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Automatic quality electrogram assessment improves phase-based reentrant activity identification in atrial

Alejandro Costoya-Sánchez1, Andreu M Climent2, Ismael Hernández-Romero3

  • 1ITACA Institute, Universitat Politècnica de València, Spain.

Computers in Biology and Medicine
|February 20, 2020
PubMed
Summary

Automatically classifying electrogram (EGM) quality improves atrial fibrillation (AF) driver localization. Discarding reentries in low-quality EGM regions enhances the accuracy of 3D phase mapping for identifying AF drivers.

Keywords:
Atrial fibrillationBasket mappingDriverPhase mappingReentryRotorSource

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Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Signal Processing

Background:

  • Identifying reentrant circuits is crucial for effective atrial fibrillation (AF) ablative therapies.
  • The quality of electrograms (EGMs) can significantly impact the accuracy of reentrant driver localization.

Purpose of the Study:

  • To investigate the impact of automatically classified EGM quality on reentrant AF driver localization.
  • To develop and validate an algorithm for automatic EGM quality classification.

Main Methods:

  • Collected EGMs from 259 AF episodes in 29 patients using 64-pole basket catheters.
  • Developed an algorithm using time and spectral domain parameters for EGM quality classification.
  • Identified electrical reentries using 3D phase maps and compared with a 2D activation-based method, assessing the effect of discarding low-quality EGM regions.

Main Results:

  • The EGM quality classification algorithm achieved high accuracy (AUC 0.94).
  • Discarding reentries in low-quality EGM regions improved the 3D phase-based method's performance (AUC increased from 0.69 to 0.80).
  • Automatic EGM quality classification is feasible, accurate, and eliminates the need for manual labeling.

Conclusions:

  • Automatic classification of EGM quality is a reliable method for improving AF driver identification.
  • Excluding reentries detected in poor-quality EGM areas enhances the specificity of 3D phase mapping for AF driver localization.