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Enhanced ventricular tachycardia substrate resolution with a novel omnipolar high-density mapping catheter: the omnimapping study

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

Defining diastolic slow-conduction channels within the borderzone (BZ) of scar-dependent re-entrant ventricular tachycardia (VT) is key for effective mapping and ablation strategies. Understanding wavefront propagation is driving advances in high-density (HD) mapping. The newly developed Advisor™ HD Grid Mapping Catheter (HD GRID) has equidistant spacing of 16, 1 mm electrodes in a 4 × 4 3 mm interspaced arrangement allowing bipolar recordings along and uniquely across the splines (orthogonal vector) to facilitate substrate mapping in a WAVE configuration (WAVE). The purpose of this study was to determine the relative importance of the WAVE configuration compared to the STANDARD linear-only bipolar configuration (STANDARD) in defining VT substrate.

Methods

Thirteen patients underwent VT ablation at our institution. In all cases, a substrate map was constructed with the HD GRID in the WAVE configuration (conWAVE) to guide ablation strategy. At the end of the procedure, the voltage map was remapped in the STANDARD configuration (conSTANDARD) using the turbo-map function. Detailed post-hoc analysis of the WAVE and STANDARD maps was performed blinded to the configuration. Quantification of total scar area, BZ and dense scar area with assessment of conduction channels (CC) was performed.

Results

The substrate maps conSTANDARD vs conWAVE showed statistically significant differences in the total scar area (56 ± 32 cm2 vs 51 ± 30 cm2; p = 0.035), dense scar area (36 ± 25 cm2 vs 29 ± 22 cm2; p = 0.002) and number of CC (3.3 ± 1.6 vs 4.8 ± 2.5; p = 0.026). conWAVE collected more points than the conSTANDARD settings (p = 0.001); however, it used fewer points in map construction (p = 0.023).

Conclusions

The multipolar Advisor™ HD Grid Mapping Catheter in conWAVE provides more efficient point acquisition and greater VT substrate definition of the borderzone particularly at the low-voltage range compared to conSTANDARD. This greater resolution within the low-voltage range facilitated CC definition and quantification within the scar, which is essential in guiding the ablation strategy.

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Author notes

  1. Dr. Riccardo Proietti and Ahmed M. Adlan contributed equally to the paper and share the first authorship.

Authors and Affiliations

  1. Department of Cardiac, Thoracic, Vascular Sciences, University of Padua, Padua, Italy

    Riccardo Proietti

  2. Department of Cardiology, University Hospital Coventry, University Hospital, Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK

    Ahmed M. Adlan, Rory Dowd, Shershah Assadullah, Bashar Aldhoon, Sandeep Panikker, Will Foster, Shamil Yusuf, Sajad Hayat, Faizel Osman, Prithwish Banerjee & Tarvinder Dhanjal

  3. Department of Cardiology, Worcestershire Royal Hospital, Worcestershire Acute Hospitals NHS Trust, Charles Hastings Way, Worcester, WR5 1DD, UK

    Bashar Aldhoon & Will Foster

  4. Department of Cardiology, Good Hope Hospital, University Hospitals Birmingham NHS Foundation Trust, Rectory Road, Sutton Coldfield, B75 7RR, UK

    Shamil Yusuf

  5. University of Warwick (Medical School), Gibbet Hill, Coventry, CV4 7AJ, UK

    Faizel Osman, Prithwish Banerjee & Tarvinder Dhanjal

Authors
  1. Riccardo Proietti
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  2. Ahmed M. Adlan
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  12. Tarvinder Dhanjal
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Correspondence to Tarvinder Dhanjal.

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Proietti, R., Adlan, A.M., Dowd, R. et al. Enhanced ventricular tachycardia substrate resolution with a novel omnipolar high-density mapping catheter: the omnimapping study. J Interv Card Electrophysiol 58, 355–362 (2020). https://doi.org/10.1007/s10840-019-00625-9

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  • DOI: https://doi.org/10.1007/s10840-019-00625-9

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