Intraseptal Mapping of Premature Ventricular Complexes Using Multipolar Catheters

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Intramyocardial mapping of left ventricular outflow tract (LVOT) premature ventricular complexes (PVCs) aids in defining the site of origin (SOO) and guiding ablation.
• Multipolar mapping catheters overcome limitations of unipolar signals in wire mapping for LVOT PVCs.

Purpose of the Study:

• To report the mapping and ablation experience of suspected LVOT PVCs using intraseptal mapping with multipolar catheters.
• To evaluate the feasibility and effectiveness of this technique.

Main Methods:

• Intraseptal mapping using multipolar catheters was performed in patients with suspected LVOT PVCs.
• V2 S-wave and R-wave pattern break (PB) ratios were calculated to predict the SOO.
• SOO was determined based on activation patterns (endocardial, intramyocardial, or epicardial).

Main Results:

• Successful mapping was achieved in 70% of patients, with PVCs most commonly originating from an intramyocardial source.
• Specific V2 PB ratios predicted the SOO for different PVC morphologies.
• Acute ablation success was 98%, with 93% freedom from recurrence at 12.4 months follow-up.

Conclusions:

• Intraseptal mapping with multipolar catheters is a feasible and highly effective method for ablating LVOT PVCs.
• ECG predictors can identify suitable candidates for intraseptal mapping.
• Reversal of late potentials during PVCs may indicate abnormal substrate in idiopathic PVCs.