title":"J. Am. Heart Assoc."}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/9\/6\/176\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:23:27Z","timestamp":1760138607000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/9\/6\/176"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,1]]},"references-count":77,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2022,6]]}},"alternative-id":["jcdd9060176"],"URL":"https:\/\/doi.org\/10.3390\/jcdd9060176","relation":{},"ISSN":["2308-3425"],"issn-type":[{"type":"electronic","value":"2308-3425"}],"subject":[],"published":{"date-parts":[[2022,6,1]]}}}