Omnipolar mapping versus point-by-point mapping approach for catheter ablation of atrioventricular accessory pathway

The conventional mapping approach for the atrioventricular accessory pathway (AP) involves point-by-point mapping to identify the connection sites of the AP to the atria or ventricle and accurate interpretation of local electrograms. Omnipolar mapping technology (OMT) explains how vector and wave speed are produced by using both unipolar and bipolar signals to obtain omnipolar signals, directions, and conduction velocity. The aim of this study is to verify the effectiveness of OMT for catheter ablation of AP.

The study enrolled 68 patients who underwent catheter ablation of APs between January 2018 and December 2023, of which 35 (OMT group) underwent high-resolution omnipolar mapping and 33 underwent radiofrequency ablation (RF) with a conventional approach (conventional group). The background characteristics and procedural details of these groups were compared.

All patients achieved acute success. Any arrhythmia recurrence was observed in one and three patients in the OMT and conventional groups, respectively (p = 0.0501). In the OMT group, AP elimination by the first RF applications (77.1% vs. 48.4%, p = 0.0143), the number of RF applications for eliminating AP (median [IQR]; 1.1 [1.0-3.0] vs. 4.4 [1.0-7.0], p = 0.0012), procedure time (median [IQR], min; 80.1 [72.2-92.7] vs. 112.0 [95.1-125.4], p < 0.01), fluoroscopy time (median [IQR], min; 12.0 [9.5-15.2] vs. 19.8 [13.6-28.1], p < 0.01), and fluoroscopy dose (median [IQR], mGy; 60.9 [45.0-83.5] vs. 129.0 [80.5-360.2], p < 0.01) were significantly lower than in the conventional group. No complications associated with mapping and ablation procedures were observed.

The OMT was useful for ablating APs and reducing the number of RF applications and radiation exposure.