Estimation of Recurrent Areas of Fast Activation in AF from ECGI

Carlos Fambuena Santos1, Clara Herrero Martín2, Ismael Hernández-Romero3, Andreu M. Climent2, Maria de la Salud Guillem Sánchez2
1UPV, 2Universitat Politècnica de València, 3ITACA Institute, Universitat Politècnica de València


Abstract

Identifying fast activation areas during AF is still challenging. Endocardial mapping only can provide sequential measurements that do not capture AF variability and take a long time to record. Recently, ECGI has been proposed as an alternative technology to measure the atrial activation frequency through the instantaneous Fourier transform. This technique allows a fast identification of the fastest activation area (FAA). Yet, artifacts from signal acquisition and the intrinsic variability of AF challenge the accuracy of the FAA location. This study evaluates a methodology to identify recurrent areas with fast activation patterns (RAFA). We compared this technique with the traditional highest dominant frequency (HDF) computed from Welch`s peri-odogram using time variant AF simulations and realistic electrical noise con-ditions. Our findings reveal that RAFA significantly outperforms the traditional HDF area. While the HDF method's sensitivity and specificity fluctuated with signal to noise ratios—showing mean sensitivities of 48.2% ± 44.3% at 20 dBs, 46.8% ± 63. 5% 10 dBs, and 31.1% ± 68.0% 3 dBs —the RAFA ap-proach demonstrated robustness with higher and more consistent mean sen-sitivities of 60.7% ± 33. 2%, 55.0% ± 40. %5, and 51.0% ± 19.5%, with simi-lar sensitivity values. These results demonstrate how RAFA can identify are-as driving AF episodes robustly and more accurately than HDF.