Determinants of atrial bipolar voltage: Inter electrode distance and wavefront angle

Beheshti, Mohammadali; Magtibay, Karl; Massé, Stéphane; Porta‐Sánchez, Andreu; Haldar, Shouvik; Bhaskaran, Abhishek; Nayyar, Sachin; Glover, Benedict; Deno, D. Curtis; Vigmond, Edward J.; Nanthakumar, Kumaraswamy

doi:10.1016/j.compbiomed.2018.07.011

Cited by 24 publications

(24 citation statements)

References 23 publications

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“…The reason for this is as follows. In an ideal case, where a catheter has a fixed position and senses a wavefront along a specific direction, Bi EGM Vpps AL and AC will give different values, as has been shown with mathematical models by Beheshti et al 11 …”

Section: Discussionmentioning

confidence: 72%

“…A wide variety of linear mapping catheters are currently used in cardiac mapping practice with different electrode and shaft configurations, electrode spacing, and electrode size. It has been shown in a number of studies 11 , 16–18 that bipolar electrode spacing and electrode size could greatly influence substrate mapping profiles, hence the interpretation of the substrate and corresponding appropriate treatment strategies 19 . The authors attempted to minimize this effect by representing conventional linear mapping catheters with a spline within the Advisor™ HD Grid array.…”

Section: Discussionmentioning

confidence: 99%

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Omnipolarity applied to equi-spaced electrode array for ventricular tachycardia substrate mapping

et al. 2019

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Aims Bipolar electrogram (Bi EGM )-based substrate maps are heavily influenced by direction of a wavefront to the mapping bipole. In this study, we evaluate high-resolution, orientation-independent peak-to-peak voltage (Vpp) maps obtained with an equi-spaced electrode array and omnipolar EGMs (OT EGMs ), measure its beat-to-beat consistency, and assess its ability to delineate diseased areas within the myocardium compared against traditional Bi EGMs on two orientations: along (AL) and across (AC) array splines. Methods and results The endocardium of the left ventricle of 10 pigs (three healthy and seven infarcted) were each mapped using an Advisor™ HD grid with a research EnSite Precision™ system. Cardiac magnetic resonance images with late gadolinium enhancement were registered with electroanatomical maps and were used for gross scar delineation. Over healthy areas, OT EGM Vpp values are larger than AL bipoles by 27% and AC bipoles by 26%, and over infarcted areas OT EGM Vpp values are 23% larger than AL bipoles and 27% larger than AC bipoles ( P < 0.05). Omnipolar EGM voltage maps were 37% denser than Bi EGM maps. In addition, OT EGM Vpp values are more consistent than bipolar Vpps showing less beat-by-beat variation than Bi EGM by 39% and 47% over both infarcted and healthy areas, respectively ( P < 0.01). Omnipolar EGM better delineate infarcted areas than traditional Bi EGMs from both orientations. Conclusion An equi-spaced electrode grid when combined with omnipolar methodology yielded the largest detectable bipolar-like voltage and is void of directional influences, providing reliable voltage assessment within infarcted and non-infarcted regions of the heart.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Omnipolarity applied to equi-spaced electrode array for ventricular tachycardia substrate mapping

et al. 2019

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“…The exact temporal offset thus determines the amplitude and morphology of the bipolar signal. In computer simulation studies, increasing interelectrode distance leads to increasing voltage which plateaus in healthy, but not diseased, tissue with spacing greater than 4 mm [17]. Further, the contribution of farfield signal may be greater when electrodes are more widely spaced [18].…”

Section: Technical Aspects Of Voltage Mappingmentioning

confidence: 99%

Left atrial voltage mapping: defining and targeting the atrial fibrillation substrate

Sim

Bishop

O’Neill

et al. 2019

J Interv Card Electrophysiol

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Low atrial endocardial bipolar voltage, measured during catheter ablation for atrial fibrillation (AF), is a commonly used surrogate marker for the presence of atrial fibrosis. Low voltage shows many useful associations with clinical outcomes, comorbidities and has links to trigger sites for AF. Several contemporary trials have shown promise in targeting low voltage areas as the substrate for AF ablation; however, the results have been mixed. In order to understand these results, a thorough understanding of voltage mapping techniques, the relationship between low voltage and the pathophysiology of AF, as well as the inherent limitations in voltage measurement are needed. Two key questions must be answered in order to optimally apply voltage mapping as the road map for ablation. First, are the inherent limitations of voltage mapping small enough as to be ignored when targeting specific tissue based on voltage? Second, can conventional criteria, using a binary threshold for voltage amplitude, truly define the extent of the atrial fibrotic substrate? Here, we review the latest clinical evidence with regard to voltage-based ablation procedures before analysing the utility and limitations of voltage mapping. Finally, we discuss omnipole mapping and dynamic voltage attenuation as two possible approaches to resolving these issues.

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“…In addition to directionality, electrode pairs spaced widely apart, as in ablation catheters, can produce large Vpps and closely spaced electrodes, as seen in modern mapping arrays, produce small Vpps. [6][7][8] These factors create unreliable and nonreproducible characterization of the cardiac substrate. Ironically, these EGM features and procedures that are fundamental to current cardiac mapping practices are themselves weaknesses and have not seen major innovation for almost a century.…”

Section: Trouble With Traditionmentioning

confidence: 99%

“…Bipolar EGM measurements are also dependent on other parameters, such as electrode distance, electrode size, wavefront speed, and extent of activation. [4][5][6][7][8] Most importantly, neither bipoles nor unipoles can provide wavefront characteristics, such as speed and direction, at a single location or voltages along the wavefront direction.…”

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confidence: 99%

Reinserting Physiology into Cardiac Mapping Using Omnipolar Electrograms

Magtibay

Porta‐Sánchez

Haldar

et al. 2019

Cardiac Electrophysiology Clinics

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Determinants of atrial bipolar voltage: Inter electrode distance and wavefront angle

Cited by 24 publications

References 23 publications

Omnipolarity applied to equi-spaced electrode array for ventricular tachycardia substrate mapping

Omnipolarity applied to equi-spaced electrode array for ventricular tachycardia substrate mapping

Left atrial voltage mapping: defining and targeting the atrial fibrillation substrate

Reinserting Physiology into Cardiac Mapping Using Omnipolar Electrograms

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