title: Resolving Myocardial Activation With Novel Omnipolar Electrograms.
abstract: With its inherent limitations, determining local activation times has been the basis of cardiac mapping for over a century. Here, we introduce omnipolar electrograms that originate from the natural direction of a travelling wave and from which instantaneous conduction velocity amplitude and direction can be computed at any single location without first determining activation times. We sought to validate omnipole-derived conduction velocities and explore potential application for localization of sources of arrhythmias.
  
  
  
  Electrograms from omnipolar mapping were derived and validated using 4 separate models and 2 independent signal acquisition methodologies. We used both electric signals and optical signals collected from monolayer cell preparations, 3-dimensional constructs built with cardiomyocytes derived from human embryonic stem cells, simultaneous optical and electric mapping of rabbit hearts, and in vivo pig electrophysiology studies. Conduction velocities calculated from omnipolar electrograms were compared with wavefront propagation from optical and electric-mapping studies with a traditional local activation time-based method. Bland-Altman analysis revealed that omnipolar measurements on optical data were in agreement with local activation time methods for wavefront direction and velocity within 25 cm/s and 30°, respectively. Similar agreement was also found on electric data. Furthermore, mathematical operations, such as curl and divergence, were applied to omnipole-derived velocity vector fields to locate rotational and focal sources, respectively.
  
  
  
  Electrode orientation-independent cardiac wavefront trajectory and speed at a single location for each cardiac activation can be determined accurately with omnipolar electrograms. Omnipole-derived vector fields, when combined with mathematical transforms may aid in real-time detection of cardiac activation sources.
authors.affiliation: From the The Hull Family Cardiac Fibrillation Management Laboratory and University Health Network, Toronto General Hospital, Toronto, ON, Canada (S.M., K.M., N.J., J.A., M.K., K.N.); St. Jude Medical, St. Paul, MN (R.B., D.C.D.); and Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada (B.Z., M.R.).
authors.forename: Stéphane
authors.initials: S
authors.lastname: Massé
authors.affiliation: From the The Hull Family Cardiac Fibrillation Management Laboratory and University Health Network, Toronto General Hospital, Toronto, ON, Canada (S.M., K.M., N.J., J.A., M.K., K.N.); St. Jude Medical, St. Paul, MN (R.B., D.C.D.); and Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada (B.Z., M.R.).
authors.forename: Karl
authors.initials: K
authors.lastname: Magtibay
authors.affiliation: From the The Hull Family Cardiac Fibrillation Management Laboratory and University Health Network, Toronto General Hospital, Toronto, ON, Canada (S.M., K.M., N.J., J.A., M.K., K.N.); St. Jude Medical, St. Paul, MN (R.B., D.C.D.); and Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada (B.Z., M.R.).
authors.forename: Nicholas
authors.initials: N
authors.lastname: Jackson
authors.affiliation: From the The Hull Family Cardiac Fibrillation Management Laboratory and University Health Network, Toronto General Hospital, Toronto, ON, Canada (S.M., K.M., N.J., J.A., M.K., K.N.); St. Jude Medical, St. Paul, MN (R.B., D.C.D.); and Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada (B.Z., M.R.).
authors.forename: John
authors.initials: J
authors.lastname: Asta
authors.affiliation: From the The Hull Family Cardiac Fibrillation Management Laboratory and University Health Network, Toronto General Hospital, Toronto, ON, Canada (S.M., K.M., N.J., J.A., M.K., K.N.); St. Jude Medical, St. Paul, MN (R.B., D.C.D.); and Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada (B.Z., M.R.).
authors.forename: Marjan
authors.initials: M
authors.lastname: Kusha
authors.affiliation: From the The Hull Family Cardiac Fibrillation Management Laboratory and University Health Network, Toronto General Hospital, Toronto, ON, Canada (S.M., K.M., N.J., J.A., M.K., K.N.); St. Jude Medical, St. Paul, MN (R.B., D.C.D.); and Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada (B.Z., M.R.).
authors.forename: Boyang
authors.initials: B
authors.lastname: Zhang
authors.affiliation: From the The Hull Family Cardiac Fibrillation Management Laboratory and University Health Network, Toronto General Hospital, Toronto, ON, Canada (S.M., K.M., N.J., J.A., M.K., K.N.); St. Jude Medical, St. Paul, MN (R.B., D.C.D.); and Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada (B.Z., M.R.).
authors.forename: Ram
authors.initials: R
authors.lastname: Balachandran
authors.affiliation: From the The Hull Family Cardiac Fibrillation Management Laboratory and University Health Network, Toronto General Hospital, Toronto, ON, Canada (S.M., K.M., N.J., J.A., M.K., K.N.); St. Jude Medical, St. Paul, MN (R.B., D.C.D.); and Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada (B.Z., M.R.).
authors.forename: Milica
authors.initials: M
authors.lastname: Radisic
authors.affiliation: From the The Hull Family Cardiac Fibrillation Management Laboratory and University Health Network, Toronto General Hospital, Toronto, ON, Canada (S.M., K.M., N.J., J.A., M.K., K.N.); St. Jude Medical, St. Paul, MN (R.B., D.C.D.); and Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada (B.Z., M.R.).
authors.forename: D Curtis
authors.initials: DC
authors.lastname: Deno
authors.affiliation: From the The Hull Family Cardiac Fibrillation Management Laboratory and University Health Network, Toronto General Hospital, Toronto, ON, Canada (S.M., K.M., N.J., J.A., M.K., K.N.); St. Jude Medical, St. Paul, MN (R.B., D.C.D.); and Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada (B.Z., M.R.).
authors.forename: Kumaraswamy
authors.initials: K
authors.lastname: Nanthakumar
mesh_terms: D000465:Algorithms; D000818:Animals; D000831:Animals, Newborn; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000503:physiopathology*; D004562:Electrocardiography; D056149:Epicardial Mapping / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D051379:Mice; D008955:Models, Cardiovascular; D039904:Pluripotent Stem Cells; D011817:Rabbits; D015203:Reproducibility of Results; D012815:Signal Processing, Computer-Assisted; D013552:Swine; D013997:Time Factors
keywords: cardiac arrhythmia; cardiac electrophysiology; catheter ablation; conduction velocity; omnipole