Middle amplitude range analysis for intracardiac atrial electrograms classification

This paper analyzes the Middle Amplitude Range (MAR) of Intracardiac Atrial Electrograms. Electrograms are obtained using bipolar catheters from the High Right Atrium during Electrophysiological (EP) studies. Three groups of stable rhythm are considered: atrial fibrillation (AF), atrial flutter (AFL) and sinus rhythm (SR). EP studies are obtained from 10 subjects many of whom presented different rhythms in different intervals of the study. The major purpose of the work is to propose a method, compatible with implementation on implantable devices, able to discriminate among SR, AF and AFL in a defined decision time interval. This aim is achieved by combining the analyses based on cycle length and MAR. The results are presented in terms of sensitivity, specificity and total accuracy for various choices of the decision time interval. The best performances are obtained for a 4 second interval and give a total accuracy of 98.9%, with specificity of 99.2% and average sensitivity of 98.8%.