PO-04-032 UTILIZATION OF OMINPOLAR TECHNOLOGY IN COMPLEX ATRIAL FLUTTERS

Abstract

Complex atrial flutters are a common occurrence that are found post cardiac surgeries or ablations, and account for a significant percentage of repeat procedures. However, due to scar density and disease progression, wavefront directionality of these complex circuits can often make traditional techniques and algorithms struggle to identify these circuits’ critical isthmus. The purpose of this abstract is to assess the utilization of omnipolar signal technology in terms of map point density in the setting of complex atrial flutters. This was a prospective observational case series with retrospective map and signal analysis of patients who underwent an ablation procedure for complex atrial flutter wherein omnipolar signal technology was primarily utilized for mapping. Omnipolar signals are acquired using a combination of three unipoles and two bipoles whereas in the traditional electrode configuration signals are acquired using orthogonal bipoles. The primary endpoint of this series was to assess the significance of map point density using omnipolar signal technology vs the traditional electrode configuration of the same high density grid catheter in the setting of complex atrial flutters. Eight patients were included, and seven out of the eight patients had prior ablation procedures. The mean recorded mapping points utilizing omnipolar signal technology was higher compared to that of the traditional electrode configuration (22000.38 vs 14412.12, p < 0.05). Total activation mapping time, which included geometry creation for all eight, had a mean of 10.6 minutes. At 3 months follow up, there were no repeat ablations or cardioversions on all eight patients. Two out of the eight patients who had prior CIED implantation recorded mode switch episodes of <1% and all eight had recorded sinus rhythm on follow up in office EKGs. The utilization of omnipolar signal technology in complex atrial arrhythmias produces higher point density maps vs the traditional electrode configuration of the same high density grid catheter. This results in reproducible maps that accurately identifies a flutter’s critical isthmus resulting in efficient, often single burn, termination of these complex flutters. Furthermore, we observed that due to the density of the map and the way onmipolar signals are acquired, the area of the isthmus is more defined vs maps rendered using the traditional electrode configuration