Key result
Novel dV/dT algorithm measures lower bipolar voltage in ~80% of porcine mapping points vs peak-to-peak methods.
Why the study?
Traditional voltage mapping in ventricular arrhythmia ablation calculates peak-to-peak measurements without distinguishing near-field from far-field components, prompting evaluation of local bipolar measurements identified by dV/dT.
Does a novel dV/dT-based algorithm improve the accuracy of voltage mapping compared to traditional peak-to-peak measurement in a porcine myocardial infarction model?
Does a novel dV/dT-based algorithm improve the accuracy of voltage mapping compared to traditional peak-to-peak measurement in a porcine myocardial infarction model?
Using dV/dT to identify bipolar voltage results in lower measured values compared to traditional peak-to-peak measurement, potentially identifying local tissue properties more accurately.
dV/dT mapping yields lower voltages than peak-to-peak in porcine infarcts; extends preclinical data but leaves clinical translation open.
BACKGROUND: In ventricular arrhythmia ablation procedures, traditional voltage mapping calculates overall peak-to-peak measurements. However, this methodology incorporates multiple signal components that do not distinguish near-field vs far-field components. OBJECTIVE: This study aimed to determine how the use of local bipolar measurements as identified by the first derivative of voltage over time (dV/dT) affects traditional voltage mapping characteristics. METHODS: Percutaneous endocardial and epicardial electroanatomic mapping was performed in a porcine myocardial infarction model (n = 5) with a multipolar and a point-by-point catheter. Electrograms were examined offline based on standard bipolar and unipolar voltage values and then reanalyzed by a novel algorithm that measures only the voltage magnitude pertaining to the maximum absolute dV/dT within a given electrogram. Computed tomography, gross pathology, and histopathology features were examined. RESULTS: There were 25,114 bipolar mapping points across multipolar catheter maps and 6317 mapping points across point-by-point catheter maps. A difference in calculated voltage occurred in >80% of all mapping points, with all changes using dV/dT methodology resulting in lower bipolar voltage values compared with traditional methods. There was a categorical change in standard voltage (scar, border zone, normal) in >7% of all points. Unipolar voltage calculated by local dV/dT also resulted in a lower value in >90% of all mapping points. Histologic examination of discrepant regions revealed patterns of diffuse fibrosis. CONCLUSION: In a porcine infarct model, the use of dV/dT to identify bipolar voltage results in lower measured values in >80% of all mapping points compared with traditional peak-to-peak measurement. This methodology may more accurately identify local tissue properties by selection of near-field components within substrates implicated in ventricular arrhythmias.
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Hayase et al. (2025) studied Myocardial infarction (porcine model) (n=5). Novel algorithm measuring voltage magnitude by maximum absolute dV/dT vs. Traditional peak-to-peak voltage mapping was evaluated on Difference in calculated bipolar voltage between methodologies. Using a novel dV/dT algorithm for bipolar voltage mapping in a porcine infarct model resulted in lower measured voltage values in >80% of mapping points compared with traditional peak-to-peak methods.
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