A cross-platform - Free Activators

December 9, 2021 / Rating: 4.7 / Views: 544

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Day ago · Researchers stealers of cryptocurrencies and data of browsers are sewn into activators of Windows and Office; EA wants to know what players think about the main aspects of Battlefield 2042; Matrix, the awakening An experience on Unreal Engine 5, preload available on PS5 and Xbox Series X

Researchers stealers of cryptocurrencies and data of.
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No previous work has made available an open-source platform for parsing and interrogating this data in a standardized format. We therefore sought to develop a standardized, open-source data structure and associated computer code to store electroanatomic mapping data in a space-efficient and easily accessible manner. Methods: A data structure was defined capturing the available anatomic and electrical data. Open EP, implemented in MATLAB, was developed to parse and interrogate this data. Functions are provided for analysis of chamber geometry, activation mapping, conduction velocity mapping, voltage mapping, ablation sites, and electrograms as well as visualization and input/output functions. Performance benchmarking for data import and storage was performed. Data import and analysis validation was performed for chamber geometry, activation mapping, voltage mapping and ablation representation. Finally, systematic analysis of electrophysiology literature was performed to determine the suitability of Open EP for contemporary electrophysiology research. Results: The average time to parse clinical datasets was 400 ± 162 s per patient. Open EP data was two orders of magnitude smaller than compressed clinical data (Open EP: 20.5 ± 8.7 Mb, vs clinical: 1.46 ± 0.77 Gb). Open EP-derived geometry metrics were correlated with the same clinical metrics (Area: R Electroanatomic mapping systems are used extensively to guide catheter-based ablation procedures (Kim et al., 2020). Electroanatomic mapping system guided procedures are extremely successful under certain conditions but there is significant variability in outcomes reported (Gaita et al., 2008; Taghji et al., 2018). Despite advancements in the understanding of the pathophysiology of both atrial (Iwasaki et al., 2011; Hansen et al., 2018; Lau et al., 2019) and ventricular arrhythmias (Anter et al., 2016; Pokorney et al., 2016; Aziz et al., 2019), this outcome variability indicates that there is still much to learn about the electropathophysiology of these arrhythmias, how electrical and structural abnormalities can be quantified by electroanatomic mapping systems and how appropriate therapeutic targets can be identified and treated using ablation. Electroanatomic mapping systems provide several core functions including catheter localization, anatomical representation, electrophysiological map construction, and localization of ablation lesions. As such, the data acquired by these systems provides key information about atrial or ventricular myocardial morphology and electrical function. Such data is interpreted conventionally within electroanatomic mapping platforms through the creation of local activation time maps and their derivatives (Williams et al., 2018), voltage maps (Kistler et al., 2004; Pak et al., 2011; Al-Kaisey et al., 2020; Pappone et al., 2020), and maps representing electrogram morphological features during arrhythmia or pacing (Chang et al., 2013; Jadidi et al., 2016). Within research settings, the same data has also been extensively post-processed to analyze complex electrogram features (Almeida et al., 2020; Vraka et al., 2020), activation patterns (El Haddad et al., 2014), conduction velocities (Cantwell et al., 2015; Aronis et al., 2020) and identify phase singularities through multiple mapping techniques (Child et al., 2018; Ríos-Muñoz et al., 2018). All of these post-processing steps depend on common data management processes including the ability to export mapping data from clinical systems, store this data in space-efficient machine-readable formats and access electrophysiological data for post-processing. Although multiple research groups are active in these areas, there is as-yet no reported, open-source, standardized framework for performing these core functionalities. The creation of software to achieve these functions represents a barrier to entry to electrophysiology research and the lack of a common data standard represents a hindrance to collaboration between research groups. We sought to develop a standardized data structure for electroanatomic mapping data together with a framework for parsing data from commonly used electroanatomic mapping platforms to facilitate electroanatomic data processing for research purposes. Here we present the Open EP (Open Electrophysiology Interface for Research) framework, associated code repositories and website. We further provide examples analyzing electrophysiology data using Open EP, benchmark its storage efficiency compared to the original raw data and validate performance against the original data. The three aims of this study were therefore (1) to present an open research data standard for storing and parsing electroanatomic mapping data; (2) to analyze the performance of an implementation framework using this data standard for storing and representing electroanatomic mapping data; and (3) to determine, through literature review, the suitability of Open EP for contemporary research thereby presenting a roadmap for future development. The computer code shared within Open EP has been under continual development for over a decade and is actively used within our research groups to analyze data from the major electroanatomic mapping platforms. The software described here is made available under the Apache License 2.0 and can be freely used for academic research. Inspection of data exported from Velocity, Precision and Carto3 electroanatomic mapping system revealed two categories of electroanatomic mapping data – surface data and electrogram data. Individual exported datatypes representing all geometric and electrical data acquired by the mapping system were grouped into each of these categories. An etymology was designed categorizing each datatype into subgroups within these categories (see “Supplementary Material”). An implementation of Open EP was developed using MATLAB R2020a (The Math Works, Inc.). For the purposes of this evaluation of the Open EP software, left atrial activation/voltage mapping data was exported from one electroanatomic mapping platform (Carto3; V6). The general format of this data consisted of a series of XML files describing the study characteristics, a series of text files, 12 per mapping point, describing the electrogram features, and a file describing the chamber geometry and electroanatomic maps created during the clinical case. Patient datasets used in this study included forty patients undergoing first-time atrial fibrillation ablation. Example datasets for use with Open EP are available in the Supplementary Material. Prior to data export from the electroanatomic mapping platform, all electrograms were manually inspected. Electrograms which were clearly far-field were excluded from the electroanatomic maps and timing annotations were corrected as necessary. Anatomical structures were added using the mapping system to represent the mitral valve annulus and all pulmonary vein ostia. Clinical data was collected during routine patient care. Health Research Authority approval was granted for the retrospective use of this data for research (REC Reference: 18/HRA/0083). To benchmark the performance of Open EP, two metrics were considered. doi: 10.3389/fphys.2021.646023 © 2021 Williams, Roney, Connolly, Sim, Whitaker, O’Hare, Kotadia, O’Neill, Corrado, Bishop, Niederer, Wright, O’Neill and Linton. Firstly, the time taken to import the data and create the Open EP data structure for each dataset was calculated. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). A recursive script was set up to automate measurement of data import time for each dataset. doi: 10.1111/jce.13990 Pub Med Abstract | Cross Ref Full Text | Google Scholar Williams SE, Roney CH, Connolly A, Sim I, Whitaker J, O’Hare D, Kotadia I, O’Neill L, Corrado C, Bishop M, Niederer SA, Wright M, O’Neill M and Linton NWF (2021) Open EP: A Cross-Platform Electroanatomic Mapping Data Format and Analysis Platform for Electrophysiology Research. 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. Performance benchmarking was performed on Mac OS (Mac Book Pro, 3.3 GHz dual core i7 processor, 16 Gb RAM, 500 Gb SSD storage), using the MATLAB environment (R2020a). No use, distribution or reproduction is permitted which does not comply with these terms. Secondly, dataset size for each patient was measured using the standard operating system tools and compared with the dataset size exported by the clinical mapping system in both compressed and uncompressed (zip) formats. The Open EP data format can be used for investigation of the electropathophysiology of both atrial and ventricular arrhythmias. Left atrial effective conducting size predicts atrial fibrillation vulnerability in persistent but not paroxysmal atrial fibrillation. Here we focus on using Open EP for atrial fibrillation electroanatomic mapping and ablation data. To benchmark the data validity of Open EP, four analyses were performed. Firstly, chamber volume and chamber surface area were calculated using Open EP and compared to chamber volume calculated using the clinical mapping system. Chamber surface area was calculated based on the original mesh including the anatomical structure cut-outs (open) and based on the same mesh with any anatomical structures closed (closed) using the Open EP functions. doi: 10.1016/j.jacep.20 Pub Med Abstract | Cross Ref Full Text | Google Scholar Williams, S. As an example, for the left atrium the “open” mesh is a mesh with cut-outs in place for the mitral valve and pulmonary veins whilst a “closed” mesh is a mesh with each of these anatomical structures filled in. Secondly, the performance of Open EP for reproducing electroanatomic maps was considered. Intra-atrial conduction delay revealed by multisite incremental atrial pacing is an independent marker of remodeling in human atrial fibrillation. Open EP provides functions to display electroanatomic maps created by the clinical system as well as additional functions to re-create electroanatomic maps from raw electrogram data. To validate these functions the total activation time (TAT) and site of earliest activation were calculated for both classes of local activation time maps, and the mean chamber voltage and percentage are of low voltage were calculated for both classes of voltage maps. Thirdly, the number of electroanatomic mapping data points identified by Open EP was compared to the expected number of electroanatomic mapping data points based on the clinical system to ensure that all mapping points were correctly identified and parsed. Finally, the number and position of ablation points was compared between Open EP and the clinical systems. Local activation time sampling density for atrial tachycardia contact mapping: how much is enough. doi: 10.1093/europace/eux037 Pub Med Abstract | Cross Ref Full Text | Google Scholar Williams, S. To determine the “real world” requirements for an electrophysiology research data storage format we performed a literature search using Pub Med for the following terms: “(electroanatomic mapping) AND [(atrial fibrillation) OR (ventricular tachycardia)]”. To ensure applicability to contemporary research the search was limited to the previous 1-year (November 2019–2020, see “Supplementary Material”). Abstracts were screened to identify research studies in which data export of clinical electroanatomic mapping data was required. doi: 10.1161/CIRCEP.117.005892 Pub Med Abstract | Cross Ref Full Text | Google Scholar Williams, S. L., Chubb, H., Whitaker, J., Kiedrowicz, R., Rinaldi, C. Review articles, case reports and case series using standard electroanatomic mapping techniques to deliver clinical treatments were excluded. Full text review was performed to identify data types that were analyzed for the purposes of these studies. Lesion index-guided ablation facilitates continuous, transmural, and durable lesions in a porcine recovery model. The following 19 data types, exposed through Open EP APIs were tabulated: chamber geometry, number of mapping points, location only points, anatomical structures, electrogram locations, bipolar electrograms, unipolar electrograms, contact force, ablation positions, ablation temperature, ablation power, ablation time, and ablation lesion indices (e.g., ablation index or lesion size index), impedance, local activation time annotations, local activation time map, bipolar map, unipolar map and fractionation map. For each study, each data type was given a score from 0–4 with 0 = data type not used; 1 = qualitative analysis using the clinical system; 2 = quantitative analysis using the clinical system; 3 = qualitative analysis following data export; and 4 = quantitative analysis following data export. doi: 10.1109/TBME.2011.2160453 Pub Med Abstract | Cross Ref Full Text | Google Scholar Whitaker, J., Fish, J., Harrison, J. Additional data types, not available through Open EP were also considered. The frequency of occurrence of each of these data types was calculated. The percentage of studies for which Open EP would have provided complete input data was subsequently calculated. Short-time estimation of fractionation in atrial fibrillation with coarse-grained correlation dimension for mapping the atrial substrate. doi: 10.3390/e22020232 Pub Med Abstract | Cross Ref Full Text | Google Scholar Weber, F. Conduction velocity restitution of the human atriuman-An efficient measurement protocol for clinical electrophysiological studies. On overview of the Open EP architecture is shown in Figure 1. doi: 10.1016/j.jacep.20 Pub Med Abstract | Cross Ref Full Text | Google Scholar Vraka, A., Hornero, F., Bertomeu-González, V., Osca, J., Alcaraz, R., and Rieta, J. M., Luik, A., Schilling, C., Seemann, G., Krueger, M. The basic architecture consists of the Open EP data format, together with Data Parsing modules and Data Analytics modules. Implementations of the Open EP standard have been created for three clinical systems to date: Carto3 (Biosense Webster), Velocity (St Jude Medical) and Precision (Abbot). doi: 10.1253/circj.72.384 Pub Med Abstract | Cross Ref Full Text | Google Scholar Taghji, P., El Haddad, M., Phlips, T., Wolf, M., Knecht, S., Vandekerckhove, Y., et al. Evaluation of a strategy aiming to enclose the pulmonary veins with contiguous and optimized radiofrequency lesions in paroxysmal atrial fibrillation. Following data export from one of these systems, processing a dataset using Open EP begins with a call to an import function, for example, . Calling these functions from the command window without arguments prompts the user to perform selections to identify the study files, the clinical map of interest, the reference mapping channel and an ECG channel. doi: 10.1016/j.compbiomed.20 Pub Med Abstract | Cross Ref Full Text | Google Scholar Sawa, A., Shimizu, A., Ueyama, T., Yoshiga, Y., Suzuki, S., Sugi, N., et al. Activation patterns and conduction velocity in posterolateral right atrium during typical atrial flutter using an electroanatomic mapping system. All of these selections can also be passed as arguments to to allow command line-only interaction. Subsequent parsing of the dataset is entirely automated and results in the creation of a data structure called userdata in the workspace, which can also be saved to disk. The core components of Open EP are the data parsing modules (used to parse data from proprietary clinical system formats) and the data analytics modules (used to access and analyze the data stored in Open EP format). “An automated algorithm for determining conduction velocity, wavefront direction and origin of focal cardiac arrhythmias using a multipolar catheter,” in In Procceings of the 2014 36th Annual International Conference IEEE Engineering Medical Biology Social, (Piscataway, NJ: IEEE). A full description of each field within this structure is given in the Supplementary Material. to fully automate the import of multiple patient datasets into Open EP format. doi: 10.1109/EMBC.2014.6943906 Pub Med Abstract | Cross Ref Full Text | Google Scholar Roney, C. A technique for measuring anisotropy in atrial conduction to estimate conduction velocity and atrial fibre direction. The process function takes as its only argument the absolute path to a directory of Open EP data files and provides a template for performing data processing sequentially on each dataset before returning the outputs in a structure. H., Whitaker, J., Sim, I., O’Neill, L., Mukherjee, R. A list of currently available data processing functions is given in Supplementary Table 3, and a live version of the Open EP code documentation will be hosted online. The clinical datasets consisted of left atrial electroanatomic mapping data created to facilitate atrial radiofrequency ablation for the treatment of atrial fibrillation. There were 963 ± 430 bipolar mapping points per patient (range 209 – 2031 points per map). The data was exported from the clinical mapping system as a single compressed archive, one per patient, containing plane text and XML files. There were averages of 35,175 ± 18,861 text files and 3,177 ± 1,719 XML files, per patient. doi: 10.3389/fphys.2018.01260 Pub Med Abstract | Cross Ref Full Text | Google Scholar Roney, C. The time taken per case to import the electroanatomic mapping data was 400 ± 162 s. The time taken to import the datasets was significantly correlated with the number of mapping points in the dataset (R Figure 2. Real-time rotational activity detection in atrial fibrillation. (A) Import time was proportional to the number of mapping points in the clinical dataset. doi: 10.1111/j.1540-8167.2010.01939.x Pub Med Abstract | Cross Ref Full Text | Google Scholar Ríos-Muñoz, G. (B) Storage space required for electroanatomic mapping data was three orders of magnitude smaller than the uncompressed Carto data and two orders of magnitude less than the compressed Carto data. The mean Open EP dataset size was 20.5 ± 8.7 Mb, which was significantly smaller than both the compressed (1.46 ± 0.77 Gb) and uncompressed (15.54 ± 8.08 Gb) export files from the electroanatomic mapping system (Figure 2B). The relationship between chamber geometry metrics measured using the electroanatomic mapping platform and Open EP is shown in Figure 3. Catheter ablation of ventricular tachycardia: lessons learned from past clinical trials and implications for future clinical trials. doi: 10.1016/j.hrthm.20 Pub Med Abstract | Cross Ref Full Text | Google Scholar Ravelli, F., Masè, M., Del Greco, M., Marini, M., and Disertori, M. Acute atrial dilatation slows conduction and increases AF vulnerability in the human atrium. There was an excellent correlation between Carto-derived metrics and Open EP-derived metrics for chamber surface area “open” (R Figure 3. Geometric measurements compared between the original electroanatomic mapping system and Open EP. (A) Number of mapping points present in the original Carto map and subsequently identified by Open EP, using Example local activation time maps created using Carto and using the interpolation functions built into Open EP are shown in Figure 5. (A) Activation maps exported from the Carto electroanatomic mapping platform. Local activation time maps were quantified using TAT, the site of earliest activation and by a point-by-point comparison of activation times. (B) Activation map created by Open EP using the Carto electroanatomic mapping data. Comparison of voltage map-guided left atrial anterior wall ablation versus left lateral mitral isthmus ablation in patients with persistent atrial fibrillation. doi: 10.1016/j.hrthm.20 Pub Med Abstract | Cross Ref Full Text | Google Scholar Pappone, C., Mecarocci, V., Manguso, F., Ciconte, G., Vicedomini, G., Sturla, F., et al. New electromechanical substrate abnormalities in high-risk patients with Brugada syndrome. doi: 10.1016/j.hrthm.20 Pub Med Abstract | Cross Ref Full Text | Google Scholar Pokorney, S. Open EP command: The total activation time was defined as the difference in activation times between the earliest and latest activation time mapping points on the Carto system. Open EP can recover this metric from the exported data (“Point-based TAT”) and provides five additional metrics for calculating total activation time as described in Supplementary Table 1. Pulmonary vein encirclement using an ablation index-guided point-by-point workflow: cardiovascular magnetic resonance assessment of left atrial scar formation. doi: 10.1093/europace/euz226 Pub Med Abstract | Cross Ref Full Text | Google Scholar Pak, H.-N., Oh, Y. TAT was calculated for all 40 patient datasets, using all six methods and compared with Carto-derived total activation time. doi: 10.1103/Phys Rev E.75.011914 Pub Med Abstract | Cross Ref Full Text | Google Scholar Nalliah, C. R., Lee, G., Voskoboinik, A., Kee, K., Goldin, J., et al. Sleep apnoea has a dose-dependent effect on atrial remodelling in paroxysmal but not persistent atrial fibrillation: a high-density mapping study. doi: 10.1093/europace/euaa275 Pub Med Abstract | Cross Ref Full Text | Google Scholar O’Neill, L., Karim, R., Mukherjee, R. There was a perfect correlation between Carto-derived TAT and Open EP point-based TAT (R Figure 6. Quantification of Open EP local activation time maps. (A) Cross correlation matrix comparing Carto-defined total activation time with the six total activation time metrics available in Open EP. (B) Point-by-point comparison of Carto-defined local activation time and Open EP-defined local activation time maps. The site of earliest activation was defined as the earliest point identified on the Carto-defined local activation time map. doi: 10.1161/CIRCEP.116.004107 Pub Med Abstract | Cross Ref Full Text | Google Scholar Mourad, A., and Nash, M. Method for quantifiying conduction velocity during ventricular fibrillation. Again, Open EP can recover this position but provides alternative methods to compute the earliest activation point, analogous to the methods for total activation time shown in Supplementary Table 2. doi: 10.1007/s11948-019-00171-7 Pub Med Abstract | Cross Ref Full Text | Google Scholar Masè, M., and Ravelli, F. “Automatic reconstruction of activation and velocity maps from electro-anatomic data by radial basis functions,” in In Procceings of the 2010 Annual International Conference IEEE Engineering Medical Biology Social, (Piscataway, NJ: IEEE). A comparison of Carto-defined earliest activation and the percentile-based electrogram method (“”) is shown in Figure 7A for a single case and summarized in Figure 7B for all 40 cases in the validation dataset. (A) Example activation map showing the site of earliest activation, defined as the earliest local activation time recorded by Carto shown in red, and the site of earliest activation using the Open EP percentile method shown in blue. doi: 10.1109/IEMBS.2010.5626616 Pub Med Abstract | Cross Ref Full Text | Google Scholar Massé, S., Magtibay, K., Jackson, N., Asta, J., Kusha, M., Zhang, B., et al. Resolving myocardial activation with novel omnipolar electrograms. The mean distance between Carto-defined and Open EP-defined earliest activation points was 10.8 ± 4.4 mm. (B) Relationship between Carto earliest activation sites and Open EP earliest activation sites for all 40 cases. a reflection on the environmental sustainability of big data initiatives. The Carto-defined earliest activation sites are shown with red spheres and the Open EP-defined earliest activation sites are shown with blue spheres. Cardiac ripple mapping: a novel three-dimensional visualization method for use with electroanatomic mapping of cardiac arrhythmias. doi: 10.1016/j.hrthm.20 Pub Med Abstract | Cross Ref Full Text | Google Scholar Lucivero, F. The connecting lines indicate the pairing of data points on a case-by-case basis. LAO, left anterior oblique; LAT, local activation time. A point-by-point comparison of all surface based local activation times was performed. The point-by-point comparison of Carto-derived and Open EP-derived interpolated local activation time maps revealed a highly significant correlation between these two metrics (R function. doi: 10.1016/20 Pub Med Abstract | Cross Ref Full Text | Google Scholar Linton, N. In addition, conduction velocity histogram analysis is available via the cv Histogram.m function (Figure 8). Currently, Open EP provides a single method to calculate conduction velocity which uses the radial basis function method (Masè and Ravelli, 2010). Conduction velocity measurement using Open EP software. (A) Conduction velocity maps of two cases in anterior-posterior orientation (left) and postero-anterior orientation (right). (B) Conduction velocity histograms corresponding to the maps in panel A; created using the Open EP function call: cv Histogram(userdata). CV, conduction velocity; AP, antero-posterior; PA, postero-anterior. Example voltage maps created directly using Carto and indirectly using the interpolation functions built into Open EP are shown in Figure 9. Voltage maps were quantified using the mean chamber voltage and the percentage of low voltage (defined as interpolated voltage Figure 9. (A) Voltage maps created using Carto, with a voltage threshold of 0.5 m V. doi: 10.1111/j.1540-8167.2007.00723.x Pub Med Abstract | Cross Ref Full Text | Google Scholar Lau, D. (B) Voltage maps created using Open EP with a voltage threshold range of 0.4–0.6 m V applied to the voltage mapping data exported by Carto. Open EP command: ; (C) Voltage maps created using Open EP with a voltage threshold range of 0.45–0.55 m V, interpolated from the raw electrogram data at every mapping point and with a color fill threshold of 10 mm. Analysis of Carto and Open EP voltage mapping data. (A) Assessment of mean chamber voltage using Carto and Open EP. Characterization of the electroanatomical substrate in human atrial fibrillation: the relationship between changes in atrial volume, refractoriness, wavefront propagation velocities, and AF burden. (B) Assessment of low voltage area using Carto and Open EP. The Open EP commands: are provided which can be used together to plot a figure containing the electrogram pertaining to a specific electroanatomic mapping point. (A) Reference, bipolar and unipolar electrogram data at five selected sites on the posterior wall of a left atrium. doi: 10.1016/20 Pub Med Abstract | Cross Ref Full Text | Google Scholar Kojodjojo, P., Peters, N. Examples of such electrograms and comparison with the clinical electrograms are shown in Figure 12. (B) Corresponding electrograms extracted and plotted using Open EP. Blue – bipolar electrogram; green – paired unipolar electrograms; red – reference coronary sinus electrogram. Red dots indicate the activation time annotations extracted from the clinical mapping platform. The effects of carbenoxolone on human myocardial conduction. Open EP function example: but have no linked electrical data. a tool to investigate the role of gap junctional uncoupling in human arrhythmogenesis. Modern electroanatomic mapping systems provide metrics which quantify energy delivery (and seek to predict lesion size) during radiofrequency ablation, such as the Lesion Size Index (Whitaker et al., 2018) and Ablation Index (O’Neill et al., 2019). doi: 10.1111/j.1540-8167.2005.00293.x Pub Med Abstract | Cross Ref Full Text | Google Scholar Kojodjojo, P., Kanagaratnam, P., Segal, O. Since these indices vary per-platform and per-case, Open EP provides helper functions for accessing radiofrequency index data which is appended to userdata and then stored in the subfields of function but the roadmap for development prioritizes the parsing of Lesion Stability Index (Precision). Example data is shown in Figure 13, and the format of the dataset created is shown in the Supplementary Material. Additional functions are provided to plot the ablation sites, colored by any available ablation parameter and calculate ablation area. doi: 10.1016/20 Pub Med Abstract | Cross Ref Full Text | Google Scholar Kojodjojo, P., Kanagaratnam, P., Markides, V., Davies, W., and Peters, N. Age-related changes in human left and right atrial conduction. Ablation parameters (time, force, impedance, temperature, and power) can currently be plotted from the available raw data and the roadmap for development includes the provision of help functions to streamline these graphing functions. Representation of ablation points and quantification of ablation area using Open EP. (A) Ablation lesion representation in the Carto electroanatomic mapping platform. Ablation lesions are colored according to the Ablation Index (low = white; high = red). (C) Specifically for the Carto electroanatomic mapping platform the “grid” of ablation positions is also exposed together with all ablation-related data (impedance, time, temperature, and contact force). Open EP function call: Following the initial literature search, 136 suitable articles were identified (see “Supplementary Material”). Case reports (n = 18), clinical series using electroanatomic mapping for treatment (n = 5), editorials (n = 5), guidelines (n = 6), conference abstracts (n = 1), non-electroanatomic mapping studies (n = 30), non-English language studies (n = 4) and review articles (n = 10) were excluded leaving 46 studies for analysis. Electrophysiologic and electroanatomic changes in the human atrium associated with age. The frequency of data types analyzed amongst all the studies is shown in Figure 14. Data types assessed by contemporary electroanatomic mapping studies. Blue bars represent the data types currently accessible through Open EP. Orange bars represent the data types which are not currently accessible through Open EP but which form objectives in the Roadmap for Development (https://openep.io/roadmap). Studies were scored according to the highest level of data analysis performed, ranging from qualitative analysis on the clinical system (score = 1) to quantitative analysis following data export (score = 4). Of the included studies, 6/46 (13%) performed qualitative analysis on the clinical system and 30/46 (65%) performed quantitative analysis on the clinical system. doi: 10.1002/joa3.12308 Pub Med Abstract | Cross Ref Full Text | Google Scholar Kistler, P. A minority of studies (10/46, 22%) performed data export from the clinical system, and all of these studies performed quantitative analysis of at least some electroanatomic mapping data. 2019 APHRS expert consensus statement on three-dimensional mapping systems for tachycardia developed in collaboration with HRS, EHRA, and LAHRS. Of all the studies analyzed, 21/41 (51%) performed quantitative analysis of chamber geometry or low voltage areas manually using area measurement tools embedded in the clinical system. The current implementation of Open EP exposes access to the full electroanatomic mapping dataset and analysis techniques required for completion of 31/46 studies (67%). When image integration and registration-type analyses, for which there are several existing software platforms, are excluded this figure rises to 36/46 (78%). doi: 10.1152/ajpheart.01108.2001 Pub Med Abstract | Cross Ref Full Text | Google Scholar Kim, Y. Additional electroanatomic mapping data requirements included access to full 12-lead ECGs at each mapping point (4 studies), re-calculation of electrogram complexity/fractionation indices (2 studies), analysis of late potentials (3 studies), segmental analysis of the atria (3 studies) or ventricles (3 study) and creation of isochronal local activation time maps (1 study). In addition, image integration analysis – for example registering electroanatomic mapping data to imaging data, importing imaging data into a clinical system or exporting imaging data from a clinical system – was performed in 7 studies. Considering all the analysis techniques applied across all the studies together, 101 analysis techniques were performed qualitatively on the clinical system, 112 analysis techniques were performed quantitatively on the clinical system, 2 analysis technique was applied qualitatively following data export and 41 analysis techniques were performed quantitatively following data export. In summary qualitative analysis was performed for 103 analysis techniques and quantitative analysis was performed for 153 analysis techniques. Considering each class of analysis technique (qualitative vs. doi: 10.1111/jce.12259 Pub Med Abstract | Cross Ref Full Text | Google Scholar Kadish, A., Johnson, D., Choe, W., Goldberger, J., and Horvath, G. Characterization of fibrillatory rhythms by ensemble vector directional analysis. quantitative) separately, the current Open EP framework would have provided access to 96 of 103 qualitatively assessed data points (93%) and 134 of 154 quantitatively assessed data points (87%). In doing so, Open EP removes a barrier to clinical electrophysiology research and facilitates offline analysis of electrophysiology data. In this study we introduce the Open EP (Open Electrophysiology Interface for Research) framework and provide performance and validation benchmarking. Application of ripple mapping with an electroanatomic mapping system for diagnosis of atrial tachycardias. We demonstrate improvements in data storage efficiency for clinical electroanatomic mapping data. We illustrate the simplicity of using Open EP for data analysis activities in electrophysiology research, many of which can be executed using single-line function calls. doi: 10.1161/CIRCEP.115.002962 Pub Med Abstract | Cross Ref Full Text | Google Scholar Jamil-Copley, S., Linton, N. We further demonstrate, through a retrospective assessment of recent literature, the suitability of the Open EP data format for representing electroanatomic mapping data used in contemporary arrhythmia research. doi: 10.1161/CIRCULATIONAHA.111.019893 Pub Med Abstract | Cross Ref Full Text | Google Scholar Jadidi, A. Finally, we introduce the Open EP website which will provide code documentation, example datasets and outlines the roadmap for future development. Atrial fibrillation pathophysiology: implications for management. S., Lehrmann, H., Keyl, C., Sorrel, J., Markstein, V., Minners, J., et al. Ablation of persistent atrial fibrillation targeting low-voltage areas with selective activation characteristics. All source code referred to in this work is linked to from the Open EP website and is licensed under the Apache License 2.0. doi: 10.1111/jce.14660 Pub Med Abstract | Cross Ref Full Text | Google Scholar Iwasaki, Y. The release used in this paper is archived with Zenodo (DOI: 10.5281/zenodo.4471319 and available from https://doi.org/10.5281/zenodo.4471319 (Williams and Linton, 2021). A key advantage of the proposed framework for data analysis is that the methods and algorithms are published in full, allowing inspection by collaborators, other researchers or industrial partners. In particular this development can ensure confidence in the published methods. doi: 10.1007/s10840-019-00570-7 Pub Med Abstract | Cross Ref Full Text | Google Scholar Hohmann, S., Henkenberens, C., Zormpas, C., Christiansen, H., Bauersachs, J., Duncker, D., et al. A novel open-source software-based high-precision workflow for target definition in cardiac radioablation. Notably, the literature survey performed here identified that a majority of recent electroanatomic mapping studies performed area measurements of either an entire chamber or of specific regions (for example low voltage regions). However analysis using Open EP showed that there were both systematic and proportional biases in the assessment of chamber area. Consistent with this observation are the existing reports that manual measurements of low voltage areas are error prone (Herczeg et al., 2020a,b). In contrast, area measurements in Open EP are implemented using conventional geometric techniques. Quantitative assessment of left atrial scar using high-density voltage mapping and a novel automated voltage analysis tool. Whilst every effort has been taken to ensure their correct implementation, the open nature of the platform further allows others to confirm the accuracy of these implementations for themselves. doi: 10.1155/2020/3981684 Pub Med Abstract | Cross Ref Full Text | Google Scholar Herczeg, S., Walsh, K., Keaney, J. Finally, by providing a standard analysis method which can be used by any researchers in future studies the provision of this platform could ensure comparability between such studies. Minimizing data storage requirements is a further benefit of the Open EP framework. There are three ways in which the Open EP format improves data storage requirements. The value of voltage histogram analysis derived right atrial scar burden in the prediction of left atrial scar burden. Firstly, Open EP eliminates redundancy in the data such that there is only one copy of every unique electrogram. doi: 10.1016/j.jacep.20 Pub Med Abstract | Cross Ref Full Text | Google Scholar Herczeg, S., Galvin, J., Keaney, J. Secondly, the entire dataset (including anatomical and electrical data) is stored as a single data structure rather than multiple individual files which eliminates the file system overheads necessary to store large numbers of files. doi: 10.1161/CIRCEP.108.774885 Pub Med Abstract | Cross Ref Full Text | Google Scholar Hansen, B. Finally, the data is stored as a binary file rather than a series of text files. J., Zhao, J., Li, N., Zolotarev, A., Zakharkin, S., Wang, Y., et al. Human atrial fibrillation drivers resolved with integrated functional and structural imaging to benefit clinical mapping. In the format exported by the clinical mapping systems each individual patient data set is typically in the order of 1–2 Gb in size. The Open EP format significantly reduced the storage requirements for this dataset. doi: 10.1161/CIRCEP.113.000833 Pub Med Abstract | Cross Ref Full Text | Google Scholar Gaita, F., Caponi, D., Scaglione, M., Montefusco, A., Corleto, A., Di Monte, F., et al. Long-term clinical results of 2 different ablation strategies in patients with paroxysmal and persistent atrial fibrillation. Given that typical electroanatomic mapping studies may recruit 1–2 hundred patients it is not uncommon for the data storage requirements for one study to be greater than that available on a single personal computer. Furthermore, transferring data between external storage media for access is time consuming, especially when many thousands of individual files make up one patient dataset. doi: 10.1109/TBME.2016.2589158 Pub Med Abstract | Cross Ref Full Text | Google Scholar El Haddad, M., Houben, R., Stroobandt, R., Van Heuverswyn, F., Tavernier, R., and Duytschaever, M. Novel algorithmic methods in mapping of atrial and ventricular tachycardia. Aside from the convenience aspect of improved data storage there is increasing awareness of the environmental impact of wasteful data storage practices (Lucivero, 2020). In this context, the Open EP framework allows electroanatomic mapping data to data to be stored in an efficient manner. We also highlight that the Open EP data structure has been designed with extensibility in mind, most easily illustrated with an example. doi: 10.1161/CIRCEP.117.005897 Pub Med Abstract | Cross Ref Full Text | Google Scholar Deno, D. When creating geometric maps of electrophysiological parameters – such as electrogram voltage or activation time – a three-dimensional interpolation is necessary to create a visual color representation of the physiological parameter of interested. C., Balachandran, R., Morgan, D., Ahmad, F., Masse, S., and Nanthakumar, K. Orientation-independent catheter-based characterization of myocardial activation. This interpolation is commonly performed using commercially available clinical electroanatomic mapping platforms. Unraveling the underlying arrhythmia mechanism in persistent atrial fibrillation. Open EP permits access to, and analysis of, these clinical data interpolations. However, there are numerous methods to perform spatial interpolation which can result in different interpretations of the same data. Open EP therefore provides its own internal framework for performing interpolations based on the originally acquired electrical data. doi: 10.1016/j.ijcard.20 Pub Med Abstract | Cross Ref Full Text | Google Scholar Child, N., Clayton, R. The Open EP function generate Interp Data() is a key function for carrying out this task and can be easily modified/extended to make use of alternative methods for data interpolation. A further example of the extensibility of the Open EP data structure is in the visualization routines. These routines make use of data “getter” methods which access the required data from the Open EP data structure. By separating the visualization routines from the “getter” routines it is possible to easily implement alternative visualization techniques whilst making use of the same data as the Open EP framework. Electrophysiological characteristics of complex fractionated electrograms and high frequency activity in atrial fibrillation. As noted above the Open EP framework has been in active development and use for over a decade within our own research groups (Linton et al., 2009; Jamil-Copley et al., 2013; Williams et al., 2017, 2018, 2019; Whitaker et al., 2018). As such it has evolved, project by project, to include additional functionality when required. In order to evaluate how well this functionality now maps to functionality required in contemporary electroanatomic mapping studies a literature review was performed to assess the datatypes and analysis methods in use in the previous 1 year of electroanatomic mapping studies (November 2019–2020, see “Supplementary Material”). This analysis revealed that the majority of data types required for recent studies are now exposed through Open EP functions. This analysis also revealed a number of areas for future development including parsing and analyzing full 12-lead ECG signals, providing methods to perform fractionation analysis of intracardiac electrograms, methods to perform segmental analysis of the atria and ventricles and methods to assess late potentials in ventricular tachycardia studies. These areas have now been mapped to the roadmap for future development, which will be made available through the Open EP website. doi: 10.1016/j.compbiomed.20 Pub Med Abstract | Cross Ref Full Text | Google Scholar Chang, S. One area that is included in the roadmap for future development is the implementation of alternative methods for calculating conduction velocity. Although a simple concept, the measurement of conduction velocities from clinical data is challenging with multiple previous techniques proposed including triangulation of electrode positions/activation times (Kojodjojo et al., 2006a,b, 2007; Sawa et al., 2008; Ravelli et al., 2011; Cantwell et al., 2014), vector loops and omnipole mapping (Kadish et al., 2003; Massé et al., 2016; Deno et al., 2017), cosine-fit techniques (Weber et al., 2011; Roney et al., 2014, 2019) polynomial fit techniques (Nalliah et al., 2021) and calculation of the spatial gradients of local activation fields (Mourad and Nash, 2007). The method currently implemented in Open EP uses radial basis function interpolation (Masè and Ravelli, 2010). Techniques for automated local activation time annotation and conduction velocity estimation in cardiac mapping. Future work is planned to incorporate other conduction velocity measurement techniques within the Open EP framework. Related to conduction velocity is the concept of local activation time assignment. Currently, local activation time assignment within Open EP is taken from the clinical mapping system. However, it could be useful to perform activation time assignment within Open EP itself in order to create activation maps which are agnostic to the clinical system used for collecting electrogram data. Several Open EP functions including will be particularly useful for developing local activation time assignment functionality which is not yet part of Open EP. “A software platform for the comparative analysis of electroanatomic and imaging data including conduction velocity mapping,” in In Proceedings of the 2014 36th Annual International Conference IEEE Engering Medical Biology Society (EMBC), (Piscataway, NJ: IEEE). During the literature review process we identified two prior studies (Brett et al., 2020; Hohmann et al., 2020) that have made code available for accessing electroanatomic mapping data. doi: 10.1109/EMBC.2014.6943908 Pub Med Abstract | Cross Ref Full Text | Google Scholar Cantwell, C. In these study the system-created voltage maps alone were exported from clinical systems and a parser was written to import these data into the 3D Slicer program. These computer codes do not therefore allow access to the full array of electroanatomic mapping/ablation data exposed by Open EP. Compared to this study the Open EP framework provides access to all the individual datatypes available from the electroanatomic mapping platforms including raw electrogram data, ECG data, ablation data and interpolated electrophysiological maps and further provides methods to visualize and analyze mapping, electrogram and ablation data. In addition, through these series of analyses we have benchmarked and validated the current performance of the Open EP framework and provided a roadmap for its future development. The Open EP framework will likely never be in a position where it could be considered “complete.” Indeed, electroanatomic mapping platforms are evolving all the time and the Open EP framework will need to continually evolve in order to continue to represent contemporary data. doi: 10.1016/20 Cross Ref Full Text | Google Scholar Cantwell, C. However, we hope that by making the software available under an open-source license we will encourage other researchers to become actively involved in this development process and we welcome them to do so. Based on our experience during the years of developing this framework, this code is entirely based on the Matlab software. This is a limitation which necessitates access to a Matlab executable in order to run the code. Novel workflow for conversion of catheter-based electroanatomic mapping to DICOM imaging for noninvasive radioablation of ventricular tachycardia. Whilst many researchers will have access to Matlab through their institution, this is not ubiquitous and may limit use of the code. One proposal within the roadmap for development is to create a standalone version of the platform which can be used with only the Matlab runtime environment which does not require a license to access whilst a further development could modify the Open EP framework to be able to use the open-source Octave platform. A more extensive refactoring to use Python, instead, would be more involved but may lead to advantages in terms of usability and extensibility and is under active consideration. The literature review performed here highlighted a number of additional functionalities that may be useful for certain contemporary studies. Amongst these we have prioritized segmental analysis of the atria and ventricles as key targets and included these within the roadmap for development. doi: 10.1109/MCG.2007.323435 Pub Med Abstract | Cross Ref Full Text | Google Scholar Brett, C. However, to complete segmental analysis will currently require code functionality that is not currently available within Open EP and will need to be developed. The opportunity exists to improve the visualization functions within Open EP. For example, the rendering of local activation time maps using the function has currently been implemented to closely resemble the maps created by the clinical electroanatomic mapping systems, using a modification of the rainbow color map. However, it is recognized that the rainbow color map has several limitations (Borland and Taylor, 2007). Improvements such as rendering isochronal lines could improve the representation of continuous scale data such as local activation times. This objective has been included in the Roadmap for Development. Targeted ablation of ventricular tachycardia guided by wavefront discontinuities during sinus rhythm: a new functional substrate mapping strategy. doi: 10.1161/CIRCULATIONAHA.119.042423 Pub Med Abstract | Cross Ref Full Text | Google Scholar Borland, D., and Taylor, R. In conclusion here we present the Open EP framework for electrophysiology research, demonstrate its space-efficiency, benchmark its performance and validate the data exposed by the framework. By making the source code available to the research community along with a supporting website we hope that the Open EP framework can provide the simultaneous benefits of lowering the barriers to conducting contemporary electrophysiology research whilst standardizing the approach to many of the core data processing functions required to conduct such research. The original contributions presented in the study are included in the article/Supplementary Material, further inquiries can be directed to the corresponding author/s. doi: 10.1161/CIRCEP.119.007792 Cross Ref Full Text | Google Scholar Aziz, Z., Shatz, D., Raiman, M., Upadhyay, G. The studies involving human participants were reviewed and approved by the Health Research Authority; 18/HRA/0083. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements. Accurate conduction velocity maps and their association with scar distribution on magnetic resonance imaging in patients with postinfarction ventricular tachycardias. SW and NL conceived and designed the analysis, wrote computer code, performed the analysis, and wrote the manuscript. CR and CC contributed to the analysis, development of the code, and reviewed and approved the manuscript. JW tested the computer code, collected the data from clinical systems and, reviewed and approved the manuscript. IS, DO’H, IK, and LO’N collected the data from clinical systems, performed preparation of the clinical data, and reviewed and approved the manuscript. High-resolution mapping of postinfarction reentrant ventricular tachycardia: electrophysiological characterization of the circuit. doi: 10.1161/CIRCULATIONAHA.116.021955 Pub Med Abstract | Cross Ref Full Text | Google Scholar Aronis, K. MW and MO’N performed clinical data collection during clinical procedures and reviewed and approved the manuscript. MB and SN critically analyzed the results, contributed to analysis designed, and reviewed and approved the manuscript. All authors contributed to the article and approved the submitted version. doi: 10.1109/TBME.2020.3021480 [Epub ahead of print]. Cross Ref Full Text | Pub Med Abstract | Google Scholar Anter, E., Tschabrunn, C. SW acknowledges support from the British Heart Foundation (FS/20/26/34952 and PG/19/44/34368) and the Academy of Medical Sciences (SGCL017\1053). CR acknowledges support from the Medical Research Council (MR/S015086/1). Extensive right atrial free wall low-voltage zone as the substrate for atrial fibrillation: successful ablation by scar homogenization. doi: 10.1093/europace/euaa233 Pub Med Abstract | Cross Ref Full Text | Google Scholar Almeida, T., Soriano, D., Mase, M., Ravelli, F., Bezerra, A., Li, X., et al. Unsupervised classification of atrial electrograms for electroanatomic mapping of human persistent atrial fibrillation. SN acknowledges support from the United Kingdom Engineering and Physical Sciences Research Council (EP/M012492/1, NS/A000049/1, and EP/P01268X/1), the British Heart Foundation (PG/15/91/31812, PG/13/37/30280, and RG/20/4/34803), National Institutes of Health (NIH R01-HL152256), European Research Council (ERC PREDICT-HF 864055). This work was supported by the Wellcome/EPSRC Centre for Medical Engineering (WT203148/Z/16/Z) at King’s College London. NL acknowledges support from the British Heart Foundation (FS/15/25/31423). The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The Supplementary Material for this article can be found online at: https:// Al-Kaisey, A. If you have used Google search engine before to search for information, you would be interested to know that you can also use Google to find and track your phone.Google can not only track an Android phone but as well help find i Phone also.As long as your phone is using any Google services, such as Android or Gmail, you can use Google to help track your phone.

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