Title
Critical appraisal of technologies to assess electrical activity during atrial fibrillation: a position paper from the European Heart Rhythm Association and European Society of Cardiology Working Group on eCardiology in collaboration with the Heart Rhythm Society, Asia Pacific Heart Rhythm Society, Latin American Heart Rhythm Society and Computing in Cardiology
Author
de Groot, N.M.S. (TU Delft Signal Processing Systems; TU Delft Biomechanical Engineering; Erasmus MC)
Shah, Dipen (University Hospital of Geneva)
Boyle, Patrick M. (University of Washington)
Anter, Elad (Cleveland Clinic Foundation)
Clifford, Gari D. (Emory University)
Deisenhofer, Isabel (German Heart Center Munich and Technical University of Munich)
van Dessel, Pascal (Medisch Spectrum Twente (MST))
Dilaveris, Polychronis (National and Capodistrian University of Athens)
van der Veen, A.J. (TU Delft Signal Processing Systems; Circuits and Systems (CAS) Group) 
Department
Biomechanical Engineering
Date
2022
Abstract
We aim to provide a critical appraisal of basic concepts underlying signal recording and processing technologies applied for (i) atrial fibrillation (AF) mapping to unravel AF mechanisms and/or identifying target sites for AF therapy and (ii) AF detection, to optimize usage of technologies, stimulate research aimed at closing knowledge gaps, and developing ideal AF recording and processing technologies. Recording and processing techniques for assessment of electrical activity during AF essential for diagnosis and guiding ablative therapy including body surface electrocardiograms (ECG) and endo- or epicardial electrograms (EGM) are evaluated. Discussion of (i) differences in uni-, bi-, and multi-polar (omnipolar/Laplacian) recording modes, (ii) impact of recording technologies on EGM morphology, (iii) global or local mapping using various types of EGM involving signal processing techniques including isochronal-, voltage- fractionation-, dipole density-, and rotor mapping, enabling derivation of parameters like atrial rate, entropy, conduction velocity/direction, (iv) value of epicardial and optical mapping, (v) AF detection by cardiac implantable electronic devices containing various detection algorithms applicable to stored EGMs, (vi) contribution of machine learning (ML) to further improvement of signals processing technologies. Recording and processing of EGM (or ECG) are the cornerstones of (body surface) mapping of AF. Currently available AF recording and processing technologies are mainly restricted to specific applications or have technological limitations. Improvements in AF mapping by obtaining highest fidelity source signals (e.g. catheter-electrode combinations) for signal processing (e.g. filtering, digitization, and noise elimination) is of utmost importance. Novel acquisition instruments (multi-polar catheters combined with improved physical modelling and ML techniques) will enable enhanced and automated interpretation of EGM recordings in the near future.
Subject
Atrial fibrillation
Cardiac implantable electronic devices
EHRA position paper
Machine learning
Mapping
Signal processing
Signal recording
To reference this document use:
http://resolver.tudelft.nl/uuid:7d9d451c-9d31-4154-96da-87ed09e688df
DOI
https://doi.org/10.1093/europace/euab254
ISSN
1099-5129
Source
Europace, 24 (2), 313-330
Part of collection
Institutional Repository
Document type
journal article
Rights
© 2022 N.M.S. de Groot, Dipen Shah, Patrick M. Boyle, Elad Anter, Gari D. Clifford, Isabel Deisenhofer, Pascal van Dessel, Polychronis Dilaveris, A.J. van der Veen, More Authors