Improved detection of activation timings in endoatrial electrograms through a modified sinusoidal recomposition method

Atrial fibrillation (AF) is the most common type of arrhythmia and the mechanisms that sustain it are not yet clearly identified. To target AF mechanisms, many theories on atrial electrical activation have been proposed. Since phase distribution of electrogram (EGM) changes over time is less affected by noise than EGM amplitude, phase analysis is one of the most robust method for identifying and quantifying spatiotemporal organization of fibrillation. In this paper we propose a new phase-based technique to detect atrial activation timings (AATs) and compared its performance versus manual annotation of AATs annotated by an expert cardiologist and versus classical methods based on Hilbert transform and sinusoidal recomposition. Detection of AATs from EGM signals in sinus rhythm applying the proposed technique overcomes the performance of classical methods and set the basis for its application on EGM in AF condition and phase map reconstruction.