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

Area of Science:

• Electrophysiology
• Cardiac Mapping
• Medical Device Technology

Background:

• Direction-aware mapping algorithms enhance voltage mapping accuracy by analyzing maximal voltage amplitude in the direction of wavefront propagation.
• The clinical utility of these algorithms for roving catheters, which collect electrograms (EGMs) at multiple angles, remains largely uninvestigated.

Purpose of the Study:

• To compare the directional dependence of bipolar voltage amplitude between stationary and roving catheters.
• To evaluate the efficacy of direction-aware mapping algorithms in reducing directional dependency in both stationary and roving catheter scenarios.

Main Methods:

• Ten swine underwent creation of a transcaval ablation line with a gap.
• Electrograms (EGMs) were recorded using an array catheter (Optrell™; Biosense Webster) over the gap.
• Mapping was performed with the catheter stationary, roving (multiple angles), and utilizing a direction-aware algorithm.

Main Results:

• Stationary catheter positions exhibited significant directional dependence in bipolar voltage distribution (32% difference), influenced by activation direction.
• Roving catheters produced largely similar bipolar voltage maps regardless of activation direction (11% difference).
• Direction-aware algorithms reduced directional dependency for stationary catheters but not for roving catheters.

Conclusions:

• The directional dependency of bipolar voltage amplitude is most pronounced with stationary catheters.
• When catheters rove and collect EGMs from multiple angles, as in clinical practice, the directional dependence of bipolar voltage becomes minimal.
• Direction-aware mapping algorithms offer limited additional benefit when using roving catheters in clinical electrophysiology.