Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5

The Omnipolar Mapping Technology - a new mapping tool to overcome "bipolar blindness" resulting in true high-density maps

J. Wörmann1, C. Scheurlen1, J.-H. van den Bruck1, S. Dittrich1, S. C. R. Erlhöfer1, Z. Arica1, K. Filipovic1, J. Lüker1, D. Steven1, A. Sultan1

1Elektrophysiologie, Herzzentrum der Universität zu Köln, Köln;

Background: High density (HD) mapping technologies facilitate with high efficacy and accuracy substrate and arrhythmia assessment for atrial and ventricular arrhythmias using bipolar signals. Specified algorithms enable detection of the highest voltage amplitude (HDwave technology) between two bipoles. However, oblique (to the bipoles) activation fronts remain undetected. Therefore, the newly introduced omnipolar technology (OT) analyzes uni- and bipolar signals in a triangle pattern to obtain single beat information not only on voltage but activation, direction and speed. Aim: We sought to compare in obtained left atrial (LA) maps differences in 3D-display of LA voltage, substrate and pulmonary vein (PV) gaps using OT vs. HDwave or a standard HD mapping setting. Methods: A HD Grid catheter was used to obtain LA maps in patients undergoing catheter ablation for persistent atrial fibrillation (persAF), recurrence of persAF and paroxysmal AF or LA tachycardia. Maps were analyzed and compared regarding LA voltage amplitudes and number of PV gaps (voltage and activation) using automated OT vs. HDwave or the HD standard setting. Results: In this analysis 20 consecutive patients with persAF or LA tachycardia were included. Obtained maps revealed a significantly higher point density using OT as compared to HDwave or HD standard setting (OT 20407±9828 points vs. HDwave 11172±4299 points vs. standard 6476±2920 points; p<0.001). Also, displayed LA mean voltage was significantly higher using OT as compared to HDwave or standard (OT 0.65±0.27 mV vs. HDwave 0.56±0.24 mV vs. standard 0.54±0.22 mV; p<0.001). Furthermore, OT maps revealed significantly more PV gaps in comparison to standard maps (OT 3 [3-4] number of detected PV gaps vs. standard setting 2 [1-3]; p=0.01). Conclusion: Signal processing in HD mapping potentially enhances displayed substrate accuracy. In a subset of patients, a comparison of the new OT vs. HDwave vs. standard setting for LA maps revealed a significantly higher point density and LA voltage for OT. Of note, using OT significantly more PV gaps were detected as compared to a standard setting. Outcome benefits using OT are to be explored.

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