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Overcoming Uncertainties in Electrogram-Based Atrial Fibrillation Mapping: A Review

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Abstract

In clinical rhythmology, intracardiac bipolar electrograms (EGMs) play a critical role in investigating the triggers and substrates inducing and perpetuating atrial fibrillation (AF). However, the interpretation of bipolar EGMs is ambiguous due to several aspects of electrodes, mapping algorithms and wave propagation dynamics, so it requires several variables to describe the effects of these uncertainties on EGM analysis. In this narrative review, we critically evaluate the potential impact of such uncertainties on the design of cardiac mapping tools on AF-related substrate characterization. Literature suggest uncertainties are due to several variables, including the wave propagation vector, the wave’s incidence angle, inter-electrode spacing, electrode size and shape, and tissue contact. The preprocessing of the EGM signals and mapping density will impact the electro-anatomical representation and the features extracted from the local electrical activities. The superposition of multiple waves further complicates EGM interpretation. The inclusion of these uncertainties is a nontrivial problem but their consideration will yield a better interpretation of the intra-atrial dynamics in local activation patterns. From a translational perspective, this review provides a concise but complete overview of the critical variables for developing more precise cardiac mapping tools.

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  1. School of Biomedical Engineering, The University of Sydney, Sydney, NSW, 2008, Australia

    Simanto Saha & Alistair McEwan

  2. Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, SA, 5000, Australia

    Dominik Linz

  3. Kumudini Women’s Medical College, The University of Dhaka, Tangail, 1940, Dhaka, Bangladesh

    Dyuti Saha

  4. School of Electrical and Mechanical Engineering, The University of Adelaide, Adelaide, SA, 5000, Australia

    Mathias Baumert

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Saha, S., Linz, D., Saha, D. et al. Overcoming Uncertainties in Electrogram-Based Atrial Fibrillation Mapping: A Review. Cardiovasc Eng Tech 15, 52–64 (2024). https://doi.org/10.1007/s13239-023-00696-w

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