On the Preprocessing of Atrial Electrograms in Atrial Fibrillation: Understanding Botteron's Approach

Background The dominant atrial frequency is a key parameter for the analysis of atrial fibrillation (AF) from intracardiac recordings. The preprocessing approach employed by Botteron et al. in an early work is able to retrieve this frequency. The preprocessing steps are: (1) 40–250-Hz band-pass filtering, (2) rectification, and (3) 20 Hz low-pass filtering. Methods and results The theoretical aspects of this process are addressed. Moreover, its time-domain and frequency-domain properties are evaluated using both simulations and real electrogram (EGM) recordings. The fundamental frequency is emphasized, due to the rectification step. As the interval between consecutive activations becomes more irregular, fundamental frequency detection becomes less robust. In the case of fractionated EGM, this approach fails. In time-domain, the waveform of the atrial beats are dramatically modified, hence hindering any further analysis on the morphology of the activations. Conclusions Botteron preprocessing succeeds in estimating the dominant atrial rate in most EGMs during AF. However, this approach presents some limitations and improved methods are required.