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Type: Journal article
Title: The inspection paradox: An important consideration in the evaluation of rotor lifetimes in cardiac fibrillation.
Author: Jenkins, E.V.
Dharmaprani, D.
Schopp, M.
Quah, J.X.
Tiver, K.
Mitchell, L.
Xiong, F.
Aguilar, M.
Pope, K.
Akar, F.G.
Roney, C.H.
Niederer, S.A.
Nattel, S.
Nash, M.P.
Clayton, R.H.
Ganesan, A.N.
Citation: Frontiers in Physiology, 2022; 13:920788-920788
Publisher: Frontiers Media SA
Issue Date: 2022
ISSN: 1664-042X
Statement of
Evan V. Jenkins, Dhani Dharmaprani, Madeline Schopp, Jing Xian Quah, Kathryn Tiver, Lewis Mitchell, Feng Xiong, Martin Aguilar, Kenneth Pope, Fadi G. Akar, Caroline H. Roney, Steven A. Niederer, Stanley Nattel, Martyn P. Nash, Richard H. Clayton, and Anand N. Ganesan
Abstract: Background and Objective: Renewal theory is a statistical approach to model the formation and destruction of phase singularities (PS), which occur at the pivots of spiral waves. A common issue arising during observation of renewal processes is an inspection paradox, due to oversampling of longer events. The objective of this study was to characterise the effect of a potential inspection paradox on the perception of PS lifetimes in cardiac fibrillation. Methods: A multisystem, multi-modality study was performed, examining computational simulations (Aliev-Panfilov (APV) model, Courtmanche-Nattel model), experimentally acquired optical mapping Atrial and Ventricular Fibrillation (AF/VF) data, and clinically acquired human AF and VF. Distributions of all PS lifetimes across full epochs of AF, VF, or computational simulations, were compared with distributions formed from lifetimes of PS existing at 10,000 simulated commencement timepoints. Results: In all systems, an inspection paradox led towards oversampling of PS with longer lifetimes. In APV computational simulations there was a mean PS lifetime shift of +84.9% (95% CI, ± 0.3%) (p < 0.001 for observed vs overall), in Courtmanche-Nattel simulations of AF +692.9% (95% CI, ±57.7%) (p < 0.001), in optically mapped rat AF +374.6% (95% CI, ± 88.5%) (p = 0.052), in human AF mapped with basket catheters +129.2% (95% CI, ±4.1%) (p < 0.05), human AF-HD grid catheters 150.8% (95% CI, ± 9.0%) (p < 0.001), in optically mapped rat VF +171.3% (95% CI, ±15.6%) (p < 0.001), in human epicardial VF 153.5% (95% CI, ±15.7%) (p < 0.001). Conclusion: Visual inspection of phase movies has the potential to systematically oversample longer lasting PS, due to an inspection paradox. An inspection paradox is minimised by consideration of the overall distribution of PS lifetimes.
Keywords: atrial fibrilation
cardiac fibrillation
inspection paradox
phase singularity
renewal theory
ventricular fibrillation
Rights: © 2022 Jenkins, Dharmaprani, Schopp, Quah, Tiver, Mitchell, Xiong, Aguilar, Pope, Akar, Roney, Niederer, Nattel, Nash, Clayton and Ganesan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
DOI: 10.3389/fphys.2022.920788
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Appears in Collections:Mathematical Sciences publications

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