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Arrhythmia is a condition characterized by an irregular heart rhythm, with ECG changes that differ based on its origin and nature. The types of arrhythmias discussed below include atrial, junctional, and ventricular arrhythmias.Atrial ArrhythmiasPremature Atrial Complexes (PACs): PACs are early atrial beats caused by stress, caffeine, alcohol, electrolyte imbalances, hypoxia, hyperthyroidism, or certain medications (e.g., bronchodilators and decongestants). The ECG shows early P waves with an...
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Bradyarrhythmias are cardiac rhythm disorders characterized by a slower-than-normal heart rate, typically defined as fewer than 60 beats per minute. Some of which are discussed here:Sinus BradycardiaSinus bradycardia presents a heart rate lower than 60 beats per minute, with a regular rhythm originating from the SA node. The ECG typically shows normal P waves preceding each QRS complex, a normal PR interval (0.12 to 0.20 seconds), and a normal QRS duration (0.06 to 0.10 seconds).First-Degree AV...
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Dysrhythmias, also known as arrhythmias, are irregular heart rhythms that result from abnormal electrical activity in the heart, affecting its ability to circulate blood efficiently. Tachyarrhythmias, a subset of dysrhythmias, are characterized by abnormally fast heart rates exceeding 100 beats per minute. Here are some types of tachyarrhythmias with their distinct ECG features:Sinus Tachycardia:Sinus tachycardia presents a regular heart rhythm with an increased rate of 101-180 beats per...
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Arrhythmia or dysrhythmia refers to an abnormal heart rhythm caused by a defect in the heart's conduction system. It can cause the heart to beat irregularly, too quickly, or too slowly, leading to symptoms like chest pain, shortness of breath, and fainting. Factors such as stress, caffeine, alcohol, nicotine, cocaine, certain drugs, congenital defects, diseases, and electrolyte abnormalities can trigger arrhythmias.
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An electrocardiogram (ECG or EKG) is a critical diagnostic tool that records the electrical signals produced by the heart during each heartbeat. This recording is achieved through electrodes placed strategically on the arms, legs, and chest. The electrocardiograph amplifies these signals and produces 12 distinct tracings, offering a comprehensive understanding of the heart's electrical activity.
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Introduction
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Atrial electrogram amplitude variability during atrial fibrillation ablation.

Urszula Hangiel1, Jacek Kuśnierz2, Aleksander Bardyszewski2

  • 1Faculty of Medicine, Lazarski University, Warsaw, Poland.

Journal of Cardiovascular Electrophysiology
|October 11, 2022
PubMed
Summary

Beat-to-beat variability in bipolar atrial electrogram amplitude during atrial fibrillation ablation is clinically relevant. This electrogram amplitude variability may impact ablation mapping and extent, particularly during remapping.

Keywords:
3D mappingatrial fibrillationcatheter-tissue contact forceelectroanatomical systemslow-voltage areas

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Area of Science:

  • Electrophysiology
  • Cardiac Ablation
  • Atrial Fibrillation Research

Background:

  • Variability in bipolar atrial electrogram amplitude can influence voltage mapping accuracy during ablation procedures.
  • Inconsistent electrogram amplitudes may affect the determination of ablation extent and efficacy.
  • Understanding this variability is crucial for optimizing atrial fibrillation ablation strategies.

Purpose of the Study:

  • To assess the beat-to-beat variability of bipolar atrial electrogram amplitude in the left atrium.
  • To evaluate the clinical relevance of electrogram amplitude variability during atrial fibrillation ablation procedures.

Main Methods:

  • Collected 362 mapping points across two series in 11 patients undergoing atrial fibrillation ablation.
  • Recorded bipolar electrogram amplitude, contact force (CF), and catheter tip orientation for three consecutive beats at each point.
  • Assessed repeatability and reproducibility using Pearson correlation coefficient, Bland-Altman analysis, RC, RSD, and CCC.

Main Results:

  • High correlation (r=0.94) for bipolar atrial electrogram amplitude between the first two beats, with limits of agreement (LoA) within ±0.98 mV.
  • Contact force influenced variability; narrower LoA observed for CF values ≤5 g (±0.49 mV) and ≥20 g (±0.71 mV).
  • Between-series measurements showed moderate agreement (CCC 0.67-0.71) with LoA within ±2.7 to 2.9 mV.

Conclusions:

  • Bipolar atrial electrogram amplitude exhibits clinically relevant beat-to-beat variability during ablation procedures.
  • The magnitude of electrogram amplitude variability increases during remapping procedures.
  • This variability necessitates careful consideration in interpreting voltage maps and guiding ablation strategies.