Principal Component-Referenced Multipolar Mapping to Localize an Arrhythmic Source From Various Depths of the...

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Intramural premature ventricular contraction (PVC) mapping is challenged by the inability of unipolar and bipolar electrograms (EGMs) to differentiate near-field from far-field activity.
• Accurate localization of PVC origins is crucial for effective treatment strategies.

Purpose of the Study:

• To test the hypothesis that multipolar EGMs offer superior source detection for PVC mapping due to improved far-field signal rejection.
• To compare the accuracy of multipolar versus unipolar EGMs in predicting the precise location of PVC sources.

Main Methods:

• Utilized a Langendorff perfused swine heart model to generate left ventricular free wall PVCs.
• Recorded ventricular surface EGMs using a customized multipolar array and the OPTRELL catheter (CARTO system).
• Analyzed EGM morphology, amplitude, width, and timing to assess predictive accuracy for source localization, including in silico modeling.

Main Results:

• Multipolar EGMs demonstrated significantly less QS morphology compared to unipolar EGMs across various depths (P < 0.001).
• A QS morphology in multipolar EGMs indicated an 8.0% likelihood of being adjacent to the PVC source.
• Multipolar EGMs generated activation maps with a single early focus, unlike unipolar maps showing diffuse breakout patterns.

Conclusions:

• Multipolar EGMs are more effective than unipolar EGMs for predicting PVC locations.
• The superior performance of multipolar EGMs is evidenced by reduced QS morphology and more precise mapping of early activation sites.
• These findings support the use of multipolar EGMs for enhanced accuracy in PVC mapping and ablation guidance.