Comparison of Pentaspline Pulsed Field Ablation Catheter Mapping Modes to Assess Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation

Figures

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  Figure 1. Catheter electrode recording configurations. Bipolar “interspline” mode records between electrode 3 on 2 adjacent splines. Pseudo‐unipolar “intraspline” mode records between electrode 3 and a virtual electrode comprised of a combination of electrodes 1,2, and 4 on the same spline. Here for illustrative purposes a single pseudo‐unipole and bipole are shown for each configuration, while all splines are actually involved in recording simultaneously. Electrode size is 8.8 mm2 and interspline configuration electrode spacing varies between 16 and 21 mm.

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  Figure 2. 3D maps and signal examples for three patients. The left‐sided panels show bipolar mapping and right‐sided panels show the same patient with pseudo‐unipolar mode. In bipolar mode, (A) appears to show connected right‐sided veins, (B) appears to show left inferior vein connection and (C) appears to show all veins as still connected. The right panels with pseudo‐unipolar mode show all veins are isolated. The roving catheter tip indicates location of individual signals displayed. The left panels show the single reference bipolar electrograms at the mapping points below the ECG reference channels. The right panel recordings show the pseudo‐unipolar electrograms with minimal signal above the lowest electrogram which is the bipolar electrogram at a similar location to those on the left panel maps (maps were taken sequentially, not simultaneously as software does not allow this).

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  Figure 3. (A) Proportion of variance explained by method, observer and patient. ICC: intraclass correlation. (B) Mapping method and ratio of isolated veins on map to truly isolated veins for each observer.

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  Central Illustration 1. Pentaspline mapping in pulsed field AF ablation.