Omnipolar mapping and vector mapping in premature ventricular contractions ablation: a comparison with bipolar mapping

Abstract

Abstract Background Omnipolar Mapping, with HD Grid high-density mapping catheter, overcomes the dependency of EGM characteristics to wavefront orientation, reconstructing the highest peak-to-peak voltage attainable within the electric field and the real wavefront direction, displayed in the form of a local activation vector [1][2]. Methods Consecutive patients who underwent radiofrequency ablation of PVCs from October 2021 to August 2023 at the Hospital Clinic of Barcelona were included in the study. EAM was performed with EnsiteX mapping system, Advisor HDgrid was used as mapping catheter. An activation map was performed if enough PVC burden. The area of interest was determined by earliest activation time combined with the morphology of unipolar electrogram during activation mapping. RF was delivered at the area of interest with target temperature of 45°C and maximum power of 50W. Both bipolar and omnipolar maps were analysed retrospectively. The reviewer was blinded to the ablation set for this analysis. A window of interest was created uniformally for all maps by defining a caliper within 15 ms before the onset of PVC. Activation vectors were displayed on the map and visually analysed. Three specific patterns were identified: Starburst, Homogeneous and Chaotic. Area of the earliest activation was measured. Earliest site of bipolar and omnipolar maps and specific location of star burst pattern were tagged. The site of the effective RF ablation was identified and the distance between points was determined. Results 18 patients were included. Overall, 11(61%) were males; age: 57,9±15,2 ys, 6(33%) patients haven't structural heart disease, 4(22%) presented PVC-induced cardiomyopathy. Mean left ventricular ejection fraction was 46±10. Mean PVC burden was 27±10%. In 9(50%) patients, PVCs were ablated from RVOT, 4(22%) in LVOT, 1(5%) in the left superior fascicle, 1(5%) in the antero-lateral papillary muscle, 2(10%) in the perihissian area and 1(5%) in the aortomitral continuity. Compared with bipolar, omnipolar mapping showed a smaller area of earliest activation(2,13±1,9mm2 vs 3,34±2,1 mm2,p<0,001), a shorter distance of the earliest point to starburst region(4,2±4,1mm vs 7,8±4,2mm,p<0,001) and shorter distance to the effective ablation site(6,1±3,9 mm vs 8,33±4,2mm, p<0,07). No significative difference was found between the effective RF ablation site and the starburst area compared to the distance between the effective RF ablation site and the omnipolar earliest deflection (6,11±3,9mm vs 6,5±4,3mm, p=0,6). No statistical significative difference was found between the timing of the earliest deflection in both settings (33,2±12,5 ms vs 31,5±12 ms, p=0,2) Conclusions Omnipolar mapping allows a better identification of the area of interest in PVC’s ablation compared to bipolar mapping. Vector mapping is a valuable asset to identify the earliest activation point to guide PVCs catheter ablation.Retrospective EAM analysisArea/distance measurements