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Arrhythmias & electrophysiologyResearch article

Performance and Limitations of Multipolar Electrogram Mapping in Scar-Related Ventricular Tachycardia

Heart RhythmPublished

  • Scar-related ventricular tachycardia (VT) maps created using the CARTO™3 system and Optrell™ catheter were analyzed
  • offline conversion of bipolar maps into multipolar maps using the CARTOREPLAY TM module
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Authors' conclusion

Multipolar activation mapping enhances diastolic potential detection but reduces sensitivity for VT substrate identification compared to bipolar LAM. These findings inform optimal electrogram annotation approaches for VT activation and substrate mapping.

Study context

Population
Patients with scar-related ventricular tachycardia (VT) mapped with the CARTO™3 system and Optrell™ catheterelectrograms from 53 maps (45 patients, age 64±9 years, 87% male, 57% ischemic) · maps 53 · patients 45
Participants
3,636 patients
Comparison
Electrograms with both near-field (NF) and far-field (FF) components-including local abnormal ventricular activities (LAVA), late potentials (LP), and diastolic signals-were compared between bipolar and multipolar maps

Main finding

As reported in the abstract

NF/FF amplitude ratio

Multipolar

1.50

range as printed 0.61–3.08

Bipolar

1.19

range as printed 0.52–2.60

P < 0.0001

Further findings

Identification of diastolic potentials (multipolar activation mapping vs bipolar wavefront mapping) · more accurate with multipolar

P < 0.0001

Sensitivity in detecting LAVA/LP (multipolar substrate mapping vs bipolar LAM) · less sensitive with multipolar

P < 0.0001

Maps with LPs missed by the multipolar algorithm but captured by late annotation mapping (LAM)

Of 30 maps with LPs, had LPs missed by the multipolar algorithm but captured by LAM
87%

Predictors of multipolar annotation errors

Smaller NF / larger FF amplitudes and perimeter electrodes predicted multipolar annotation errors

Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.

Original publication

Performance and Limitations of Multipolar Electrogram Mapping in Scar-Related Ventricular Tachycardia. Heart Rhythm. Published 6 October 2026. doi:10.1016/j.hrthm.2026.09.052
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Summarised from the published abstract; every number is checked against it