Omnipolar versus Bipolar Electrode Mapping in Patients with Atrial Fibrillation Undergoing Catheter Ablation

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  • Background: Peak-to-peak bipolar voltage varies with electrode orientation, fractionation, and collision events. Novel, omnipolar mapping is less dependent on electrode orientation. While studied in animal models, endocardial omnipolar mapping has limited data in humans. Objective: To compare bipolar peak-to-peak voltage with omnipolar maximum voltage (Vmax) during sinus rhythm in the left atrium (LA) of patients with persistent (PerAF) or paroxysmal atrial fibrillation (ParAF) undergoing catheter ablation. Methods: Baseline voltage maps were generated with bipolar and omnipolar mapping techniques in 30 cardiac atria from 29 patients, with low-voltage <0.5 mV and scar <0.1 mV. Mean voltage was compared with unpaired t-testing. Percent low-voltage and scar were compared with Chi-square. A point-to-point comparison of all mapping points was performed with Bland-Altman analysis. Results: Among all patients, mean age was 62.2 +/- 9.9 years, 34% were women, and 41% had heart failure. Overall, in 10 atria with known scar, bipolar mapping overestimated the extent of low-voltage (p < 0.0001) and scar (p < 0.0001). In complete voltage analyses, omnipolar mapping identified significantly higher mean voltage than bipolar mapping in all patients, and bipolar mapping identified significantly more points as low-voltage (PerAF: 43.4% vs 32.9%; ParAF: 25.6% vs 19.2%) and scar (PerAF: 12.1% vs 7.72%; ParAF: 6.07% vs 4.03%) (all p < 0.0001). Omnipolar Vmax displayed significant disagreement with bipolar measurements by Bland-Altman analysis. Conclusion: Omnipolar mapping identifies higher voltage and has greater specificity for the detection of low-voltage and scar than conventional bipolar mapping both in patients with either persistent or paroxysmal AF.
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  • 0000-0003-1927-0281
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