Direction-aware mapping algorithms have minimal impact on bipolar voltage maps created using high-resolution multielectrode catheters.

Introduction Direction-aware mapping algorithms improve the accuracy of voltage mapping by measuring the maximal voltage amplitude recorded in the direction of wavefront propagation. While beneficial for stationary catheters, its utility for roving catheters collecting electrograms at multiple angles is unknown. Objective To compare the directional dependency of bipolar voltage amplitude between stationary and roving catheters. Methods In 10 swine, a transcaval ablation line with gap was created. The gap was mapped using an array catheter (Optrell™, Biosense Webster). In step 1, the array was kept stationary over the gap, and 4 voltage maps were created during activation of the gap from superior, inferior, septal, and lateral directions. In step 2, 4 additional maps were created, however the catheter was allowed to move with points acquired at multiple angles. In step 3, the gap was re-mapped, however bipoles were computed using a direction-aware mapping algorithm. Results In a stationary catheter position, bipolar voltage distribution was influenced by the direction of activation with maximal differences obtained between orthogonal directions 32% (13-53%). However, roving the catheter produced similar bipolar voltage maps irrespective of the direction of activation 11% (5-18%). A direction-aware mapping algorithm was beneficial for reducing the directional dependency of voltage maps created by stationary catheters but not by roving catheters. Conclusions The directional dependency of bipolar voltage amplitude is greatest when the catheter is stationary. However, when the catheter is allowed to rove and collect electrograms at multiple angles as occurs clinically, the directional dependency of bipolar voltage is minimal. This article is protected by copyright. All rights reserved.