Why the study?
Multi-electrode catheters with smaller, closely spaced electrodes may be superior to large single-tip electrodes, but direct comparisons among conventional, micro-, and mini-electrodes are needed.
Does multi-electrode mapping improve mapping time and density compared to single-tip mapping in post-myocardial infarction patients undergoing VT ablation?
Does multi-electrode mapping improve mapping time and density compared to single-tip mapping in post-myocardial infarction patients undergoing VT ablation?
Multi-electrode mapping is faster and yields denser maps than single-tip mapping, while applying electrode-specific bipolar voltage cut-offs can improve electrogram interpretation during VT ablation.
Answers are grounded in this paper and cite their sources.
Multi-electrode catheters shorten ischemic VT mapping time; supports their preferential use in substrate ablation based on randomized comparison.
Background In patients with ischemic cardiomyopathy and ventricular tachycardia (VT), functional substrate mapping and ablation of evoked delayed potential (EDPs) have proven effective. Previous research suggests that multi-electrode catheters, with smaller and more closely spaced electrodes, may be superior to large single-tip electrodes. Purpose This two-center prospective study directly compares substrate mapping using conventional, micro-, and mini-electrodes. Methods Between June 2021 and March 2024, 21 post-myocardial infarction patients (median age 66 years old [61-76], 100% male, LVEF 39% [33-45]) undergoing VT ablation were systematically mapped with a single-tip (QDOT) and multi-electrode (Pentaray) catheter during sinus rhythm (SR) and right ventricular extrastimulation (RVE). Baseline patient characteristics, mapping data and outcomes were collected. Bipolar voltage (BV) maps (4830 and 9159 SR and 1166 and 3498 RVE points respectively) were analyzed offline and electrogram (EGM) characteristics were compared. Results Mapping times were significantly shorter with the multi-electrode catheter (24 [20-32] versus 57 minutes [49-73], P<0.0001) and produced significantly denser maps (392 [326-440] versus 222 [184-37281] SR and 158 [120-181] versus 52 [45-72] RVE mapping points, both P<0.0001). BV amplitudes were highest and EGM durations shortest when using micro-electrodes as compared with other electrodes. BV amplitudes recorded across electrode types were positively correlated, enabling the definition of electrode-specific BV cut-offs. Using these cut-offs, complex EGMs and EDPs consistently localized to low voltage areas. Conclusions Multi-electrode mapping is faster and yields denser maps, while micro-electrode mapping with a single-tip catheter provides the most accurate approximation of local activation. Applying electrode-specific BV cut-offs may improve EGM interpretation. Figure legend: Representative bipolar voltage maps of remodeled and non-remodeled left ventricle as recorded with conventional, micro- and mini-electrodes using different cut-off values. Orange tags indicate evoked delayed potentials.
No takes yet. Share an insight, caveat, or question.
Smet et al. (2026) studied this question.
Synapse has enriched 10 related papers. Consider them for comparative context: