In clinical rhythmology, intracardiac bipolar electrograms (EGMs) play a critical role in investigating the triggers and substrates inducing and perpetuating atrial fibrillation (AF). However, the interpretation of bipolar EGMs is ambiguous due to several aspects of electrodes, mapping algorithms and wave propagation dynamics, so it requires several variables to describe the effects of these uncertainties on EGM analysis. In this narrative review, we critically evaluate the potential impact of such uncertainties on the design of cardiac mapping tools on AF-related substrate characterization. Literature suggest uncertainties are due to several variables, including the wave propagation vector, the wave’s incidence angle, inter-electrode spacing, electrode size and shape, and tissue contact. The preprocessing of the EGM signals and mapping density will impact the electro-anatomical representation and the features extracted from the local electrical activities. The superposition of multiple waves further complicates EGM interpretation. The inclusion of these uncertainties is a nontrivial problem but their consideration will yield a better interpretation of the intra-atrial dynamics in local activation patterns. From a translational perspective, this review provides a concise but complete overview of the critical variables for developing more precise cardiac mapping tools.

在临床节律学中，心内双极电图 (EGM) 在研究诱发和持续房颤 (AF) 的触发因素和基质方面发挥着关键作用。然而，由于电极、映射算法和波传播动力学等几个方面的原因，双极 EGM 的解释是不明确的，因此需要多个变量来描述这些不确定性对 EGM 分析的影响。在这篇叙述性综述中，我们批判性地评估了这种不确定性对 AF 相关基质表征的心脏绘图工具设计的潜在影响。文献表明，不确定性是由几个变量造成的，包括波传播矢量、波的入射角、电极间间距、电极尺寸和形状以及组织接触。EGM 信号和映射密度的预处理将影响电解剖表示和从局部电活动中提取的特征。多个波的叠加使 EGM 的解释进一步复杂化。包含这些不确定性是一个不平凡的问题，但对它们的考虑将更好地解释局部激活模式中的心房内动态。从转化的角度来看，这篇综述对开发更精确的心脏绘图工具的关键变量进行了简洁而完整的概述。