Criteria for local myocardial electrical activation: effects of electrogram characteristics.

Detection of local electrical myocardial activation by means of extracellular recordings is often difficult in the presence of polyphasic electrograms. The purpose of this investigation was to compare the ability of several variables to distinguish unipolar deflections due to local activation from those due to nonlocal activity. A model of polyphasic deflections based on atrial recordings during reentrant tachycardia was used to facilitate distinction of local and distant activity by methods independent of the test variables. The performance of variables were assessed by comparing areas under receiver operating characteristic curves. Optimal thresholds of test variables were identified by maximizing statistics which corrected for the pretest probability of local activation. We found that the greatest negative first derivative of the unipolar potential discriminated between local and distant ventricular signals, but performed less well than the ratio of the first derivative to the potential for distinguishing between local atrial signals and distant ventricular signals. A linear combination of the potential and the ratio of the first derivative and the potential performed well for all groups of signals studied. We conclude that optimal criteria for detecting local activation depends on the characteristics of the population of signals and that a statistical approach can be used to identify optimal criteria for a given population.