The Omnipolar Mapping Technology - a new mapping tool to overcome bipolar blindness resulting in true high-density maps

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. BACKGROUND: Mapping, using the novel omnipolar technology (OT) obtains omnipolar signals displaying true voltage, real-time wavefront direction and speed, independent of catheter orientation and external reference. Employment of OT potentially overcomes so called "bipolar blindness" (conventional bipolar electroanatomic mapping). Hence, OT potentially improves substrate assessment, comprehension of tachycardia mechanisms and gap detection after previous catheter ablation (CA). PURPOSE: Purposes of our study was to analyze previously performed left atrial (LA) and left ventricular (LV) maps for differences using automated OT vs. SD vs. the previously published HD Wave (HDW) algorithm. METHODS: Maps of patients undergoing CA for atrial or ventricular arrhythmia were initially acquired using HDW settings in conjunction with the Advisor HD Grid mapping catheter. These maps were then analyzed retrospectively applying the automated OT algorithm vs. SD vs. HDW. to reveal differences in voltage and point density. Additionally, detection of pulmonary vein (PV) gaps and LV scar area was evaluated. RESULTS: In 45 consecutive patients 135 maps were analyzed. The study population undergoing CA consisted of: 30 (22.2%) patients undergoing repeated CA for recurrence of persistent atrial fibrillation (persAF)/left atrial tachycardia (AT) and 15 (11.1%) patients with ventricular tachycardia (VT) or premature ventricular contractions (PVC). Atrial maps revealed a significantly higher point density using OT (21471) vs. SD (6682) or HDW (12189, p<0.001). Mean voltage was significantly higher using OT (0.75mV) vs. SD (0.61mV) or HDW (0.64mV, p<0.001). OT maps detected significantly more PV gaps vs. SD (4 vs. 2, p=0.001). In LV maps, OT revealed a significantly higher point density (25951) vs. SD (8582) and HDW (17071), p<0.001. Mean voltage was significantly higher for OT (1.49mV) vs. SD (1.19mV) and HDW (1.2mV), p<0.001. Detected scar area was significantly smaller using OT (25.3%) vs. SD (33.9%, p<0.001). CONCLUSION: Using OT results in a higher voltage and point density compared to SD and HDW. Therefore displayed scar extend is significantly smaller in atrial and ventricular maps. Also, more PV gaps were detected using OT. The OT algorithm potentially improves scar delineation, facilitates substrate characterization, and may improve procedural outcome.