Insights from the use of multipolar mapping during ablation of supraventricular and ventricular arrhythmias

Background: Multipolar mapping, a novel method of electrogram acquisition and annotation distinct from unipolar and bipolar acquisitions, provides orientation-independent near-field signal acquisition with enhanced spatial precision. Multipolar mapping use in humans has not been described. Objective: This study aimed to present findings on the use of multipolar mapping in a variety of different arrhythmia types and mechanisms. Methods: We performed consecutive ablation procedures using a high-density multipolar-capable mapping catheter (OPTRELL, Biosense Webster, Irvine, CA). Parallel mapping using multipolar signal acquisition and conventional bipolar signal acquisition was performed during ablation of various supraventricular and ventricular arrhythmias. Multipolar and bipolar voltage and local activation time maps were compared. A comparison was also made between multipolar, bipolar, and unipolar electrograms in areas of interest. Results: During ablation to treat atrial fibrillation, atrial tachycardia, accessory pathway, premature ventricular contractions, and ventricular tachycardia, we observed 4 advantages of multipolar mapping compared with traditional bipolar mapping: (1) an improved ability to remove far-field signals while preserving the local waveform, (2) wavefront direction independence, (3) a more accurate representation of voltage, and (4) improved ability to identify the origin of focal arrhythmias. Conclusion: In this small observational study of multipolar mapping during ablation of various "real-world" arrhythmias, several advantages of multipolar mapping are demonstrated. Larger studies including evaluation of patient outcomes will help further define the benefit of this novel mapping strategy.