Arrhythmias & electrophysiology
Combined bipolar and unipolar voltage mapping to identify epicardial breakthrough regions after pulsed field ablation
Authors' conclusion
Combined BV and UV mapping provides additional information for identifying epicardial breakthrough regions at PFA application sites.
Study context
- Population
- Patients with atrial fibrillation undergoing initial PFA-PVI with a pentaspline catheter under fluoroscopic guidancepatients, 17 patients had 27 epicardial breakthrough regions, yielding 276 local unipolar electrograms · QR pattern electrograms 160 · RS pattern electrograms 116
- Participants
- 30 patients
- Index test or model
- UV amplitude cutoff distinguishing QR from RS electrogram morphologies within the isolated PV antrum (BV <0.1 mV)
- Target condition
- epicardial breakthrough regions
Performance
As reported in the abstract
- UV amplitude cutoff
- 1.15 mV
- Sensitivity
- 91.9%
- Specificity
- 84.5%
- AUC
- 0.922
- P
- P<0.001
Further findings
| Outcome | Values | P value |
|---|---|---|
| UV amplitude, QR vs RS electrogramsSignificantly higher UV amplitudes with QR | QR electrograms median 1.64 mV · RS electrograms median 0.70 mV | P < 0.001 |
| RS vs non-RS electrograms around the isolation boundary (245 local unipolar electrograms, excluding QR electrograms) | UV amplitude cutoff 0.48 mV · sensitivity 83.6% · specificity 86.8% · AUC 0.923 · P P<0.001 · Negative intrinsic deflection slope cutoff 0.020 mV/ms · sensitivity 97.4% · specificity 94.5% · AUC 0.992 · P P<0.001 |
RS vs non-RS electrograms around the isolation boundary (245 local unipolar electrograms, excluding QR electrograms)
- RS electrograms had higher UV amplitudes and steeper negative intrinsic deflection slopes than non-RS electrograms, suggesting possible intramural conduction gaps
Distribution of electrograms
- QR electrograms were distributed broadly within the isolated PV, whereas RS electrograms occurred exclusively around the isolation boundary
Original publication
Combined bipolar and unipolar voltage mapping to identify epicardial breakthrough regions after pulsed field ablation. Heart Rhythm. Published 27 October 2026. doi:10.
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