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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

de Groot, Natasja M S; Shah, Dipen; Boyle, Patrick M; Anter, Elad; Clifford, Gari D; Deisenhofer, Isabel; Deneke, Thomas; van Dessel, Pascal; Doessel, Olaf; Dilaveris, Polychronis; Heinzel, Frank R; Kapa, Suraj; Lambiase, Pier D; Lumens, Joost; Platonov, Pyotr G; Ngarmukos, Tachapong; Martinez, Juan Pablo; Sanchez, Alejandro Olaya; Takahashi, Yoshihide; Valdigem, Bruno P; van der Veen, Alle-Jan; Vernooy, Kevin; Casado-Arroyo, Ruben; De Potter, Tom; Dinov, Borislav; Kosiuk, Jedrzej; Linz, Dominik; Neubeck, Lis; Svennberg, Emma; Kim, Young-Hoon; Wan, Elaine; Lopez-Cabanillas, Nestor; Locati, Emanuela T; Macfarlane, Peter; ESC Scientific Document Group


Natasja M S de Groot

Dipen Shah

Patrick M Boyle

Elad Anter

Gari D Clifford

Isabel Deisenhofer

Thomas Deneke

Pascal van Dessel

Olaf Doessel

Polychronis Dilaveris

Frank R Heinzel

Suraj Kapa

Pier D Lambiase

Joost Lumens

Pyotr G Platonov

Tachapong Ngarmukos

Juan Pablo Martinez

Alejandro Olaya Sanchez

Yoshihide Takahashi

Bruno P Valdigem

Alle-Jan van der Veen

Kevin Vernooy

Ruben Casado-Arroyo

Tom De Potter

Borislav Dinov

Jedrzej Kosiuk

Dominik Linz

Emma Svennberg

Young-Hoon Kim

Elaine Wan

Nestor Lopez-Cabanillas

Emanuela T Locati

Peter Macfarlane

ESC Scientific Document Group


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.

Journal Article Type Article
Acceptance Date Sep 21, 2021
Online Publication Date Dec 8, 2021
Publication Date Feb 2, 2022
Deposit Date Mar 31, 2022
Journal EP Europace
Print ISSN 1099-5129
Electronic ISSN 1532-2092
Publisher Oxford University Press
Peer Reviewed Peer Reviewed
Volume 24
Issue 2
Pages 313-330
Keywords Atrial fibrillation, Signal recording, Signal processing, Mapping, Machine learning, Cardiac implantable electronic devices, EHRA position paper
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