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Bipolar electrograms characteristics at the left atrial-pulmonary vein junction: toward a new algorithm for automated verification of pulmonary vein isolation

(2015) HEART RHYTHM. 12(1). p.21-31
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Abstract
BACKGROUND: Verification of pulmonary vein isolation (PVI) is challenging because of the coexistence of PV and far-field potentials in bipolar electrograms recorded at the Left atrial-pulmonary vein (LA-PV) junction. OBJECTIVE: The purpose of this study was to characterize algorithmically LA-PV potentials before and after PVI and to develop an algorithm to differentiate nonisolated from isolated PVs. METHODS: In 61 patients, we characterized by type (morphology) and parameters-1440 electrograms recorded during sinus rhythm before and after PVI. Based on vein-dependent prevalence of a given type before and after PVI (first step) and based on vein- and type-dependent cutoff values in parameters specific for recordings before and after PVI (second step), we developed a 2-step algorithm to differentiate nonisolated from isolated PVs. We prospectively validated this algorithm in another dataset of 20 patients. RESULTS: Characteristics before and after PVI were as follows: low voltage (10% +/- 7% vs 36% +/- 15%), monophasic (13% +/- 4% vs 27% +/- 9%), biphasic (18% +/- 4% vs 21% +/- 7 9%), triphasic (22% +/- 5% vs 11% +/- 13%), multiphasic (26% +/- 7% vs 3% +/- 3%), double potentials (11% +/- 5% vs 2% +/- 1%), peak-to-peak amplitude (0.97 +/- 0.21 mV vs 0.35 +/- 0.23 mV), maximal slope (0.179 +/- 0.033 mV/ms vs 0.071 +/- 0.029 mV/ms), minimal slope (0.030 +/- 0.003 mV/ms vs 0.024 +/- 0.002 mV/ms), and sharpest peak (1.82 degrees +/- 0.26 degrees vs 3.45 degrees +/- 0.85 degrees, P < .01 for all except biphasic). Overall sensitivity and specificity of the 2-step algorithm was 100% and 87%, respectively. CONCLUSION: We algorithmically characterized LA-PV potentials before and after PVI in a Large dataset (library of types and parameters). This library enabled us to develop an accurate 2-step algorithm to automatically differentiate nonisolated from isolated PVs. The 2-step algorithm is objective and reliable for assessing PV isolation without the need for pacing maneuvers.
Keywords
Algorithm, Ablation, Atrial fibrillation ablation, Electrogram, Pulmonary vein isolation, Pulmonary vein potential, POTENTIALS, ABLATION

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MLA
El Haddad, Milad, Richard Houben, Benjamin Berte, et al. “Bipolar Electrograms Characteristics at the Left Atrial-pulmonary Vein Junction: Toward a New Algorithm for Automated Verification of Pulmonary Vein Isolation.” HEART RHYTHM 12.1 (2015): 21–31. Print.
APA
El Haddad, M., Houben, R., Berte, B., Van Heuverswyn, F., Stroobandt, R., Vandekerckhove, Y., Tavernier, R., et al. (2015). Bipolar electrograms characteristics at the left atrial-pulmonary vein junction: toward a new algorithm for automated verification of pulmonary vein isolation. HEART RHYTHM, 12(1), 21–31.
Chicago author-date
El Haddad, Milad, Richard Houben, Benjamin Berte, Frederic Van Heuverswyn, Roland Stroobandt, Yves Vandekerckhove, Rene Tavernier, and Mattias Duytschaever. 2015. “Bipolar Electrograms Characteristics at the Left Atrial-pulmonary Vein Junction: Toward a New Algorithm for Automated Verification of Pulmonary Vein Isolation.” Heart Rhythm 12 (1): 21–31.
Chicago author-date (all authors)
El Haddad, Milad, Richard Houben, Benjamin Berte, Frederic Van Heuverswyn, Roland Stroobandt, Yves Vandekerckhove, Rene Tavernier, and Mattias Duytschaever. 2015. “Bipolar Electrograms Characteristics at the Left Atrial-pulmonary Vein Junction: Toward a New Algorithm for Automated Verification of Pulmonary Vein Isolation.” Heart Rhythm 12 (1): 21–31.
Vancouver
1.
El Haddad M, Houben R, Berte B, Van Heuverswyn F, Stroobandt R, Vandekerckhove Y, et al. Bipolar electrograms characteristics at the left atrial-pulmonary vein junction: toward a new algorithm for automated verification of pulmonary vein isolation. HEART RHYTHM. 2015;12(1):21–31.
IEEE
[1]
M. El Haddad et al., “Bipolar electrograms characteristics at the left atrial-pulmonary vein junction: toward a new algorithm for automated verification of pulmonary vein isolation,” HEART RHYTHM, vol. 12, no. 1, pp. 21–31, 2015.
@article{5761222,
  abstract     = {{BACKGROUND: Verification of pulmonary vein isolation (PVI) is challenging because of the coexistence of PV and far-field potentials in bipolar electrograms recorded at the Left atrial-pulmonary vein (LA-PV) junction. 
OBJECTIVE: The purpose of this study was to characterize algorithmically LA-PV potentials before and after PVI and to develop an algorithm to differentiate nonisolated from isolated PVs.
METHODS: In 61 patients, we characterized by type (morphology) and parameters-1440 electrograms recorded during sinus rhythm before and after PVI. Based on vein-dependent prevalence of a given type before and after PVI (first step) and based on vein- and type-dependent cutoff values in parameters specific for recordings before and after PVI (second step), we developed a 2-step algorithm to differentiate nonisolated from isolated PVs. We prospectively validated this algorithm in another dataset of 20 patients. 
RESULTS: Characteristics before and after PVI were as follows: low voltage (10% +/- 7% vs 36% +/- 15%), monophasic (13% +/- 4% vs 27% +/- 9%), biphasic (18% +/- 4% vs 21% +/- 7 9%), triphasic (22% +/- 5% vs 11% +/- 13%), multiphasic (26% +/- 7% vs 3% +/- 3%), double potentials (11% +/- 5% vs 2% +/- 1%), peak-to-peak amplitude (0.97 +/- 0.21 mV vs 0.35 +/- 0.23 mV), maximal slope (0.179 +/- 0.033 mV/ms vs 0.071 +/- 0.029 mV/ms), minimal slope (0.030 +/- 0.003 mV/ms vs 0.024 +/- 0.002 mV/ms), and sharpest peak (1.82 degrees +/- 0.26 degrees vs 3.45 degrees +/- 0.85 degrees, P < .01 for all except biphasic). Overall sensitivity and specificity of the 2-step algorithm was 100% and 87%, respectively. 
CONCLUSION: We algorithmically characterized LA-PV potentials before and after PVI in a Large dataset (library of types and parameters). This library enabled us to develop an accurate 2-step algorithm to automatically differentiate nonisolated from isolated PVs. The 2-step algorithm is objective and reliable for assessing PV isolation without the need for pacing maneuvers.}},
  author       = {{El Haddad, Milad and Houben, Richard and Berte, Benjamin and Van Heuverswyn, Frederic and Stroobandt, Roland and Vandekerckhove, Yves and Tavernier, Rene and Duytschaever, Mattias}},
  issn         = {{1547-5271}},
  journal      = {{HEART RHYTHM}},
  keywords     = {{Algorithm,Ablation,Atrial fibrillation ablation,Electrogram,Pulmonary vein isolation,Pulmonary vein potential,POTENTIALS,ABLATION}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{21--31}},
  title        = {{Bipolar electrograms characteristics at the left atrial-pulmonary vein junction: toward a new algorithm for automated verification of pulmonary vein isolation}},
  url          = {{http://dx.doi.org/10.1016/j.hrthm.2014.08.030}},
  volume       = {{12}},
  year         = {{2015}},
}

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