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Omnipolarity applied to equi-spaced electrode array for ventricular tachycardia substrate mapping.

Andreu Porta-Sánchez1,2, Karl Magtibay2, Sachin Nayyar2

  • 1Dept de Medicina, Universitat de Barcelona, Barcelona and Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|February 7, 2019
PubMed
Summary

Omnipolar electrograms (OTEGMs) provide more consistent and accurate voltage mapping of heart tissue than traditional bipolar electrograms (BiEGMs). This orientation-independent method improves delineation of diseased areas in the myocardium.

Keywords:
BipolarElectroanatomic mappingElectrogramMyocardial infarctionOmnipolarPorcineUnipolarVoltage

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Area of Science:

  • Cardiovascular electrophysiology
  • Cardiac mapping technology
  • Myocardial substrate characterization

Background:

  • Bipolar electrogram (BiEGM) mapping is sensitive to wavefront direction.
  • Accurate assessment of myocardial substrate is crucial for understanding cardiac disease.

Purpose of the Study:

  • Evaluate high-resolution, orientation-independent peak-to-peak voltage (Vpp) maps using omnipolar EGMs (OTEGMs).
  • Compare OTEGM Vpp map consistency and accuracy against traditional BiEGMs.
  • Assess the ability of OTEGM to delineate diseased myocardial areas.

Main Methods:

  • Utilized an equi-spaced electrode grid and omnipolar methodology for mapping.
  • Mapped the left ventricle endocardium in pigs (healthy and infarcted).
  • Registered electroanatomical maps with cardiac MRI for scar delineation.

Main Results:

  • OTEGM Vpp values were significantly larger than BiEGM Vpp values in both healthy and infarcted areas.
  • Omnipolar EGM voltage maps demonstrated higher resolution and consistency (less beat-to-beat variation).
  • OTEGM maps better delineated infarcted areas compared to BiEGMs.

Conclusions:

  • Equi-spaced electrode grids with omnipolar methodology yield superior voltage assessment.
  • OTEGM is void of directional influences, offering reliable voltage evaluation.
  • This technique enhances the characterization of myocardial substrate in diseased hearts.