Discrimination of Retrograde from Anterograde Atrial Activation Using Intracardiac Electrogram Waveform Analysis

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Abstract
THRONE, R.D., ET AL.: Discrimination of Retrograde from1 Anterograde Atrial Activation Using Intra- cardiac Electrogram Waveform Analysis. The prevention of pacemaker-mediated tachycardias requires a safe, reliable method for distinguishing retrograde from anterograde atrial activation by dual chamber pacemakers. In this study, a technique was developed to detect the morphological change that occurs in the waveform of the intra-atrial electrogram during retrograde atrial activation. The method employed for waveform analysis is based upon statistical correlation. In 19 patients undergoing electrophysiological studies, atrial electrograms were recorded from bipolar endocardia1 electrodes during sinus rhythm and 1:1 retrograde atrial depolarization while undergoing right ventricular pacing. Data were digitally sam- pled at 750,1,000, and 1,500 Hz. Templates of anterograde atrial depolarization were constructed by signal averaging waveforms from an initial sinus rhythm passage, These were used for analysis of anterograde depolarizations from a subsequent passage of sinus rhythm and a passage of known retrograde atrial depolarization. In all 19 cases, a patient-specific threshold could be derived to separate anterograde from retrograde atrial depolarizations using 1,000 Hz and 1,500 Hz sampling rates. However, at a sampling rate of 750 Hz, separation of anterograde from retrograde atrial activation was possible in only 16/19 patients (84%). We conclude that correlation waveform analysis of' a suitably sampled atrial electrogram is a reliable method of discriminating retrograde atrial depo1ariz:ation from anterograde atrial depolarization in intracardiac electrograms. (PACE, Vol. 12, October 1989) pacemaker, pacemaker-mediated tachycardia, correlation waveform analysis, dual chamber pacemaker, tachycardia, tachyarrhythmia