Spatial resolution of catheter-based atrial pace activation mapping using signal-averaged electrograms

Prior work suggests resolution of atrial pace mapping by surface P wave is 17-32 mm. The present study used computer-aided signal processing algorithms to improve 2-point resolution of atrial endocardial pace activation mapping in swine right atrium (RA). Unipolar sites in swine RA were paced using multipolar catheters of known spacing. A basket catheter was used to record up to 25 RA endocardial signals. A difference metric was calculated from changes in electrogram morphology and time shifts in signals from true different paced sites. Receiver operating characteristics were calculated using this difference metric for pacing sites separated by 0-17.5 mm. With this difference metric, pacing sites in swine RA can be distinguished when separated by >2.5 mm with good sensitivity and specificity. The authors suggest this technique be expanded to the clinical setting in order to improve pace activation mapping of arrhythmia foci.