High-density Grid Research Articles

Quantifying cardiac tissue heterogeneity using high-density grid catheter: validation in porcine model

Abstract Background and Objectives Characterizing cardiac substrate is crucial for diagnosing and treating cardiac arrhythmias due to its association with the presence of fibrotic tissue. Omnipolar Electrogram (EGM) technology provides orientation-independent signal generation and instantaneous propagation direction determination. Although traditionally, the amplitude of the bipolar signal has been the most used metric, it alone does not suffice for comprehensive tissue characterization. Recently, a novel metric has been developed to quantify the degree of directional propagation disorganization within cardiac tissue, defined as Vector Field Heterogenity (VFH)[1] that can provide additional insights to the tissue characterization. Due to the presence of tissues with varying impedance, changes in the direction of propagation of cardiac electrical signals can occur. Therefore, the objective of this study is to characterize how the presence of fibrotic or necrotic tissue can influence the disorganization of electrical activity propagation, and thus assess the effectiveness of the heterogeneity metric in characterizing these tissues. Method We worked with a database of a female swine records of the left atrium. These records include data pre and post-ablation by electroporation. From the unipolar signals available in the database, we have calculated the Omnipolar EGMs in cross configuration. From the omnipolar signals, we calculated the propagation direction. On this propagation direction, we applied the heterogeneity metric for each catheter position along all the left atrium. This metric has a normalized range between 0 and 1, 0 describing the minimum disorganization and 1 the maximum. These calculations have been applied in the same way in the registers pre and post-ablation to evaluate the differences. Results Pre-procedure bipolar peak-to-peak voltages averaged 2.7591mV (SD = 3.4257), decreasing post-procedure to 0.754mV (SD = 1.1666), (p< 0.0001) indicating a significant decrease in bipolar amplitude following ablation. Heterogeneity scores increased post-ablation (mean = 0.3753, SD = 0.21218; post: mean = 0.53526, SD = 0.1320, p<0.0001. This indicates that after ablation, not only does the signal amplitude decrease, but also the level of disorganization of electrical propagation increases. These findings are visually depicted in Figure 1. Conclusion The ablation procedure led to reduced tissue electrical activity, manifested by decreased amplitude and increased propagation heterogeneity, indicative of tissue disorganization. Transitioning from homogeneous to heterogeneous conduction post-ablation suggests the presence of necrotic tissue, hindering uniform wave propagation. This highlights the significance of heterogeneity scoring in evaluating tissue health and ablative intervention outcomes.Figure 1.Catheter HD Grid

Spatial analysis and characteristics of persistent late potentials after ablation of scar-related VT substrate: Implications for late potential elimination as a procedural endpoint with high-resolution mapping

BackgroundLate potential (LP) elimination has been proposed as a surrogate endpoint for scar-related ventricular tachycardia (VT) ablation procedures. The characteristics, distribution, and predictors of persistent late potentials (pLPs) after ablation have not been studied. ObjectiveThe purpose of this study was to characterize the spatial distribution and features of pLP after catheter ablation of VT substrate with high-resolution mapping. MethodsCases of scar-related VT ablation with adequate pre- and postablation electroanatomic maps (EAMs) acquired exclusively using a high-density grid catheter were reviewed from 2021 to 2023. ResultsA total of 62 EAMs (pre- and postablation) from 31 cases using a high-density grid catheter were reviewed. pLPs were observed in 19 cases (61%) after ablation. New LP, spatially distinct from preablation LP, at the periphery of the ablation area comprised the majority of pLPs (16/19 [84%]). Isolated pLPs were more prevalent than fractionated pLPs, with a median amplitude of 0.26 mV (0.09–0.59 mV). The presence of pLP was associated with a significantly lower left ventricular ejection fraction (LVEF) and septal ablation but not low voltage, LP, or ablation area compared to absence of pLP (22.8% ± 7.8% vs 31.5% ± 8.0%, P = .008 for LVEF; 83% vs 44%, P = .033 for septal ablation). ConclusionFormation of spatially distinct new LP after targeted VT ablation is common, especially in patients with lower LVEF and septal substrate independent of ablation burden. This finding highlights the limitations of complete LP elimination as an endpoint to VT ablation procedures.

Reduced variability of erector spinae activity in people with chronic low back pain when performing a functional 3D lifting task

BackgroundChronic low back pain (LBP) is a leading cause of disability, which is exacerbated in some by repeated lifting. Electromyography (EMG) assessments of isolated erector spinae (ES) regions during lifting identified conflicting results. Here, high-density EMG comprehensively assesses the lumbar and thoracolumbar ES activity in people with and without LBP performing a multiplanar lifting task. MethodsFour high-density EMG grids (two bilaterally) and reflective markers were affixed over the ES and trunk to record muscle activity and trunk kinematics respectively. The task involved cyclical lifting of a 5 kg box for ∼7 min from a central shelf to five peripheral shelves, returning to the first between movements, while monitoring perceived exertion. ResultsFourteen LBP (26.9 ± 11.1 years) and 15 control participants (32.1 ± 14.6 years) completed the study. LBP participants used a strategy characterised by less diffuse and more cranially-focussed ES activity (P < 0.05). LBP participants also exhibited less variation in ES activity distribution between sides during movements distal to the central shelf (P < 0.05). There were few consistent differences in kinematics, but LBP participants reported greater exertion (P < 0.05). ConclusionIn the presence of mild LBP, participants used a less variable motor strategy, with less diffuse and more cranially-focussed ES activity; this motor strategy occurred concomitantly with increased exertion while completing this dynamic task.

Association between high-density mapping of atypical atrial flutter, clinical outcomes and healthcare utilization.

Success of atypical atrial flutter (AAFL) ablation has historically been limited by difficulty mapping the complex re-entrant circuits involved. While high-density (HD) mapping has become commonplace in clinical practice, there are limited data on outcomes of HD versus non-HD mapping for AAFL ablation. To compare clinical outcomes and healthcare utilization using HD mapping versus non-HD mapping for AAFL ablation. Retrospective analysis of all AAFL procedures between 2005 and 2022 at an academic medical center was conducted. Procedures utilizing a 16-electrode HD Grid catheter and Precision mapping system were compared to procedures using prior generation 10-20 electrode spiral catheters and the Velocity system (Abbott, IL). Cox regression models and Poisson regression models were utilized to examine procedural and healthcare utilization outcomes. Models were adjusted for left ventricular ejection fraction, CHA2DS2-VASc, and history of prior ablation. There were 108 patients (62% HD mapping) included in the analysis. Baseline clinical characteristics were similar between groups. Use of HD mapping was associated with a higher rate of AAFL circuit delineation (92.5% vs. 76%; p = .014) and a greater adjusted procedure success rate, defined as non-inducibility at procedure end, (aRR (95% CI) 1.26 (1.02-1.55) p = .035) than non-HD mapping. HD mapping was also associated with a lower rate of ED visits (aIRR (95% CI) 0.32 (0.14-0.71); p = .007) and hospitalizations (aIRR (95% CI) 0.32 (0.14-0.68); p = .004) for AF/AFL/HF through 1 year. While there was a lower rate of recurrent AFL through 1 year among HD mapping cases (aHR (95% CI) 0.60 (0.31-1.16) p = .13), statistical significance was not met likely due to the low sample size and higher rate of ambulatory rhythm monitoring in the HD group (61% vs. 39%, p = .025). Compared to non-HD mapping, AAFL ablation with HD mapping is associated with improvements in the ability to define the AAFL circuit, greater procedural success, and a reduction in the number of ED visits and hospitalization for AF/AFL/HF.

Quantifying local cardiac substrate heterogeneity from high density recordings: an experimental study

Abstract Background and Purpose High-density (HD) grid catheters offer enhanced local electrical conduction characterization, owing to their unique grid arrangement. This arrangement enables the generation of orientation-independent EGMs, termed omnipolar EGMs (oEGMs), overcoming limitations associated with traditional unipolar and bipolar EGMs. This innovation holds potential for differentiating healthy tissue from scarred or arrhythmogenic areas. In this study, we introduce a novel metric, the Vector Field Heterogeneity (VFH), designed to quantify the heterogeneity of propagation wavefronts in local vector maps derived from oEGMs. Methods We developed and validated the VFH metric through a combination of simulations and experiment conducted on Langendorff-perfused rabbit hearts. Simulations involved creating a model that generated 100,000 simulated maps exhibiting various levels of disorganization. For experimental data, 68 propagation maps were utilized, including 29 from basal recordings, 39 from recordings with stimulation (4 or 6Hz), from five Langendorff-perfused rabbit hearts at 37ºC, using a multielectrode mapping catheter with 128 electrodes spaced 1mm apart. The VFH metric, based on vector field theory (see figure 2), was computed and compared to the widely adopted the Spatial Inhomogeneity Index (SI) from Statistical analysis was then performed to assess the distribution of heterogeneity values. Results The analysis of the VFH metric through simulations revealed a linear increase in VFH values with disorganization up to a 45º angle, followed by a plateau. Different catheter grid sizes demonstrated that larger grids reduced the standard deviation, with the VFH metric converging to a lower value of approximately 0.62 for larger grids. Experimental data indicated that for a 4x4 grid, VFH values averaged 0.35 without stimulation and decreased to 0.11 with stimulation. The VFH metric consistently outperformed the SI index in binary classification of basal vs stimulated conditions, as evidenced by higher Area Under Curve (AUC) values in both Receiver Operating Characteristic (ROC) and Precision-Recall (PR) analyses across various catheter sizes. For example, in the 4x4 grid, the AUROC for the VFH metric was 0.9752 compared to 0.8311 for the SI index, showcasing the VFH metric’s superior accuracy in assessing cardiac wavefront heterogeneity (see figure 2). Conclusion Vector Field Heterogeneity (VFH) emerges as an effective tool for characterizing cardiac tissue. It successfully differentiates between stimulated and non-stimulated tissue, accurately representing progressive disorganization in simulated maps. The VFH metric demonstrates superiority over the established Spatial Inhomogeneity (SI) index, making it a reliable parameter for assessing cardiac heterogeneity, especially on small high-density grids. It holds promise for clinical use in studying and understanding the cardiac substrate during arrhythmic conditions.Figure 1.Abstract Figure.Figure 2.Methods and Results.

Transbaffle or retrograde aortic approach for atrial arrhythmias ablation in patients with D-TGA treated with atrial switch surgery

Abstract Introduction Patients with D- transposition of the great arteries (TGA) treated with Senning or Mustard surgeries have high incidence of supraventricular tachycardias (SVTs). Accessing to the pulmonary venous atrium (PVAt) is frequently required to perform the ablation, however it can be challenging. Aim To investigate the differences between a retrograde aortic approach (Re-Aa) and transbaffle approach (TBa) for PVAt ablation in this set of patients. Methods Prospective observational study in a third level hospital since April 2018 until October 2022, with a medium-term follow-up. All consecutive patients (pt) with history of SVT and atrial switch surgery that underwent electrophysiologic study (EP) and electroanatomic mapping using a high-density Grid mapping catheter and a contact-force ablation catheter were included. Results A total of 25 EPs were performed in 20 pt (13 (52%) Female, median age 37 y.o [IQR 34-41], median follow-up time 13 month [IQR 10-37]). In 14 pt the PVAt was mapped and ablated via Re-Aa, and in 11 with TBa. Table 1 shows basal patients characteristics, note that no significant differences between groups were found. In 19 pt (76%) a CTI-dependent flutter was documented (10 (71%) in Re-Aa group and 9 (82%) in TBa, p=0.6). Furthermore, in 7 pt other tachycardia circuits were found. Accurate mapping of all the CTI walls were achieved with both strategies, however, the posterior PVAt wall and the pulmonary veins were suboptimal mapped with Re-Aa due to a lack of catheter contact. Acute ablation success was 83% in Re-Aa and 100% in TBa (p=0.5). Despite a higher recurrence rate in the Re-Aa in the first months (20% vs 0%), no significant differences in recurrences were found between groups within 1 year of follow-up (HR 1.3 [95%CI: 0,2-7], p=0.8) (FIGURE). Complication rate was 20% in Re-Aa and 0% in TBa. All complications were directly related to the arterial vascular access (1 femoral pseudoaneurysm, 1 iliac dissection, 1 mediastinal hematoma), and were successfully treated. Conclusion In D-TGA treated with atrial switch surgery, PVAt mapping and ablation is feasible with both strategies with a high acute success rate and without significant differences in recurrences at mid-term follow up. However, TBa is associated with a lower complications rate and also with a better catheter contact and accurate mapping in the PVAt posterior wall.

Earthworm-Inspired Soft Skin Crawling Robot.

Earthworms are fascinating animals capable of crawling and burrowing through various terrains using peristaltic motion and the directional friction response of their epidermis. Anisotropic anchoring governed by tiny appendages on their skin called setae is known to enhance the earthworm's locomotion. A multi-material fabrication technique is employed to produce soft skins with bristles inspired by the earthworm epidermis and their setae. The effect of bristles arranged in triangular and square grids at two spatial densities on the locomotion capability of a simple soft crawling robot comprised of an extending soft actuator covered by the soft skin is investigated experimentally. The results suggest that the presence of bristles results in a rostral to caudal friction ratio of µR/µC > 1 with some variations across bristle arrangements and applied elongations. Doubling the number of bristles increases the robot's speed by a factor of 1.78 for the triangular grid while it is less pronounced for the rectangular grid with a small factor of 1.06. Additionally, it is observed that increasing the actuation stroke for the skin with the high-density triangular grid, from 15% to 30%, elevates the speed from 0.5 to 0.9mms-1, but further increases in stroke to 45% may compromise the durability of the actuators with less gains in speed (1mms-1). Finally, it is demonstrated that a crawling robot equipped with soft skin can traverse both a linear and a curved channel.

Arm muscle synergies enhance hand posture prediction in combination with forearm muscle synergies

Objective. We analyze and interpret arm and forearm muscle activity in relation with the kinematics of hand pre-shaping during reaching and grasping from the perspective of human synergistic motor control. Approach. Ten subjects performed six tasks involving reaching, grasping and object manipulation. We recorded electromyographic (EMG) signals from arm and forearm muscles with a mix of bipolar electrodes and high-density grids of electrodes. Motion capture was concurrently recorded to estimate hand kinematics. Muscle synergies were extracted separately for arm and forearm muscles, and postural synergies were extracted from hand joint angles. We assessed whether activation coefficients of postural synergies positively correlate with and can be regressed from activation coefficients of muscle synergies. Each type of synergies was clustered across subjects. Main results. We found consistency of the identified synergies across subjects, and we functionally evaluated synergy clusters computed across subjects to identify synergies representative of all subjects. We found a positive correlation between pairs of activation coefficients of muscle and postural synergies with important functional implications. We demonstrated a significant positive contribution in the combination between arm and forearm muscle synergies in estimating hand postural synergies with respect to estimation based on muscle synergies of only one body segment, either arm or forearm (p < 0.01). We found that dimensionality reduction of multi-muscle EMG root mean square (RMS) signals did not significantly affect hand posture estimation, as demonstrated by comparable results with regression of hand angles from EMG RMS signals. Significance. We demonstrated that hand posture prediction improves by combining activity of arm and forearm muscles and we evaluate, for the first time, correlation and regression between activation coefficients of arm muscle and hand postural synergies. Our findings can be beneficial for myoelectric control of hand prosthesis and upper-limb exoskeletons, and for biomarker evaluation during neurorehabilitation.

Trajectory outlier detection method based on group division

Trajectory-outlier detection can be used to discover the fraudulent behaviour of taxi drivers during operations. Existing detection methods typically consider each trajectory as a whole, resulting in low accuracy and slow speed. In this study, a trajectory outlier detection method based on group division is proposed. First, the urban vector region is divided into a series of grids of fixed size, and the grid density is calculated based on the urban road network. Second, according to the grid density, the grids were divided into high- and low-density grids, and the code sequence for each trajectory was obtained using grid coding and density. Third, the trajectory dataset is divided into several groups based on the number of low-density grids through which each trajectory passes. Finally, based on the high-density grid sequences, a regular subtrajectory dataset was obtained within each trajectory group, which was used to calculate the trajectory deviation to detect outlying trajectories. Based on experimental results using real trajectory datasets, it has been found that the proposed method performs better at detecting abnormal trajectories than other similar methods.

The effect of macular visual field test density on central structure-function concordance in glaucoma

ABSTRACT Clinical relevance Central visual field (VF) testing often requires focussed high-density test grids. The critical number of test locations for maximising structure-function concordance in the macula is not known. Purpose The aim of this work is to determine the impact of the number of test locations in the central VF on binarized structure-function concordance in glaucoma. Methods Humphrey Field Analyser (HFA) 10–2 test grid and Cirrus optical coherence tomography Ganglion Cell Analysis (GCA) results from one eye of 155 glaucoma patients were extracted. Following anatomical correction for retinal ganglion cell displacement, the pointwise results of the central 36 locations of the 10–2 pattern deviation map and their corresponding locations within the GCA deviation map were recorded. The number of test locations was systematically reduced from 36 (4 locations per step) and added from 1 (1 location per step) and binarized structure-function concordance (p < 0.05 for both) at each step was evaluated. Eleven test point subtraction and addition models were developed. Concordance rates (proportion) were plotted as a function of number of test locations, and were fitted using segmental nonlinear regression to identify the critical point of inflection at which concordance was maximised and discordance minimised. Results Subtractive and additive approaches returned two-way estimates of the critical number, with, on average 8–14 test locations being the range at which structure-function concordance was optimised in the present cohort across all models. A randomised approach to subtracting or adding test locations returned critical numbers that were similar to systematic and empirical models, suggesting that specific test location was not as critical in optimising structure-function concordance compared to the number of test locations. Conclusion There is a potential critical number (8–14) in macular visual field testing where binarized structure-function concordance is optimised, providing a framework for guiding the development of integrated macular test locations in VF testing for glaucoma.

MORSA: Multi-objective reptile search algorithm based on elite non-dominated sorting and grid indexing mechanism for wind farm layout optimization problem

The proposal of the wind farm layout optimization (WFLO) problem aims to better utilize wind energy. A multi-objective reptile search algorithm (MORSA) based on elite non-dominated sorting and grid indexing mechanism was proposed to solve the multi-objective optimization problem of wind farm layout under the Jansen wake model to maximize power generation while minimizing costs. Firstly, the elite non-dominated sorting method was used to sort the population, and then the crowding distance method was used to maintain the diversity between the optimal sets. By calculating the crowding distance, the same level of non-dominated populations are sorted. Then, the grid index mechanism is added to the archive for selection and deletion. Leaders can use the roulette wheel to select and delete some solutions in high-density grids. By obtaining the optimal Pareto solution set while maintaining the diversity of the population, the effectiveness of solving multi-objective optimization problems is improved. The improved algorithm solves the WFLO problem based on the Jansen wake model by using two different initial self-flow winds for performance testing while considering the effects of single wake and multiple wake with or without partial wake occlusion. The performance of the WFLO (output power and cost) was compared without considering wake obstruction, MORSA can obtain the minimum turbine cost of 26.3601 and the maximum power generation of 2.3078E-08 with a single wake flow of 16 m/s. The experimental results show that the proposed MORSA has better convergence and applicability, and has shown good results in multi-objective layout optimization of wind farms.

Electrode Surface Area Impacts Measurement of High Frequency Oscillations in Human Intracranial EEG.

High-frequency oscillations (HFOs) are a promising prognostic biomarker of surgical outcome in patients with epilepsy. Their rates of occurrence and morphology have been studied extensively using recordings from electrodes of various geometries. While electrode size is a potential confounding factor in HFO studies, it has largely been disregarded due to a lack of consistent evidence. Therefore, we designed an experiment to directly test the impact of electrode size on HFO measurement. We first simulated HFO measurement using a lumped model of the electrode-tissue interaction. Then eight human subjects were each implanted with a high-density 8x8 grid of subdural electrodes. After implantation, the electrode sizes were altered using a technique recently developed by our group, enabling intracranial EEG recordings for three different electrode surface areas from a static brain location. HFOs were automatically detected in the data and their characteristics were calculated. The human subject measurements were consistent with the model. Specifically, HFO rate measured per area of tissue decreased significantly as electrode surface area increased. The smallest electrodes recorded more fast ripples than ripples. Amplitude of detected HFOs also decreased as electrode surface area increased, while duration and peak frequency were unaffected. These results suggest that HFO rates measured using electrodes of different surface areas cannot be compared directly. This has significant implications for HFOs as a tool for surgical planning, particularly for individual patients implanted with electrodes of multiple sizes and comparisons of HFO rate made across patients and studies.

Effect of Mo microalloying on impact toughness of X80 pipeline steel in SCGHAZ

The microstructure and impact toughness of subcritically reheated coarse-grained heat-affected zone (SCGHAZ) of X80 pipeline steels with different Mo content (0Mo and 0.11 wt%Mo) were investigated. Gleeble 3500 thermal simulation experiment was used to simulate the heat-affected zone (HAZ) of X80 pipeline circumferential weld, and the two samples were characterized by a series of material testing techniques such as SEM, TEM, EBSD and XRD. The research showed that: Appropriate addition of Mo element can improve the hardenability of the matrix, increase the content of bainitic ferrite (BF) in the microstructure, refine the BF lath, cause plastic deformation, and reduce local stress concentration. The increase of BF content greatly increases the proportion of high angle grain boundary (HAGB) in order to effectively inhibit crack propagation. On the other hand, Mo element influences precipitation with solid solution, reduces the early energy barrier for nucleation, delays the disappearance of dislocation lines at high temperature, forms high-density dislocation grid, so that it can increase the nucleation site for NbC precipitation, prevent the coarsing of NbC, increases the threshold of external stress required for the generation of micropores induced by precipitation, and hinder crack initiation. The impact toughness of SCGHAZ was significantly improved by adjusting the microstructure and second phase morphology of HAZ by using Mo element microalloying.

Probing the Intrinsic Strain in Suspended Graphene Films Using Electron and Optical Microscopy.

Quantifying the intrinsic properties of 2D materials is of paramount importance for advancing their applications. Large-scale production of 2D materials merits the need for approaches that provide direct information about the role of growth substrate on 2D material properties. Transferring the 2D material from its growth substrates can modify the intrinsic properties of the asgrown 2D material. In this study, suspended chemical vapor deposition (CVD) graphene films are prepared directly on their growth substrates in a high-density grid array. The approach facilitates the quantification of intrinsic strain and doping in suspended CVD graphene films. To achieve this, transmission electron microscopy and large-area Raman mapping are employed. Remarkably, the analysis reveals consistent patterns of compressive strain (≈-0.2%) both in the diffraction patterns and Raman maps obtained from these suspended graphene films. By conducting investigations directly on the growth substrates, the potential influences introduced during the transfer process are circumvented effectively. Consequently, the methodology offers a robust and reliable means of studying the intrinsic properties of 2D materials in their authentic form, uninfluenced by the transfer-induced alterations that may skew the interpretation of their properties.

High Density grid catheter mapping for complex atrial arrhythmias

High Density grid catheter mapping for complex atrial arrhythmias

Quantification of local heterogeneity from activation maps of omnipolar multielectrode recordings

Abstract Background and Purpose The study of cardiac arrhythmias requires understanding the heart's electrical conduction patterns. Using multielectrode catheters and other mapping systems have allowed a futher understanding of the wavefront. In particular, novel high-density (HD) grid catheters, enable the recording of omnipolar electrograms, which are purportedly not influenced by catheter orientation, allowing real-time determination of signal propagation direction. We propose a novel heterogeneity metric to quantify the degree of disorganisation in the vector maps from reconstructed omnipolar electrograms, which could potentially be utilised to detect and assess the degree of fibrosis in cardiac tissue. Methods We utilised basal and stimulated recordings from 5 Langendorff-perfused rabbit hearts, where signals were obtained using a multielectrode mapping catheter with 128 electrodes spaced at 1mm. Three recordings were taken for each series, basal at 37°C, plus stimulation performed using a bipolar electrode at 4 Hz and 6 Hz . An angle propagation matrix is computed for the local area of recording, by means of the orthogonal bipolar loops of each clique. A local heterogeneity metric is derived from the summation of angular variations of neighbouring elements. An illustration of the heterogeneity map, and heterogeneity metric for the recording area (H) is illustrated in figure 1. A statistical analysis is performed then to assess the distribution of heterogeneity values. Results Heterogeneity values for each experimental heart, and the distributions of H values obtained according to the stimulation type are shown in figure 2A. The ROC curve obtained from the values of H has an AUC of 0.996, with an optimal threshold value of 0.113, resulting in a confusion matrix presented in 12 TP, 30 TN, 3 FP and 0 FN. The study shows that the proposed heterogeneity metric can quantify the degree of disorganization in the vector maps and can be used to differentiate between basal and stimulated groups with p&amp;lt;0.001. Conclusion This study proposes a novel heterogeneity metric to quantify the degree of disorganization in the vector maps from reconstructed omnipolar electrograms. The methodology was assessed on basal and stimulated epicardial rabbit recordings and found to be effective in differentiating between the two groups with high accuracy. Future studies should focus on the efficiency of assessing fibrotic tissue using the proposed metric.Figure 1Figure 2

Improving omnipolar electrogram reconstruction: an animal model study

Abstract Background Cardiac arrhythmias are a significant cause of morbidity and mortality worldwide. The characterization of cardiac tissue's electrophysiological substrate is crucial for the diagnosis and treatment of these conditions. High-density (HD) electrode arrays, such as the Advisor™ HD Grid Mapping Catheter and Sensor Enabled™ (SE), are commonly used to examine cardiac tissue locally and create activation maps. However, the current method for reconstructing omnipolar EGMs, a novel technique claimed to be orientation-independent, has limitations. The enhancement of this reconstruction methodology has the potential to improve the accuracy and reliability of electrophysiological mapping. This, in turn, can have a positive impact on patients suffering from cardiac arrhythmias, ultimately leading to better clinical outcomes. Purpose We propose a novel reconstruction method to estimate omnipolar EGM that overcomes the angle dependence weakness of the current method to enhance the reconstruction of electrophysiological signals. Methodology Prior experiments were conducted on isolated rabbit hearts using a 128-electrode array with electrodes spaced 1mm apart over the ventricular epicardium. Four-electrode cliques were designed from these experiments, with different inter-electrode distances as depicted in Figure 1A, to reconstruct the current and novel omnipolar configurations. Metrics were designed to assess the quality of the electrogram signals, including the bipolar loop area and the ratio of the bipolar components of the omnipole (see fig. 2). The bipoles were calculated from unipolar electrograms, and the signal was corrected with a 45º offset in the cross. The propagation angle was then detected, and the local activation time (LAT) was estimated. Results In the bipole plots, it was observed that the morphology of the bipolar loop becomes distorted with an increase in the inter-electrode distance, becoming thinner for distances less than 2mm. There is a direct relation between the areas in the bipolar loop and the inter-electrode distance (see Figure 2A). Furthermore, the values of the area in the cross are always comparable to the best-performing triangular clique. For the ratio of bipoles, the relation is inversely related to distance (see Figure 2B). Similarly, the performance of the cross is comparable to the best-performing triangular omnipole. Conclusion This study highlights the importance of accurate reconstruction of omnipolar EGMs for the diagnosis and treatment of cardiac arrhythmias. To achieve precise reconstruction, inter-electrode distances smaller than 2mm are recommended. The proposed reconstruction method based on the cross configuration is more accurate and robust to wavefront propagation, provided that the recommended distance criterion is met. This study opens up new possibilities for the design of new devices and practices in the clinic.Figure 1Figure 2

Use of the advisor™ HD Grid mapping catheter in transcatheter ablation of atrial arrhythmias in palliated CHD and children without CHD.

In this study, we describe our experience utilising Advisor™ High Density (HD) Grid mapping catheter in transcatheter ablation of intraatrial re-entrant and focal atrial tachycardias with or without CHD. Forty-five consecutive patients with intraatrial re-entrant and focal atrial tachycardia who underwent a transcatheter ablation procedure by using Advisor™ HD Grid mapping catheter and high-density mapping system in our hospital from January 2017 to January 2023 were included into the study. The mean age of the patients was 14.2 ± 7.3 years (6-32 years), and the mean weight was 48.3 ± 16.2 kg (22-83 kg). Of the total 45 patients, 21 were intraatrial re-entrant tachycardia and 25 were focal atrial tachycardia. Of the 21 re-entrant circuits, 15 were classified as cavotricuspid isthmus-dependent and 5 were non-cavotricuspid isthmus-dependent. In one patient, two re-entrant circuits were identified. A transbaffle ablation was successfully performed from the left atrium in one patient. Of the 25 focal atrial tachycardia, 19 were from right atrium and 6 were from left atrium. A cryoablation was performed in only one patient and radiofrequency ablation in others. The mean procedure time was 180 ± 64 minutes. The mean follow-up period was 69.3 ± 35.3 months. Acute success was 95.5%. Recurrence was noted in two patients (4.4%). Advisor™ HD Grid mapping catheter was found to be safe and achieved an acceptable success in transcatheter ablation of patients with intraatrial re-entrant tachycardia and focal atrial tachycardias.

Assessment of the Interelectrode Distance Effect over the Omnipole with High Multielectrode Arrays.

The development of high-density multielectrode catheters has significantly advanced cardiac electrophysiology mapping. High-density grid catheters have enabled the creation of a novel technique for reconstructing electrogram (EGM) signals known as "omnipole," which is believed to be more reliable than other methods, especially in terms of orientation independence. This study aims to evaluate how distance affects the omnipolar reconstruction of EGMs by comparing different configurations. Using an animal set up of perfused isolated rabbit hearts, recordings were taken using an ad hoc high-density epicardial multielectrode catheter. Inter-electrode distances ranging from 1 to 4 mm were analysed for their effect on the quality of resulting EGMs. Two biomarkers were computed to evaluate the robustness of the reconstructions: the areas contained within the bipolar loops and the amplitudes of the omnipoles. We hypothesised that both bipolar and omnipolar electrograms would be more robust at shorter inter-electrode distances. The results showed that an increase in distance triggers an increase in loop areas and amplitudes, which supports the hypothesis. This finding provides a more reliable estimate of wavefront propagation for the cross-omnipolar reconstruction method. These results emphasise the importance of distance in cardiac electrophysiology mapping and provide valuable insights into the use of high-density multielectrode catheters for EGM reconstruction.Clinical Relevance- The results of this study have direct clinical relevance in the application of the described techniques to recording systems in the cardiac electrophysiology laboratory, enabling clinicians to obtain more precise characterisation of signals in the myocardium.

Long-term success of a multi-electrode substrate mapping and ablation strategy versus a classic single tip mapping and ablation strategy for ventricular tachycardia ablation in patients with ischemic cardiomyopathy.

Over the past years, mapping and ablation techniques for the treatment of ventricular tachycardia (VT) have evolved rapidly. High Density (HD) substrate mapping is now routine and pre-procedural imaging is increasingly used. The additional value of these techniques for long-term VT-free survival is not clear. We compared baseline and procedural characteristics, procedural success, safety and outcome of mapping and ablation of ventricular tachycardia in patients with ischemic heart disease between two groups. (1) Low Density (LD) group: VT mapping and ablation with a 4mm single tip catheter (2) HD group: HD substrate mapping with the Pentaray (Biosense Webster, USA) or HD Grid (Abbott, USA) catheter and ablation with a 4mm single tip catheter. VT ablation was performed in 133 patients (71 patients in LD group and 62 patients in HD group). The median follow-up was 5.0 years in LD group and 2.0 years in HD group. One-, two-, and five-year VT recurrence rates were 47%, 56%, and 65% in the LD group versus 39%, 50%, and 55% in the HD group (log-rank test for VT recurrence p=.70). One-, two-, and five-year ICD shock recurrence rates were 14%, 18%, and 24% in the LD group versus 8%, 15%, and 19% in the HD group (log-rank test for ICD-shock p=.79). All-cause mortality, cardiac (non-arrhythmic), and arrhythmic death, were similar in both groups. Severe procedural complications (tamponade, stroke, or procedural death) occurred in four patients (5%, 1 vascular, 3 tamponade) in the LD group versus two patients (3%, both tamponade) in the HD group (NS). In univariate and multivariable analysis, only a higher LVEF was significantly associated with VT-free survival. HD mapping was not significantly associated with VT-free survival. Anterior infarct location and age were significantly associated with ICD recurrent shock in both univariate and multivariable analyses. In patients with ischemic cardiomyopathy, a HD substrate mapping, and ablation strategy did not lead to higher VT-free survival and shock-free survival compared to a single tip mapping and ablation strategy. In this study, only LVF is an independent predictor for VT recurrence. Anterior infarct location and age predict recurrent ICD shocks.