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High-Resolution Measurement of Local Activation Time Differences From Bipolar Electrogram Amplitude

Localized changes in myocardial conduction velocity (CV) are pro-arrhythmic, but high-resolution mapping of local CV is not yet possible during clinical electrophysiology procedures. This is in part because measurement of local CV at small spatial scales (1 mm) requires accurate annotation of local...

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Autores principales: Gaeta, Stephen, Bahnson, Tristram D., Henriquez, Craig
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8100452/
https://www.ncbi.nlm.nih.gov/pubmed/33967825
http://dx.doi.org/10.3389/fphys.2021.653645
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author Gaeta, Stephen
Bahnson, Tristram D.
Henriquez, Craig
author_facet Gaeta, Stephen
Bahnson, Tristram D.
Henriquez, Craig
author_sort Gaeta, Stephen
collection PubMed
description Localized changes in myocardial conduction velocity (CV) are pro-arrhythmic, but high-resolution mapping of local CV is not yet possible during clinical electrophysiology procedures. This is in part because measurement of local CV at small spatial scales (1 mm) requires accurate annotation of local activation time (LAT) differences with very high temporal resolution (≤1 ms), beyond that of standard clinical methods. We sought to develop a method for high-resolution measurement of LAT differences and validate against existing techniques. First, we use a simplified theoretical model to identify a quantitative relationship between the LAT difference of a pair of electrodes and the peak amplitude of the bipolar EGM measured between them. This allows LAT differences to be calculated from bipolar EGM peak amplitude, by a novel “Determination of EGM Latencies by Transformation of Amplitude” (DELTA) method. Next, we use simulated EGMs from a computational model to validate this method. With 1 kHz sampling, LAT differences less than 4 ms were more accurately measured with DELTA than by standard LAT annotation (mean error 3.8% vs. 22.9%). In a 1-dimensional and a 2-dimension model, CV calculations were more accurate using LAT differences found by the DELTA method than by standard LAT annotation (by unipolar dV/dt timing). DELTA-derived LAT differences were more accurate than standard LAT annotation in simulated complex fractionated EGMs from a model incorporating fibrosis. Finally, we validated the DELTA method in vivo using 18,740 bipolar EGMs recorded from the left atrium of 10 atrial fibrillation patients undergoing catheter ablation. Using clinical EGMs, there was agreement in LAT differences found by DELTA, standard LAT annotation, and unipolar waveform cross-correlation. These results demonstrate an underlying relationship between a bipolar EGM’s peak amplitude and the activation time difference between its two electrodes. Our computational modeling and clinical results suggest this relationship can be leveraged clinically to improve measurement accuracy for small LAT differences, which may improve CV measurement at small spatial scales.
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spelling pubmed-81004522021-05-07 High-Resolution Measurement of Local Activation Time Differences From Bipolar Electrogram Amplitude Gaeta, Stephen Bahnson, Tristram D. Henriquez, Craig Front Physiol Physiology Localized changes in myocardial conduction velocity (CV) are pro-arrhythmic, but high-resolution mapping of local CV is not yet possible during clinical electrophysiology procedures. This is in part because measurement of local CV at small spatial scales (1 mm) requires accurate annotation of local activation time (LAT) differences with very high temporal resolution (≤1 ms), beyond that of standard clinical methods. We sought to develop a method for high-resolution measurement of LAT differences and validate against existing techniques. First, we use a simplified theoretical model to identify a quantitative relationship between the LAT difference of a pair of electrodes and the peak amplitude of the bipolar EGM measured between them. This allows LAT differences to be calculated from bipolar EGM peak amplitude, by a novel “Determination of EGM Latencies by Transformation of Amplitude” (DELTA) method. Next, we use simulated EGMs from a computational model to validate this method. With 1 kHz sampling, LAT differences less than 4 ms were more accurately measured with DELTA than by standard LAT annotation (mean error 3.8% vs. 22.9%). In a 1-dimensional and a 2-dimension model, CV calculations were more accurate using LAT differences found by the DELTA method than by standard LAT annotation (by unipolar dV/dt timing). DELTA-derived LAT differences were more accurate than standard LAT annotation in simulated complex fractionated EGMs from a model incorporating fibrosis. Finally, we validated the DELTA method in vivo using 18,740 bipolar EGMs recorded from the left atrium of 10 atrial fibrillation patients undergoing catheter ablation. Using clinical EGMs, there was agreement in LAT differences found by DELTA, standard LAT annotation, and unipolar waveform cross-correlation. These results demonstrate an underlying relationship between a bipolar EGM’s peak amplitude and the activation time difference between its two electrodes. Our computational modeling and clinical results suggest this relationship can be leveraged clinically to improve measurement accuracy for small LAT differences, which may improve CV measurement at small spatial scales. Frontiers Media S.A. 2021-04-22 /pmc/articles/PMC8100452/ /pubmed/33967825 http://dx.doi.org/10.3389/fphys.2021.653645 Text en Copyright © 2021 Gaeta, Bahnson and Henriquez. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Physiology
Gaeta, Stephen
Bahnson, Tristram D.
Henriquez, Craig
High-Resolution Measurement of Local Activation Time Differences From Bipolar Electrogram Amplitude
title High-Resolution Measurement of Local Activation Time Differences From Bipolar Electrogram Amplitude
title_full High-Resolution Measurement of Local Activation Time Differences From Bipolar Electrogram Amplitude
title_fullStr High-Resolution Measurement of Local Activation Time Differences From Bipolar Electrogram Amplitude
title_full_unstemmed High-Resolution Measurement of Local Activation Time Differences From Bipolar Electrogram Amplitude
title_short High-Resolution Measurement of Local Activation Time Differences From Bipolar Electrogram Amplitude
title_sort high-resolution measurement of local activation time differences from bipolar electrogram amplitude
topic Physiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8100452/
https://www.ncbi.nlm.nih.gov/pubmed/33967825
http://dx.doi.org/10.3389/fphys.2021.653645
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