Mapping and Removing the Ventricular Far Field Component in Unipolar Atrial Electrograms

Area of Science:

• Cardiovascular Electrophysiology
• Biomedical Signal Processing
• Medical Device Technology

Background:

• Unipolar intracardiac electrograms (uEGMs) are crucial for cardiac electro-anatomic mapping.
• Ventricular far field (VFF) signals contaminate uEGMs, complicating analysis.
• Current VFF removal methods extend mapping procedure times.

Purpose of the Study:

• To develop and validate novel methods for VFF component removal from uEGMs.
• To enable faster and more accurate cardiac mapping.
• To reduce the clinical mapping procedure duration.

Main Methods:

• Developed two models: Polynomial fit and dipole fit, to approximate VFF spatio-temporal distribution.
• Benchmarked models using simulated cardiac excitation in human heart models.
• Applied models to clinical electrogram data.

Main Results:

• A dipole model achieved a median VFF deviation of 0.029 mV and attenuation of 142 under realistic noise.
• Extrapolating VFF from a 5mm endocardial layer yielded a median deviation of 0.082 mV (49x attenuation).
• Models demonstrated feasibility in personalized VFF component modeling and removal.

Conclusions:

• Personalized modeling and effective removal of the VFF component from uEGMs is feasible.
• The developed methods are simple, computationally inexpensive, and do not prolong data acquisition.
• Immediate diagnostic assessment of uEGM data is enabled, improving clinical workflow.