Measurement Bias in Activation-recovery Intervals from Unipolar Electrograms

The activation-recovery interval (ARI) calculated from unipolar electrograms is regularly used as a convenient surrogate measure of local cardiac action potential durations (APD). This method enables important research bridging between computational studies and in vitro and in vivo human studies. The Wyatt method is well established as a theoretically sound method for calculating ARIs; however, some studies have observed that it is prone to a bias error in measurement when applied to positive T waves. This article demonstrates that recent theoretical and computational studies supporting the use of the Wyatt method are likely to have underestimated the extent of this bias in many practical experimental recording scenarios. This work addresses these situations and explains the measurement bias by adapting existing theoretical expressions of the electrogram to represent practical experimental recording configurations. A new analytic expression for the electrogram's local component is derived, which identifies the source of measurement bias for positive T waves. A computer implementation of the new analytic model confirms our hypothesis that the bias is systematically dependent on the electrode configuration. These results provide an aid to electrogram interpretation in general, and this work's outcomes are used to make recommendations on how to minimize measurement error.