OT's novel approach with signal processing and real-time visualization allows for a newly detailed characterization of myocardial activation that is insensitive to catheter orientation.
Background:
Low-voltage–guided substrate modification is an emerging strategy in atrial fibrillation (AF) ablation. A major limitation to contemporary bipolar electrogram (EGM) analysis in AF is the resultant lower peak-to-peak voltage (V
pp
) from variations in wavefront direction relative to electrode orientation and from fractionation and collision events. We aim to compare bipole V
pp
with novel omnipolar peak-to-peak voltages (V
max
) in sinus rhythm (SR) and AF.
Methods and Results:
A high-density fixed multielectrode plaque was placed on the epicardial surface of the left atrium in dogs. Horizontal and vertical orientation bipolar EGMs, followed by omnipolar EGMs, were obtained and compared in both SR and AF. Bipole orientation has significant impact on bipolar EGM voltages obtained during SR and AF. In SR, vertical values were on average 66±119% larger than horizontal (
P
=0.004). In AF, vertical values were on average 31±96% larger than horizontal (
P
=0.07). Omnipole V
max
values were 99.9±125% larger than both horizontal (99.9±125%;
P
<0.001) and vertical (41±78%;
P
<0.0001) in SR and larger than both horizontal (76±109%;
P
<0.001) and vertical (52±70%;
P
value <0.0001) in AF. Vector field analysis of AF wavefronts demonstrates that omnipolar EGMs can account for collision and fractionation and record EGM voltages unaffected by these events.
Conclusions:
Omnipolar EGMs can extract maximal voltages from AF signals which are not influenced by directional factors, collision or fractionation, compared with contemporary bipolar techniques.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.