Direction-aware mapping algorithms have minimal impact on bipolar voltage maps created using high-resolution multielectrode catheters.

INTRODUCTION: Direction-aware mapping algorithms improve the accuracy of voltage mapping by measuring the maximal voltage amplitude recorded in the direction of wavefront propagation. While beneficial for stationary catheters, its utility for roving catheters collecting electrograms (EGMs) at multiple angles is unknown. OBJECTIVE: To compare the directional dependence of bipolar voltage amplitude between stationary and roving catheters. METHODS: In 10 swine, a transcaval ablation line with a gap was created. The gap was mapped using an array catheter (Optrell™; Biosense Webster). In Step 1, the array was kept stationary over the gap, and four voltage maps were created during activation of the gap from superior, inferior, septal, and lateral directions. In Step 2, four additional maps were created; however, the catheter was allowed to move with points acquired at multiple angles. In Step 3, the gap was remapped; however, bipoles were computed using a direction-aware mapping algorithm. RESULTS: In a stationary catheter position, bipolar voltage distribution was influenced by the direction of activation with maximal differences obtained between orthogonal directions 32% (13%-53%). However, roving the catheter produced similar bipolar voltage maps irrespective of the direction of activation 11% (5%-18%). A direction-aware mapping algorithm was beneficial for reducing the directional dependence of voltage maps created by stationary catheters but not by roving catheters. CONCLUSION: The directional dependency of bipolar voltage amplitude is greatest when the catheter is stationary. However, when the catheter is allowed to rove and collect EGMs at multiple angles as occurs clinically, the directional dependence of bipolar voltage is minimal.

Multipolar Electrograms: A New Configuration That Increases the Measurement Accuracy of Intracardiac Signals.

BACKGROUND: Accurate measurements of intracardiac electrograms (EGMs) remain a clinical challenge because of the suboptimal attenuation of far-field potentials. Multielectrode mapping catheters provide an opportunity to construct multipolar instead of bipolar EGMs for rejecting common far-field potentials recorded from a multivectorial space. OBJECTIVES: The purpose of this study was to develop a multipolar EGM and compare its characteristics to those of bipolar EGMs METHODS: Using a 36-electrode array catheter (Optrell-36; Biosense Webster), a far-field component was mathematically constructed from clusters of electrodes surrounding each inspected electrode. This component was subtracted from the unipolar waveform to produce a local unipolar, referred to as a "multipolar EGM." The performance of multipolar EGMs was evaluated in 7 swine with healed anteroseptal infarction. RESULTS: Multipolar EGMs proved superior in attenuating far-field potentials in infarct border zones, increasing the near-field to far-field ratio from 0.92 ± 0.2 to 2.25 ± 0.3 (P < 0.001). Removal of far-field components reduced the voltage amplitude (P < 0.001) and enlarged the infarct surface area (P = 0.02), aligning more closely with histological findings. Of 379 EGMs with ≥20 ms activation time difference between bipolar and multipolar EGMs, 95.3% (361 of 379) were accurately annotated using multipolar EGMs, while annotation based on bipolar EGM was predominantly made on far-field components. CONCLUSIONS: Multielectrode array catheters provide a unique platform for constructing multipolar EGMs. This new EGM may be beneficial for "purifying" local potentials within a complex electrical field, resulting in more accurate voltage and activation maps.

Propagation Vectors Facilitate Differentiation Between Conduction Block, Slow Conduction, and Wavefront Collision.

[Figure: see text].