title: Impact of Electrode Type on Mapping of Scar-Related VT.
abstract: BACKGROUND
  Substrate-based VT ablation is mostly based on maps acquired with ablation catheters. We hypothesized that multipolar mapping catheters are more effective for identification of scar and local abnormal ventricular activity (LAVA).
  
  
  RESULTS
  Phase1: In a sheep infarction model (2 months postinfarction), substrate mapping and LAVA tagging (CARTO®3) was performed, using a Navistar (NAV) versus a PentaRay (PR) catheter (Biosense Webster). Phase2: Consecutive VT ablation patients from a single center underwent NAV versus PR mapping. Point pairs were defined as a PR and a NAV point located within a 3D-distance of ≤3 mm. Agreement was defined as both points in a pair being manually tagged as normal or LAVA. Four sheep (4 years, 50 ± 4.8 kg) and 9 patients were included (53 ± 14 years, 8 male, 6 ischemic cardiomyopathy). Mapping density was higher within the scar with PR versus NAV (3.2 vs. 0.7 points/cm2, P = 0.001) with larger bipolar scar area (68 ± 55 cm2vs. 58 ± 48 cm2, P = 0.001). In total, 818 point pairs were analyzed. Using PR, far-field voltages were smaller (PR vs. NAV; bipolar: 1.43 ± 1.84 mV vs. 1.64 ± 2.04 mV, P = 0.001; unipolar; 4.28 ± 3.02 mV vs. 4.59 ± 3.67 mV, P < 0.001). More LAVA were also detected with PR (PR vs. NAV; 126 ± 113 vs. 36 ± 29, P = 0.001). When agreement on LAVA was reached (overall: 72%; both LAVA, 40%; both normal, 82%) higher LAVA voltages were recorded on PR (0.48 ± 0.33 mV vs. 0.31 ± 0.21 mV, P = 0.0001).
  
  
  CONCLUSIONS
  Multipolar mapping catheters with small electrodes provide more accurate and higher density maps, with a higher sensitivity to near-field signals. Agreement between PR and NAV is low.
authors.affiliation: Hôpital Cardiologique du Haut-L'évêque, Université de Bordeaux, LIRYC Institute, Bordeaux, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Berte
authors.affiliation: Hôpital Cardiologique du Haut-L'évêque, Université de Bordeaux, LIRYC Institute, Bordeaux, France.
authors.forename: Jatin
authors.initials: J
authors.lastname: Relan
authors.affiliation: Hôpital Cardiologique du Haut-L'évêque, Université de Bordeaux, LIRYC Institute, Bordeaux, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Sacher
authors.affiliation: Hôpital Cardiologique du Haut-L'évêque, Université de Bordeaux, LIRYC Institute, Bordeaux, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Pillois
authors.affiliation: Hôpital Cardiologique du Haut-L'évêque, Université de Bordeaux, LIRYC Institute, Bordeaux, France.
authors.forename: Anthony
authors.initials: A
authors.lastname: Appetiti
authors.affiliation: Hôpital Cardiologique du Haut-L'évêque, Université de Bordeaux, LIRYC Institute, Bordeaux, France.
authors.forename: Seigo
authors.initials: S
authors.lastname: Yamashita
authors.affiliation: Hôpital Cardiologique du Haut-L'évêque, Université de Bordeaux, LIRYC Institute, Bordeaux, France.
authors.forename: Saagar
authors.initials: S
authors.lastname: Mahida
authors.affiliation: Hôpital Cardiologique du Haut-L'évêque, Université de Bordeaux, LIRYC Institute, Bordeaux, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Casassus
authors.affiliation: Hôpital Cardiologique du Haut-L'évêque, Université de Bordeaux, LIRYC Institute, Bordeaux, France.
authors.forename: Darren
authors.initials: D
authors.lastname: Hooks
authors.affiliation: Hôpital Cardiologique du Haut-L'évêque, Université de Bordeaux, LIRYC Institute, Bordeaux, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Sellal
authors.affiliation: Hôpital Cardiologique du Haut-L'évêque, Université de Bordeaux, LIRYC Institute, Bordeaux, France.
authors.forename: Sana
authors.initials: S
authors.lastname: Amraoui
authors.affiliation: Hôpital Cardiologique du Haut-L'évêque, Université de Bordeaux, LIRYC Institute, Bordeaux, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Denis
authors.affiliation: Hôpital Cardiologique du Haut-L'évêque, Université de Bordeaux, LIRYC Institute, Bordeaux, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Derval
authors.affiliation: Hôpital Cardiologique du Haut-L'évêque, Université de Bordeaux, LIRYC Institute, Bordeaux, France.
authors.forename: Hubert
authors.initials: H
authors.lastname: Cochet
authors.affiliation: Hôpital Cardiologique du Haut-L'évêque, Université de Bordeaux, LIRYC Institute, Bordeaux, France.
authors.forename: Mélèze
authors.initials: M
authors.lastname: Hocini
authors.affiliation: Hôpital Cardiologique du Haut-L'évêque, Université de Bordeaux, LIRYC Institute, Bordeaux, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Haïssaguerre
authors.affiliation: Hôpital Cardiologique du Haut-L'évêque, Université de Bordeaux, LIRYC Institute, Bordeaux, France.
authors.forename: Rukshen
authors.initials: R
authors.lastname: Weerasooriya
authors.affiliation: Hôpital Cardiologique du Haut-L'évêque, Université de Bordeaux, LIRYC Institute, Bordeaux, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Jaïs
keywords: LAVA; PentaRay catheter; bipolar mapping; catheter ablation; multipolar mapping; substrate mapping; ventricular tachycardia