Electrograms 101 - Heart Rhythm Congress · Electrograms 101 Dr Stuart Tan Essex CTC . Definition...
Transcript of Electrograms 101 - Heart Rhythm Congress · Electrograms 101 Dr Stuart Tan Essex CTC . Definition...
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Electrograms 101
Dr Stuart Tan
Essex CTC
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Definition
• A graph of voltage over time
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Definition
• A graph of voltage over time
• 12L ECG
• Intra-cardiac Electrograms
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Definition
• A graph of voltage over time
• 12L ECG
• Intra-cardiac Electrograms
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1. Basics of Electrograms
2. Electrograms in the EP lab
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Recording modes
• Unipolar
• Bipolar
• Laplacian
• Monophasic action potentials
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Recording modes
• Unipolar
• Bipolar
• Laplacian
• Monophasic action potentials
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Recording modes
• Unipolar
• Bipolar
• Laplacian
• Monophasic action potentials
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Unipolar Recording mode
• Different electrode at the recording site
• Indifferent electrode at point of zero reference
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Jacques M.T. de Bakker, and Fred H.M. Wittkampf Circ
Arrhythm Electrophysiol. 2010;3:204-213
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Jacques M.T. de Bakker, and Fred H.M. Wittkampf Circ
Arrhythm Electrophysiol. 2010;3:204-213
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Recording modes
• Unipolar
• Bipolar
• Laplacian
• Monophasic action potentials
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Bipolar Recording mode
• Different Electrode and indifferent electrode close together
• Created by subtracting two unipolar electrograms
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Direction dependence
+ -
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Direction dependence
+ -
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Direction dependence
+ -
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Unipolar vs Bipolar recordings
• Unipolar recordings measure an amplified version of voltage at a single electrode and retain both near and far field signal components
• Bipolar recordings measure the amplified signal between two unipolar electrodes which reduces common-mode noise and far-field signal components
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Unipolar
• Local + remote
• Catheter orientation independent
• Interference
• Directionality of propagation
Bipolar
• Local
• Catheter orientation dependant
• Reduces interference
• No directionality of propagation
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• Times when a unipolar electrogram is useful
• Looking for points of earliest activation
– Pathways
– Focal AT/VT
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Stevenson W, Soejima K ;J Cardiovasc Electrophysiol. 2005;16(9):1017-1022.
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Issa ZF, Miller JM, Zipes DP; Clinical Arrhythmology and Electrophysiology
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Issa ZF, Miller JM, Zipes DP; Clinical Arrhythmology and Electrophysiology
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• Times when a unipolar electrogram is useful
• Looking for points of earliest activation
– Pathways
– AT
• Examining farfield events
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Recording Artefacts
Sources of Intracardiac Recording Artefact
Cause
Electrode Polarisation
Excessive Contact Pressure
Catheter motion
Poor contact
Contact with other catheters
Repolarisation
Electromagnetic Interference
Poor Grounding
Manifestation
Electrogram Drift
ST elevation
Fractionation
Low amplitude
High-frequency signals
Late or mid diastolic potentials
High Frequency noise
High Frequency noise
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Filtering
• Filtering necessary • High/Low/Band pass filters
• Notch Filters
• Can affect EGM • Amplitude
• Timing
• Morophology
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Jacques M.T. de Bakker, and Fred H.M. Wittkampf Circ
Arrhythm Electrophysiol. 2010;3:204-213
![Page 32: Electrograms 101 - Heart Rhythm Congress · Electrograms 101 Dr Stuart Tan Essex CTC . Definition •A graph of voltage over time . Definition •A graph of voltage over time •12L](https://reader036.fdocuments.in/reader036/viewer/2022062506/5fbd201f0fae9417c40c8697/html5/thumbnails/32.jpg)
Complex Electrograms
• Double potentials
• Fractionated Potentials
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Double potential
• Lines of functional block
• Lines of anatomical block
• Adjacent structures
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Turn around point = End of a fixed or functional barrier such as scar tissue (fixed) or the crista terminalis (functional)
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Fractionated electrograms
Where do they arise? Where is the activation time?
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First Deflection? Largest Deflection?
Last deflection?
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1. Basics of Electrograms
2. Electrograms in the EP lab
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Electrograms
• Recording mode
• Sources of error
• Complex electrograms
• Multiple electrograms in different anatomical sites to interpret the EP study
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Thank you