Journal of arrhythmia · 2025
The signal quality of tripolar Laplacian electrogram compared to bipolar electrogram in cardiac electrophysiology.
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Yamashita Soichiro, Takemoto Makoto, Fujimoto Wataru, Kuroda Koji, Imanishi Junichi, Iwasaki Masamichi, Todoroki Takafumi, Okuda Masanori
Аннотация
BACKGROUND: The usefulness of tripolar Laplacian electrogram (TLE) in cardiac electrophysiology is unknown.
OBJECTIVE: We investigated the difference in the morphology, voltage amplitude, noise level, and far-field potential (FFP) between TLE and bipolar electrogram (BE).
METHODS: Twenty-two patients who underwent catheter ablation for atrial fibrillation were analyzed. TLE and BE were simultaneously obtained using 64-electrode basket catheters during atrial tachycardia or pacing. Local electrograms (EGMs) were analyzed at the locations of three activation patterns: normal conduction, wavefront collision, and slow conduction (SC). In addition, each activation pattern was analyzed at two different wavefront angles: horizontal and vertical, respectively. The voltage amplitude, duration, morphology, and deflection number were compared. The noise level and FFP amplitude were also analyzed.
RESULTS: With all activation patterns and wavefront angles, the voltage amplitude was significantly lower on TLE than on BE, and the mean amplitude ratio of TLE/BE was 0.75. The duration and deflection number of EGM were comparable. The ventricular FFP amplitude was lower on TLE than on BE (0.04 mV vs. 0.40 mV, p = .01). TLE also had less noise than BE (0.08 mV vs. 0.15 mV, p = .02), with a noise reduction of 47%. At the SC area, low-voltage EGMs below the mean noise levels were more common with BE than with TLE (29% vs. 8%, p = .04).
CONCLUSION: TLE has a lower voltage amplitude than BE for all activation patterns and wavefront angles, and it removes more noise and FFPs. TLE is useful for analyzing low-voltage and fractionated EGMs regardless of the wavefront angle.
OBJECTIVE: We investigated the difference in the morphology, voltage amplitude, noise level, and far-field potential (FFP) between TLE and bipolar electrogram (BE).
METHODS: Twenty-two patients who underwent catheter ablation for atrial fibrillation were analyzed. TLE and BE were simultaneously obtained using 64-electrode basket catheters during atrial tachycardia or pacing. Local electrograms (EGMs) were analyzed at the locations of three activation patterns: normal conduction, wavefront collision, and slow conduction (SC). In addition, each activation pattern was analyzed at two different wavefront angles: horizontal and vertical, respectively. The voltage amplitude, duration, morphology, and deflection number were compared. The noise level and FFP amplitude were also analyzed.
RESULTS: With all activation patterns and wavefront angles, the voltage amplitude was significantly lower on TLE than on BE, and the mean amplitude ratio of TLE/BE was 0.75. The duration and deflection number of EGM were comparable. The ventricular FFP amplitude was lower on TLE than on BE (0.04 mV vs. 0.40 mV, p = .01). TLE also had less noise than BE (0.08 mV vs. 0.15 mV, p = .02), with a noise reduction of 47%. At the SC area, low-voltage EGMs below the mean noise levels were more common with BE than with TLE (29% vs. 8%, p = .04).
CONCLUSION: TLE has a lower voltage amplitude than BE for all activation patterns and wavefront angles, and it removes more noise and FFPs. TLE is useful for analyzing low-voltage and fractionated EGMs regardless of the wavefront angle.