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Review
. 2024 Mar;67(2):399-408.
doi: 10.1007/s10840-023-01562-4. Epub 2023 May 25.

The omnipolar mapping technology-a new mapping tool to overcome "bipolar blindness" resulting in true high-density maps

Sebastian Dittrich  1 , Cornelia Scheurlen  2 , Jan-Hendrik van den Bruck  2 , Karlo Filipovic  2 , Jonas Wörmann  2 , Susanne Erlhöfer  2 , Jan-Hendrik Schipper  2 , Jakob Lüker  2 , Daniel Steven  2 , Arian Sultan  2
Affiliations
Review

The omnipolar mapping technology-a new mapping tool to overcome "bipolar blindness" resulting in true high-density maps

Sebastian Dittrich et al. J Interv Card Electrophysiol. 2024 Mar.

Abstract

Background: Omnipolar mapping (OT) is a novel tool to acquire omnipolar signals for electro-anatomical mapping, displaying true voltage and real-time wavefront direction and speed independent of catheter orientation. The aim was to analyze previously performed left atrial (LA) and left ventricular (LV) maps for differences using automated OT vs. standard bipolar settings (SD) and HD wave (HDW) algorithm.

Methods: Previously obtained SD and HDW maps of the LA and LV using a 16-electrode, grid-shaped catheter were retrospectively analyzed by applying automated OT, comparing voltage, point density, pulmonary vein (PV) gaps, and LV scar area.

Results: In this analysis, 135 maps of 45 consecutive patients (30 treated for LA, 15 for LV arrhythmia) were included. Atrial maps revealed significantly higher point densities using OT (21471) vs. SD (6682) or HDW (12189, p < 0.001). Mean voltage was significantly higher using OT (0.75 mV) vs. SD (0.61 mV) or HDW (0.64 mV, p < 0.001). OT maps detected significantly more PV gaps per patient vs. SD (4 vs. 2), p = 0.001. In LV maps, OT revealed significantly higher point densities (25951) vs. SD (8582) and HDW (17071), p < 0.001. Mean voltage was significantly higher for OT (1.49 mV) vs. SD (1.19 mV) and HDW (1.2 mV), p < 0.001. Detected scar area was significantly smaller using OT (25.3%) vs. SD (33.9%, p < 0.001).

Conclusion: OT mapping leads to significantly different substrate display, map density, voltage, detection of PV gaps, and scar size, compared to SD and HDW in LA and LV procedures. Successful CA might be facilitated due to true HD maps.

Keywords: 3D mapping; Atrial fibrillation; Atrial tachycardia; Catheter ablation; High-density mapping; Ventricular tachycardia.

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Conflict of interest statement

AS and DS received honorary lecture fees from Abbott.

Figures

Fig. 1
Fig. 1
Electrode configuration and voltage points in HDW and OT configuration. Electrode configuration on the HD Grid catheter is displayed for HD wave SolutionTM (A) and EnsiteTM Omnipolar (B, C). A In HD wave configuration, the Best Duplicate algorithm choses the local bipole with the higher voltage. B In omnipolar configuration, local omnipoles are created that lead to a total of 36 mapping points. C Local omnipoles are created inside of a triangle formed by a clique of three adjacent electrodes
Fig. 2
Fig. 2
Substrate map of the LA in the area of PV gaps in OT and SD configuration. Atrial substrate maps of the LA displaying PV gaps around the right pulmonary veins (A) and left pulmonary veins (B). The displayed substrate maps have been performed using either OT settings (left) or SD settings (right). Scar threshold is set to 0.1 mV as used in many centers for demonstration purposes
Fig. 3
Fig. 3
Mapping data of atrial maps. Line graphs displaying the amount of collected points (A) and voltage (B) of atrial maps for standard configuration (SD), HD wave, and omnipolar technology (OT). **** p < 0.0001
Fig. 4
Fig. 4
Substrate map of the LA in the area of a PV gap and associated EGMs. Substrate map of the LA at the site of a PV gap. The map has been performed using OT. The associated EGMs at the identified location of the PV gap are shown on the right (red box), calculated by OT and HDW. Amplitudes of the local EGMs around the gap site are higher in OT configuration vs. HDW configuration (0.62 mV vs. 0.28 mV), as visualized in the green boxes
Fig. 5
Fig. 5
Mapping data of ventricular maps. Line graphs displaying the amount of collected points (A) and voltage (B) of ventricular maps for standard configuration (SD), HD wave, and omnipolar technology (OT). **** p < 0.0001
Fig. 6
Fig. 6
Substrate map of the posterior LV. Substrate mapping in the posterior LV using HDW and OT configuration. The OT map detects an area as viable myocardium that has been detected as scar in HDW configuration. The same voltage settings were used
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