Optimizing Atrial Electrogram Classification Based on Local Ablation Outcome in Human Atrial Fibrillation

Changes in atrial fibrillation cycle length (AF-CL) are broadly used as a 'ground truth' to assess the effect of substrate modification during AF ablation. This work sought to optimize thresholds for changes in coronary sinus CL (CS-CL) after local ablation using different atrial electrogram (AEG)-derived markers. 834 AEGs were collected from 11 patients undergoing persAF ablation. CS-CL was measured before and after each ablation point. Five AEG-derived markers were tested as classifiers for CS-CL changes: ICL (Biosense Webster), CFE-Mean (St. Jude Medical), Wave Similarity, Shannon Entropy and AEG-CL. The area under the receiver operating characteristic (AUROC) curve was used to assess the quality of classification for each marker. Maximum AUROC was found at threshold values between 9 and 14 ms in all markers, except for Shannon Entropy. The average AUROC of the five markers reached a maximum of 0.60 at a threshold value of 10 ms. The 10 ms threshold is suggested as a starting setpoint for future studies seeking to identify AF ablation targets based on an objective 'ground truth'.