Detection of Endo-epicardial Asynchrony in the Atrial Wall Using One-Sided Unipolar and Bipolar Electrograms

Lisette J.M.E. van der Does, Roeliene Starreveld, Rohit K. Kharbanda, Paul Knops, Charles Kik, Ad J.J.C. Bogers, Natasja M.S. de Groot*

*Corresponding author for this work

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Endo-epicardial asynchrony (EEA) is a new mechanism possibly maintaining atrial fibrillation. We aimed to determine the sensitivity and best recording modus to detect EEA on electrograms recorded from one atrial side using electrogram fractionation. Simultaneously obtained right atrial endo- and epicardial electrograms from 22 patients demonstrating EEA were selected. Unipolar and (converted) bipolar electrograms were analyzed for presence and characteristics of fractionation corresponding to EEA. Sensitivity of presence of EEA corresponding fractionation was high in patients (86–96%) and moderately high (65–78%) for the asynchronous surface area for unipolar and bipolar electrograms equally. In bipolar electrograms, signal-to-noise ratio of EEA corresponding fractionation decreased and additional fractionation increased for electrograms recorded at the endocardium. Sensitivity of fractionation corresponding to EEA is high for both unipolar and bipolar electrograms. Unipolar electrograms are more suited for detection of EEA due to a larger signal-to-noise ratio and less disturbance of additional fractionation. Graphical Abstract: [Figure not available: see fulltext.].

Original languageEnglish
Pages (from-to)902-911
Number of pages10
JournalJournal of Cardiovascular Translational Research
Issue number5
Early online date29 Mar 2021
Publication statusPublished - Oct 2021


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