Focal Arrhythmia Ablation With Multipolar Mapping: Does it Still Make Sense to Stay Off-Grid?

Multipolar mapping has primarily been studied in complex arrhythmia substrates or re-entrant circuits. Chieng et al. use a Case-Control design to compare multipolar mapping and point-by-point mapping with an ablation catheter for focal atrial and ventricular tachycardias, showing reduced procedure times and earlier electrograms in the multipolar mapping group but no difference in clinical outcomes. It is plausible that faster mapping and better delineation of earliest signals may translate to improved clinical outcomes if studied in a randomized trial in a larger population. Future multipolar mapping systems will guide the operator toward the focus in real-time and may even triangulate the source in three dimensions, giving an estimate of depth within the myocardium or likely focus in the opposite chamber.