Before any troubleshooting you should first understand the problem correctly. That will either help you to find the solution yourself, or to explain it to our experts correctly - this will help us to solve the problem ASAP. Here are few points to not forget.



1.  Channels/Caheters affected (Surface ECG, All EGM, Dedicated Catheter, Ablation catheter etc.)

2. Link to procedure step (persisting constantly, during ablation, during pacing, any other action)

3. Timeframe (persistent daily, appears only in the morning, only since last week etc.)

4. Frequency of noise (in Hz)

5. Which Equipment is in use during the case



1.  Electrodes/Caheters affected (All Catheters, Dedicated Catheter, Ablation catheter, ABL D)

2. Link to procedure step (persisting constantly, during ablation, during pacing, any other action)

3. Is it shift, drift or distortion? (shift - sudden move of the catheter, drift gradual move)

4. Direction and recurrence 

5. Which Equipment is in use during the case




1. Ultra High Definition Mapping of Atrial Arrhythmias (Sok-Sithikun Bun, MD, Gabriel Decebal Latcu, MD, Tahar Delassi, MD & others)

Yet in selected cases of very diseased and scarred atria, low-voltage signals may still not be seen with a standard cutoff sensitivity. The confidence mask is a complex multifactorial specific algorithm designed to improve scar identification within low-voltage areas. It uses the combination of an amplitude-based definition and the consistency of the timing of local EGMs with those of the surrounding areas. The operator may have to increase the sensitivity (scar thresholding) to very low values (as low as 0.015 mV in our experience) to make the distinction between low-voltage but viable and conducting areas, and dense scar tissue. Similarly, a decrease in sensitivity promotes scar exposure (Figure 3). The very low noise on the bipolar EGMs recorded with the basket catheter allows setting of a low scar threshold.

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2. Signals and Signal Processing for the Electrophysiologist (K.L. Venkatachalam, MD, Joel E. Herbrandson, RN and Samuel J.Asirvatam, MD)

Successful mapping and ablation in the electrophysiology (EP) laboratory is critically dependent on acquiring multiple, low-amplitude, intracardiac signals in the presence of numerous sources of electric noise and interference and displaying these signals in an uncomplicated and clinically relevant fashion, with minimal artifact. This represents a significant engineering challenge and, in a real-life EP laboratory, is not always successful. Understanding the challenges and reasons for failure and knowing how to optimize the electronic data acquisition system in the EP laboratory can go a long way toward ensuring smooth procedures and good outcomes.

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3. Optimising Signal Acquisition and Recording in an EP Laboratory (Amir S. Jadidi, MD, Heiko Lehrmann, MD, Reinhold Weber, MD, Chan-II Park, MD, Thomas Arentz, MD)

The correct diagnosis of arrhythmia is based on successful mapping in the electrophysiology laboratory, which depends on a high-quality display of both surface electrocardiogram (ECG) and intracardiac electrogramm (EGM). This article discusses the optimal settings for acquisition of high-quality surface ECG and bipolar intracardiac recordings. Typical examples of noise and artifacts on surface ECG and intracardiac recordings are demonstrated.

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4. Why some noise issues are not getting solved (Ivan Eltsov, MD, SinusTec)

So what the majority of EP-physiscians are calling noise is any additional signal on the ECG or EGM which should not be there. In the ideal world Surface ECG and intracardiac EGM’s must contain only the electrical activity coming from the heart and nothing else. 

However we are not living in the ideal world and apart of electrical activity of the heart there are many other activities (internal or external) which can be recorded by an EP system and overlay normal ECG/EGM traces. 

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