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ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias

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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...

Electrocardiogram

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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.
Three major waveforms are present in a typical ECG recording: the P wave, the QRS complex, and the T...

Pulse rhythm

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Pulse rhythm refers to the pattern of pulsations within specific intervals, offering valuable insights into the regularity or irregularity of the heart's beats as observed through the pattern of pulsation within specific intervals. A regular pulse exhibits a consistent heart rate with uniform waveforms and pulsation force, variations of which can be classified as normal, weak, or bounding.
Conversely, an irregular pulse pattern is termed dysrhythmia, stemming from disruptions in cardiac muscle...

Dysrhythmias V: Evaluating Dysrhythmias

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Dysrhythmias III: Characteristics of Dysrhythmias

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High-Resolution Endocardial and Epicardial Optical Mapping in a Sheep Model of Stretch-Induced Atrial Fibrillation

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Detection of Spatio-Temporal Dispersion Electrograms Using Complex Signal Identification-Labeled Abnormal Potential

Kazuki Ito¹, Yoshihisa Naruse¹, Yuki Tokonami¹

¹Department of Internal Medicine III, Division of Cardiology, Hamamatsu University School of Medicine, Handayama, Chuo-ku, Hamamatsu, Japan.

Journal of Cardiovascular Electrophysiology

|June 15, 2026

Summary

Complex Signal Identification (CSI) accurately identifies spatio-temporal dispersion electrograms (STDEs) in persistent atrial fibrillation (AF) patients. This automated tool aids in guiding ablation strategies beyond standard pulmonary vein isolation (PVI).

Keywords:

CARTO 3 version 8 complex signal identification persistent atrial fibrillation spatio‐temporal dispersion electrograms

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Real-Time Cardiac Mapping with a Noninvasive Imageless Electrocardiographic Imaging System

Real-Time Cardiac Mapping with a Noninvasive Imageless Electrocardiographic Imaging System

Published on: April 11, 2025

Area of Science:

Electrophysiology
Cardiac Arrhythmia Research
Medical Device Technology

Background:

Pulmonary vein isolation (PVI) combined with ablation of spatio-temporal dispersion electrograms (STDEs) may decrease atrial fibrillation (AF) recurrence in persistent AF.
Current methods for identifying STDEs are subjective.
Complex Signal Identification (CSI) software integrated into the CARTO 3 mapping system offers automated electrogram analysis.

Purpose of the Study:

To evaluate the accuracy of Complex Signal Identification (CSI) parameters in identifying STDEs.
To determine if CSI can provide an objective method for STDE detection during catheter ablation for persistent AF.

Main Methods:

Retrospective analysis of 4453 intracardiac electrogram points from five patients with persistent AF.
Data collected using the CARTO 3 version 8 mapping system and OCTARAY catheter.
Comparison of operator-identified STDEs with CSI-derived metrics, including fractionation score, complex duration, %cycle length, and complex onset.

Main Results:

The CSI fractionation score showed the highest diagnostic accuracy for STDE identification (AUC=0.905) with an optimal cutoff of 4.1.
Sensitivity was 80.4%, specificity 98.6%, positive predictive value 94.1%, and negative predictive value 93.1% for the fractionation score.
Other CSI metrics like complex duration, %cycle length, and complex onset demonstrated lower diagnostic accuracy.

Conclusions:

A CSI fractionation score cutoff of 4.1 accurately identifies STDEs.
CSI-guided mapping represents a potentially practical tool for adjunctive ablation strategies in persistent AF, complementing PVI.