Unipolar electrogram‐based voltage mapping with far‐field cancellation to improve detection of abnormal atrial substrate during atrial fibrillation

Introduction An important substrate for atrial fibrillation (AF) is fibrotic atrial myopathy. Identifying low voltage, myopathic regions during AF using traditional bipolar voltage mapping is limited by the directional dependency of wave propagation. Our objective was to evaluate directionally indep...

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Published in:Journal of cardiovascular electrophysiology 2021-06, Vol.32 (6), p.1572-1583
Main Authors: Ragot, Don, Nayyar, Sachin, Massin, Sophia Z., Ha, Andrew C. T., Singh, Sheldon M., Labos, Christopher, Suszko, Adrian, Dalvi, Rupin, Chauhan, Vijay S.
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Language:English
Subjects:
Algorithms
atrial fibrillation
Cardiac arrhythmia
Catheters
far‐field signal
Fibrillation
human
Mapping
Myopathy
signal processing
substrate mapping
unipolar electrogram
Voltage
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cited_by cdi_FETCH-LOGICAL-c3539-6745461e31a74034c5ca0987b1fcfb88559a02eefcc31bdd0eb62f61e837e663
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container_issue 6
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container_title Journal of cardiovascular electrophysiology
container_volume 32
creator Ragot, Don
Nayyar, Sachin
Massin, Sophia Z.
Ha, Andrew C. T.
Singh, Sheldon M.
Labos, Christopher
Suszko, Adrian
Dalvi, Rupin
Chauhan, Vijay S.
description Introduction An important substrate for atrial fibrillation (AF) is fibrotic atrial myopathy. Identifying low voltage, myopathic regions during AF using traditional bipolar voltage mapping is limited by the directional dependency of wave propagation. Our objective was to evaluate directionally independent unipolar voltage mapping, but with far‐field cancellation, to identify low‐voltage regions during AF. Methods In 12 patients undergoing pulmonary vein isolation for AF, high‐resolution voltage mapping was performed in the left atrium during sinus rhythm and AF using a roving 20‐pole circular catheter. Bipolar electrograms (EGMs) (Bi) 
doi_str_mv 10.1111/jce.14999
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T. ; Singh, Sheldon M. ; Labos, Christopher ; Suszko, Adrian ; Dalvi, Rupin ; Chauhan, Vijay S.</creator><creatorcontrib>Ragot, Don ; Nayyar, Sachin ; Massin, Sophia Z. ; Ha, Andrew C. T. ; Singh, Sheldon M. ; Labos, Christopher ; Suszko, Adrian ; Dalvi, Rupin ; Chauhan, Vijay S.</creatorcontrib><description>Introduction An important substrate for atrial fibrillation (AF) is fibrotic atrial myopathy. Identifying low voltage, myopathic regions during AF using traditional bipolar voltage mapping is limited by the directional dependency of wave propagation. Our objective was to evaluate directionally independent unipolar voltage mapping, but with far‐field cancellation, to identify low‐voltage regions during AF. Methods In 12 patients undergoing pulmonary vein isolation for AF, high‐resolution voltage mapping was performed in the left atrium during sinus rhythm and AF using a roving 20‐pole circular catheter. Bipolar electrograms (EGMs) (Bi) &lt; 0.5 mV in sinus rhythm identified low‐voltage regions. During AF, bipolar voltage and unipolar voltage maps were created, the latter with (uni‐res) and without (uni‐orig) far‐field cancellation using a novel, validated least‐squares algorithm. Results Uni‐res voltage was ~25% lower than uni‐orig for both low voltage and normal atrial regions. Far‐field EGM had a dominant frequency (DF) of 4.5–6.0 Hz, and its removal resulted in a lower DF for uni‐orig compared with uni‐res (5.1 ± 1.5 vs. 4.8 ± 1.5 Hz; p &lt; .001). Compared with Bi, uni‐res had a significantly greater area under the receiver operator curve (0.80 vs. 0.77; p &lt; .05), specificity (86% vs. 76%; p &lt; .001), and positive predictive value (43% vs. 30%; p &lt; .001) for detecting low‐voltage during AF. Similar improvements in specificity and positive predictive value were evident for uni‐res versus uni‐orig. Conclusion Far‐field EGM can be reliably removed from uni‐orig using our novel, least‐squares algorithm. Compared with Bi and uni‐orig, uni‐res is more accurate in detecting low‐voltage regions during AF. This approach may improve substrate mapping and ablation during AF, and merits further study.</description><identifier>ISSN: 1045-3873</identifier><identifier>EISSN: 1540-8167</identifier><identifier>DOI: 10.1111/jce.14999</identifier><identifier>PMID: 33694221</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Algorithms ; atrial fibrillation ; Cardiac arrhythmia ; Catheters ; far‐field signal ; Fibrillation ; human ; Mapping ; Myopathy ; signal processing ; substrate mapping ; unipolar electrogram ; Voltage</subject><ispartof>Journal of cardiovascular electrophysiology, 2021-06, Vol.32 (6), p.1572-1583</ispartof><rights>2021 Wiley Periodicals LLC</rights><rights>2021 Wiley Periodicals LLC.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3539-6745461e31a74034c5ca0987b1fcfb88559a02eefcc31bdd0eb62f61e837e663</citedby><cites>FETCH-LOGICAL-c3539-6745461e31a74034c5ca0987b1fcfb88559a02eefcc31bdd0eb62f61e837e663</cites><orcidid>0000-0001-9264-5073 ; 0000-0002-7972-5375 ; 0000-0001-8185-1998 ; 0000-0002-8210-3112</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33694221$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ragot, Don</creatorcontrib><creatorcontrib>Nayyar, Sachin</creatorcontrib><creatorcontrib>Massin, Sophia Z.</creatorcontrib><creatorcontrib>Ha, Andrew C. T.</creatorcontrib><creatorcontrib>Singh, Sheldon M.</creatorcontrib><creatorcontrib>Labos, Christopher</creatorcontrib><creatorcontrib>Suszko, Adrian</creatorcontrib><creatorcontrib>Dalvi, Rupin</creatorcontrib><creatorcontrib>Chauhan, Vijay S.</creatorcontrib><title>Unipolar electrogram‐based voltage mapping with far‐field cancellation to improve detection of abnormal atrial substrate during atrial fibrillation</title><title>Journal of cardiovascular electrophysiology</title><addtitle>J Cardiovasc Electrophysiol</addtitle><description>Introduction An important substrate for atrial fibrillation (AF) is fibrotic atrial myopathy. Identifying low voltage, myopathic regions during AF using traditional bipolar voltage mapping is limited by the directional dependency of wave propagation. Our objective was to evaluate directionally independent unipolar voltage mapping, but with far‐field cancellation, to identify low‐voltage regions during AF. Methods In 12 patients undergoing pulmonary vein isolation for AF, high‐resolution voltage mapping was performed in the left atrium during sinus rhythm and AF using a roving 20‐pole circular catheter. Bipolar electrograms (EGMs) (Bi) &lt; 0.5 mV in sinus rhythm identified low‐voltage regions. During AF, bipolar voltage and unipolar voltage maps were created, the latter with (uni‐res) and without (uni‐orig) far‐field cancellation using a novel, validated least‐squares algorithm. Results Uni‐res voltage was ~25% lower than uni‐orig for both low voltage and normal atrial regions. Far‐field EGM had a dominant frequency (DF) of 4.5–6.0 Hz, and its removal resulted in a lower DF for uni‐orig compared with uni‐res (5.1 ± 1.5 vs. 4.8 ± 1.5 Hz; p &lt; .001). Compared with Bi, uni‐res had a significantly greater area under the receiver operator curve (0.80 vs. 0.77; p &lt; .05), specificity (86% vs. 76%; p &lt; .001), and positive predictive value (43% vs. 30%; p &lt; .001) for detecting low‐voltage during AF. Similar improvements in specificity and positive predictive value were evident for uni‐res versus uni‐orig. Conclusion Far‐field EGM can be reliably removed from uni‐orig using our novel, least‐squares algorithm. Compared with Bi and uni‐orig, uni‐res is more accurate in detecting low‐voltage regions during AF. This approach may improve substrate mapping and ablation during AF, and merits further study.</description><subject>Algorithms</subject><subject>atrial fibrillation</subject><subject>Cardiac arrhythmia</subject><subject>Catheters</subject><subject>far‐field signal</subject><subject>Fibrillation</subject><subject>human</subject><subject>Mapping</subject><subject>Myopathy</subject><subject>signal processing</subject><subject>substrate mapping</subject><subject>unipolar electrogram</subject><subject>Voltage</subject><issn>1045-3873</issn><issn>1540-8167</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp1kc9O3DAQh62qVaG0B14AWeqFHgJ2bMfJEa3oPyH1Qs-R7YwXr5w42A6IG4_Are_XJ6mXXXqoVF_GGn3zaUY_hI4pOaPlnW8MnFHedd0rdEgFJ1VLG_m6_AkXFWslO0DvUtoQQllDxFt0wFjT8bqmh-jXz8nNwauIwYPJMayjGn8_PmmVYMB3wWe1BjyqeXbTGt-7fIOtigWwDvyAjZoMeK-yCxPOAbtxjuEO8AC52LbNYLHSU4ij8ljl6EpJi045qlywJW61-751Orq97D16Y5VP8GFfj9D158vr1dfq6seXb6uLq8owwbqqkVzwhgKjSnLCuBFGka6VmlpjddsK0SlSA1hjGNXDQEA3tS0DLZPQNOwIne60Ze3bBVLuR5eeL5ogLKmvBSFMCkm26Md_0E1Y4lSWKxSTreg454X6tKNMDClFsP0c3ajiQ09Jvw2rL2H1z2EV9mRvXPQIw1_yJZ0CnO-Ae-fh4f-m_vvqcqf8AzH9o00</recordid><startdate>202106</startdate><enddate>202106</enddate><creator>Ragot, Don</creator><creator>Nayyar, Sachin</creator><creator>Massin, Sophia Z.</creator><creator>Ha, Andrew C. T.</creator><creator>Singh, Sheldon M.</creator><creator>Labos, Christopher</creator><creator>Suszko, Adrian</creator><creator>Dalvi, Rupin</creator><creator>Chauhan, Vijay S.</creator><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-9264-5073</orcidid><orcidid>https://orcid.org/0000-0002-7972-5375</orcidid><orcidid>https://orcid.org/0000-0001-8185-1998</orcidid><orcidid>https://orcid.org/0000-0002-8210-3112</orcidid></search><sort><creationdate>202106</creationdate><title>Unipolar electrogram‐based voltage mapping with far‐field cancellation to improve detection of abnormal atrial substrate during atrial fibrillation</title><author>Ragot, Don ; Nayyar, Sachin ; Massin, Sophia Z. ; Ha, Andrew C. T. ; Singh, Sheldon M. ; Labos, Christopher ; Suszko, Adrian ; Dalvi, Rupin ; Chauhan, Vijay S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3539-6745461e31a74034c5ca0987b1fcfb88559a02eefcc31bdd0eb62f61e837e663</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Algorithms</topic><topic>atrial fibrillation</topic><topic>Cardiac arrhythmia</topic><topic>Catheters</topic><topic>far‐field signal</topic><topic>Fibrillation</topic><topic>human</topic><topic>Mapping</topic><topic>Myopathy</topic><topic>signal processing</topic><topic>substrate mapping</topic><topic>unipolar electrogram</topic><topic>Voltage</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ragot, Don</creatorcontrib><creatorcontrib>Nayyar, Sachin</creatorcontrib><creatorcontrib>Massin, Sophia Z.</creatorcontrib><creatorcontrib>Ha, Andrew C. T.</creatorcontrib><creatorcontrib>Singh, Sheldon M.</creatorcontrib><creatorcontrib>Labos, Christopher</creatorcontrib><creatorcontrib>Suszko, Adrian</creatorcontrib><creatorcontrib>Dalvi, Rupin</creatorcontrib><creatorcontrib>Chauhan, Vijay S.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium &amp; Calcified Tissue Abstracts</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of cardiovascular electrophysiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ragot, Don</au><au>Nayyar, Sachin</au><au>Massin, Sophia Z.</au><au>Ha, Andrew C. T.</au><au>Singh, Sheldon M.</au><au>Labos, Christopher</au><au>Suszko, Adrian</au><au>Dalvi, Rupin</au><au>Chauhan, Vijay S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Unipolar electrogram‐based voltage mapping with far‐field cancellation to improve detection of abnormal atrial substrate during atrial fibrillation</atitle><jtitle>Journal of cardiovascular electrophysiology</jtitle><addtitle>J Cardiovasc Electrophysiol</addtitle><date>2021-06</date><risdate>2021</risdate><volume>32</volume><issue>6</issue><spage>1572</spage><epage>1583</epage><pages>1572-1583</pages><issn>1045-3873</issn><eissn>1540-8167</eissn><abstract>Introduction An important substrate for atrial fibrillation (AF) is fibrotic atrial myopathy. Identifying low voltage, myopathic regions during AF using traditional bipolar voltage mapping is limited by the directional dependency of wave propagation. Our objective was to evaluate directionally independent unipolar voltage mapping, but with far‐field cancellation, to identify low‐voltage regions during AF. Methods In 12 patients undergoing pulmonary vein isolation for AF, high‐resolution voltage mapping was performed in the left atrium during sinus rhythm and AF using a roving 20‐pole circular catheter. Bipolar electrograms (EGMs) (Bi) &lt; 0.5 mV in sinus rhythm identified low‐voltage regions. During AF, bipolar voltage and unipolar voltage maps were created, the latter with (uni‐res) and without (uni‐orig) far‐field cancellation using a novel, validated least‐squares algorithm. Results Uni‐res voltage was ~25% lower than uni‐orig for both low voltage and normal atrial regions. Far‐field EGM had a dominant frequency (DF) of 4.5–6.0 Hz, and its removal resulted in a lower DF for uni‐orig compared with uni‐res (5.1 ± 1.5 vs. 4.8 ± 1.5 Hz; p &lt; .001). Compared with Bi, uni‐res had a significantly greater area under the receiver operator curve (0.80 vs. 0.77; p &lt; .05), specificity (86% vs. 76%; p &lt; .001), and positive predictive value (43% vs. 30%; p &lt; .001) for detecting low‐voltage during AF. Similar improvements in specificity and positive predictive value were evident for uni‐res versus uni‐orig. Conclusion Far‐field EGM can be reliably removed from uni‐orig using our novel, least‐squares algorithm. Compared with Bi and uni‐orig, uni‐res is more accurate in detecting low‐voltage regions during AF. This approach may improve substrate mapping and ablation during AF, and merits further study.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>33694221</pmid><doi>10.1111/jce.14999</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0001-9264-5073</orcidid><orcidid>https://orcid.org/0000-0002-7972-5375</orcidid><orcidid>https://orcid.org/0000-0001-8185-1998</orcidid><orcidid>https://orcid.org/0000-0002-8210-3112</orcidid></addata></record>
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source Wiley-Blackwell Read & Publish Collection
subjects Algorithms
atrial fibrillation
Cardiac arrhythmia
Catheters
far‐field signal
Fibrillation
human
Mapping
Myopathy
signal processing
substrate mapping
unipolar electrogram
Voltage
title Unipolar electrogram‐based voltage mapping with far‐field cancellation to improve detection of abnormal atrial substrate during atrial fibrillation
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